The effectiveness of family medicine-led antenatal/postnatal care programs in Saudi Arabia: A systematic review

ABSTRACT

Maternal and infant health are strongly influenced by the quality of antenatal and postnatal care (PNC). Access to high-quality healthcare services is essential for reducing maternal and neonatal morbidity and mortality. Family medicine-led antenatal and PNC programs are increasingly recognized as promising models for improving maternal health outcomes, enhancing patient satisfaction, and promoting healthcare utilization. This systematic review aims to evaluate the effectiveness of family medicine-led antenatal and PNC programs in Saudi Arabia. This review systematically evaluated studies published between 2009 and 2025, with a particular focus on the impact of family medicine-led care initiatives on maternal health outcomes in Saudi Arabia. A total of seven studies were included, comprising cross-sectional studies and randomized controlled trials (RCTs). Studies were selected based on their focus on family medicine-led antenatal and PNC, maternal satisfaction, and barriers to healthcare utilization. The findings highlight several major barriers to the effective utilization of antenatal and PNC, including geographic accessibility, maternal education level, lack of awareness, and logistical challenges such as childcare and transportation. Family medicine-led care programs are effective in promoting the earlier initiation of antenatal care (ANC), increasing postpartum care utilization, and enhancing maternal self-efficacy through structured education. Furthermore, the evidence indicates that individualized, community-based care and flexible service delivery models can significantly help overcome these barriers, thereby improving patient engagement and satisfaction. Family medicine-led antenatal and PNC programs are highly effective in improving maternal health outcomes in Saudi Arabia. Through structured education and individualized support, these initiatives enhance maternal self-efficacy, promote earlier initiation of care, and increase PNC utilization. The integration of organized education and continuous support within family medicine models may substantially improve patient satisfaction and long-term health engagement, thereby contributing to better maternal and neonatal health outcomes.

Introduction

Particularly in low- and middle-income environments, where preventable pregnancy- and childbirth-related issues still account for a significant proportion of morbidity and mortality, maternal and newborn health remain major concerns in global public health.[1,2] The World Health Organization (WHO) reports that antenatal care (ANC) provided by qualified healthcare providers is crucial for reducing perinatal and maternal morbidity and mortality.[3] ANC helps to identify, prevent, and manage concurrent illnesses as well as pregnancy-related risks, provides health education, facilitates birth preparation, and ensures timely referral to more advanced care when necessary.[4,5] Furthermore, postnatal care (PNC) is equally vital: the period following birth is a critical window for preserving the health and well-being of both mother and newborn, including support for breastfeeding, newborn care, detection of post-birth complications, and maternal and child health planning beyond delivery.[6]

National initiatives emphasize the importance of comprehensive maternity care in Saudi Arabia.[7] The Saudi Ministry of Health (MOH) has implemented national guidelines for birth center policies, midwifery clinics, and a “Mother and Child Health Passport,” to provide integrated, continuous, family-centered antenatal, intrapartum, and PNC.[8,9] Despite these technical improvements, challenges remain. In some areas, for example, early initiation of ANC—ideally in the first trimester—is not always the norm. A recent study from the Jazan region found that while most women (78.9%) began ANC in the first trimester, only about one-third underwent an ultrasound, indicating that geographic location remains a barrier.[10] Cultural, educational, and socioeconomic factors also influence the utilization of ANC and PNC services.[11]

Moreover, there is growing interest in the role of primary care, particularly family medicine, in delivering prenatal and PNC.[12] Family medicine, with its holistic, continuous, and community-oriented approach, offers several advantages, including continuity of care, integration of mother and newborn services, and improved linkages between local and higher-level healthcare facilities.[13] By combining preventive care, education, and risk monitoring throughout pregnancy and the early postpartum period, recent studies suggest that such an approach can reduce complications and improve maternal and newborn health outcomes.[14]

To date, however, no organized review of the available evidence on the effectiveness of family medicine–led ANC and PNC initiatives in Saudi Arabia exists. Given the MOH’s policy focus on family- and midwifery-centered maternity care, and the potential benefits of continuity of care, such a review is timely and may inform future health system planning, resource allocation, and clinical practice. Accordingly, this systematic review aims to evaluate the existing body of scientific evidence on family medicine-led antenatal and PNC initiatives in Saudi Arabia, assessing their effectiveness in improving maternal and newborn outcomes, service utilization, and quality of care.

