Individual and Socioeconomic Determinants of Antenatal Care Access for Disadvantaged Pregnant Women: A Systematic Review and Empirical Analysis

Socioeconomic disadvantage has consistently been associated with reduced maternal healthcare utilization; however, the extent to which individual-level socioeconomic and demographic characteristics explain antenatal care (ANC) access remains uncertain. This study examined associations between socioeconomic status (SES), basic demographic factors, and ANC completion, while synthesizing global evidence on social vulnerability and maternal healthcare access among disadvantaged pregnant women. The analysis combined secondary data from 2,019 women obtained from the Institute for Health Metrics and Evaluation (IHME) dataset with a systematic review and meta-analysis conducted in accordance with the PRISMA 2020 guidelines. Multivariable logistic regression and exploratory machine learning approaches (K-Nearest Neighbors and XGBoost) were applied to assess the discriminative capacity of individual-level variables for ANC completion. A random-effects me-ta-analysis was used to synthesize adjusted odds ratios (aORs) from eligible observational studies. In the IHME dataset, SES was not significantly associated with ANC completion after adjustment (aOR = 0.97; 95% CI: 0.78–1.21), and individual-level models demonstrated limited discriminatory performance (AUC range: 0.49–0.50). In contrast, the meta-analysis of six studies showed that socioeconomic disadvantage was significantly associated with inadequate or delayed prenatal care (pooled aOR = 1.96; 95% CI: 1.26–3.07), with substantial heterogeneity across studies. Although conceptually distinct, indicators such as migrant status and neighborhood risk were synthesized as proxies of broader social vulnerability. Overall, these findings suggest that individual-level so-cioeconomic and demographic variables alone provide limited explanatory value for maternal healthcare utilization, highlighting the potential importance of broader structural and health system-level factors influencing access to antenatal care.