Background: World Health Organization emphasizes that childbirth preparation is a key component of antenatal care, reducing maternal mortality and improving birth experiences. Understanding participation barriers requires resource-based interventions and qualitative inquiry. This study explored health provider perspectives on barriers to prenatal class attendance in Iran.
Methods: This qualitative study included 36 participants, purposively selected among class instructors and key informants across 30 health centers from May 2024 to March 2025. Data were collected via semi-structured, in-depth individual interviews using an interview guide. Data were analyzed using conventional content analysis, following Graneheim and Lundman, with attention to the trustworthiness of the findings.
Results: After data saturation, the analysis yielded 452 codes, which were organized into 94 sub-sub-themes, 10 sub-themes, 4 themes, and 1 main theme. The main theme, “Navigating a whirlwind of challenges,” emerged from four themes: Lack of Accessibility; Lack of Acceptability; Negative Feedback; and Lack of Rethinking to Start Over.
Conclusions: Addressing these key areas can help health systems improve prenatal class attendance. Effective prenatal classes should be accessible, acceptable, available, affordable, accountable, and include high-quality updates. Implementing the perspectives of healthcare providers, particularly midwives, requires coordinated policy support and ongoing evaluation.