Methodology

A methodical review was conducted to assess the effectiveness of family medicine-led antenatal and PNC initiatives in Saudi Arabia. This review aimed to identify, evaluate, and synthesize research investigating outcomes related to maternal and newborn health, service utilization, and the quality of care associated with family medicine-led programs. The approach adhered to established standards for systematic reviews, including guidance from the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

A comprehensive search of electronic databases, including PubMed, Scopus, and Google Scholar, was performed to identify relevant studies. The search combined keywords related to family medicine, ANC, PNC, maternal health, neonatal health, and Saudi Arabia, covering publications from 2000 to the present. Boolean operators were used to combine terms, and filters were applied for language (English) and study type (peer-reviewed articles). In addition to database searches, the reference lists of included studies were manually screened to identify additional relevant research.

Studies were included if they evaluated the effect of family medicine-led antenatal or PNC programs in Saudi Arabia and reported quantitative or qualitative outcomes on maternal health, newborn health, or healthcare service utilization. Studies conducted outside Saudi Arabia, those focused on hospital-based care or other models not led by family medicine specialists, and studies lacking specific maternal or newborn outcome data were excluded.

Data extraction was performed independently by two reviewers to ensure reliability and minimize bias. For each included study, relevant information was collected on study design, sample size, program characteristics, outcomes assessed, and key findings. Disagreements between reviewers were resolved through discussion and consensus, with a third reviewer consulted if necessary. The quality of the included studies was assessed using appropriate tools, including the Critical Appraisal Skills Programme (CASP) checklists for qualitative and quantitative research.

Due to the heterogeneity of study designs and outcomes, a narrative synthesis was employed to summarize the findings. Meta-analysis was not feasible. The studies were organized according to major themes, including patient satisfaction, neonatal health outcomes, maternal health outcomes, and the effectiveness of family medicine-led interventions in improving service utilization and access to care.

Results

Seven studies [Figure 1][9,10,15,16,17,18,19] examining the efficacy of family medicine-led antenatal and PNC initiatives in Saudi Arabia highlight both the benefits and challenges women face in accessing these services. Early initiation of care is generally found to be important, particularly in ANC, where maternal education and geographical accessibility are key influencing factors. For example, a study from Jazan revealed that 78.9% of women began ANC in the first trimester; maternal education was positively associated with early initiation, whereas distance to healthcare facilities was a major barrier.[10] This study underscores the importance of family medicine-led programs in underserved areas to improve educational outreach and accessibility, thereby addressing these obstacles and potentially increasing early ANC initiation rates.

Figure 1.

PRISMA flow diagram of study selection. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Similarly, research on postpartum care in Alahsa found that only 50.8% of women attended at least one postnatal visit, with the main barriers being lack of knowledge, childcare responsibilities, and transportation issues.[15] This indicates that, despite national healthcare policies advocating postpartum care, uptake remains low. Family medicine-led initiatives can play a crucial role in these contexts by increasing awareness through education, addressing practical challenges such as childcare, and ensuring follow-up care is accessible and individualized.[15]

Additional barriers to ANC utilization include inconvenient clinic hours and anxiety regarding medical examinations, particularly among women with lower education levels or mobility challenges.[16] This research demonstrates that women who received insufficient ANC visits faced both personal and structural obstacles, suggesting that family medicine-led interventions could help reduce these barriers through flexible scheduling, patient education, and continuous care.[16]

A survey in the Jazan region also reported that 80% of women had two or fewer postnatal appointments, with health beliefs and logistical challenges contributing to low utilization rates.[17] Many women perceived PNC as unnecessary if they felt well, explaining low uptake. Family medicine-led care, by combining individualized treatment with health education during antenatal visits, may help modify these beliefs and increase awareness of the importance of PNC for maternal and newborn well-being.[17]

Organized antenatal education has also been shown to significantly improve maternal outcomes. A randomized controlled trial (RCT) in Jeddah demonstrated that structured antenatal education programs enhanced maternal self-efficacy, which is critical for improving women’s confidence and preparedness for childbirth.[18] This study suggests that family medicine-led education initiatives can substantially strengthen maternal self-efficacy, improve the quality of ANC, and better prepare women for labor. Incorporating these initiatives into family medicine-led care would further support women throughout pregnancy, particularly given the current lack of organized antenatal education within the Saudi healthcare system.

A study in Medina evaluating ANC services found that, while general service performance was adequate, there were gaps in health promotion and individualized care.[19] Activities such as psychosocial support and social history taking were poorly covered. Integrating health promotion into routine ANC visits ensures that family medicine-led care can address these gaps, providing personalized care and attention to psychosocial needs, and enhancing overall ANC quality.

Finally, a study conducted in Riyadh on patient satisfaction with ANC services found that triage assessments and service delivery received the highest satisfaction ratings, whereas consultation and examination processes had room for improvement.[9] The study also found that higher education and income levels were associated with greater satisfaction. By incorporating education into consultations and facilitating better communication between patients and providers, family medicine-led ANC programs may help increase overall patient satisfaction.

Discussion

This systematic review aimed to evaluate the role and effectiveness of family medicine-led antenatal and PNC initiatives in improving maternal and newborn health outcomes in Saudi Arabia. The studies examined reveal several key factors influencing patient satisfaction, health outcomes, and care utilization. Family medicine-led models of care can effectively address these factors, which include health beliefs, maternal education, geographic accessibility, and logistical and service-related barriers.

A major finding from this review is the significant impact of maternal education on the early initiation of ANC. Early ANC initiation was reported in Alhazmi et al.[10] (2025), where 78.9% of women started ANC in the first trimester, and maternal education was positively associated with early care-seeking. This finding aligns with global data showing that higher maternal education is correlated with better health-seeking behavior.[20,21] Andersen’s behavioral model of healthcare utilization supports this, indicating that predisposing factors such as maternal education play a crucial role in care-seeking decisions.[22] By providing targeted educational interventions during antenatal visits to enhance maternal knowledge and empower women to make informed health decisions, family medicine-led initiatives can improve early ANC uptake.[23,24]

Beyond geographical barriers, unawareness and logistical challenges emerged as recurring themes, particularly in postpartum care. For example, Alkhamis et al.[15] (2025) reported that only 50.8% of women attended at least one postpartum visit, with barriers including transportation issues, childcare responsibilities, and lack of knowledge. These findings are consistent with previous research demonstrating that postpartum care is often underutilized due to misconceptions about its importance and practical difficulties.[25,26] Family medicine-led care can help overcome these barriers by educating women on the importance of PNC during antenatal visits, providing individualized care tailored to each woman’s needs, and offering flexible scheduling to accommodate their daily lives.[27,28]

The literature also highlights the positive impact of organized antenatal education on maternal self-efficacy. AlSomali et al.[18] (2023) found that structured antenatal education significantly increased mothers’ confidence in managing labor and delivery. This aligns with other studies emphasizing that prenatal education improves women’s preparedness for childbirth, enhances confidence, and increases satisfaction with care.[29,30] When antenatal education is planned, accessible, and integrated into routine care, family medicine-led programs can meaningfully improve maternal self-efficacy, enhance childbirth experiences, and reduce labor-related anxiety.[29]

Studies further indicate that health promotion in ANC services is often inadequate, particularly regarding psychological support and individualized care. Habib et al.[19] (2009) reported that although general ANC performance was rated as fair, major gaps existed in areas such as social history taking, breast examinations, and development of personalized care plans. Family medicine-led care can address these gaps by integrating health promotion and psychosocial support into routine visits, thereby improving ANC quality and maternal well-being.[31,32]

Finally, patient satisfaction was found to be critical for promoting healthcare utilization and engagement. Alhaqbani and Bawazir[9] (2022) reported high satisfaction with triage assessments and service delivery, while consultation and examination processes were rated lower. Family medicine-led care can address these gaps by providing ongoing education, fostering open communication, and offering individualized consultations, thereby enhancing patient satisfaction and supporting long-term engagement with healthcare services.[31,33] A summary of the included studies, including study design, key findings, and identified barriers, is presented in Table 1.

Table 1.

Overview of studies on antenatal care services in primary healthcare settings in Saudi Arabia

Study	Year	Region	Study Design	Key Findings	Sociodemographic Characteristics	Barriers/Facilitators	Role/Effectiveness of Family Medicine-led Care or Education Program
Alhaqbani S and Bawazir[9]	2022	Riyadh	Cross-sectional	High satisfaction with triage and services; lower satisfaction with consultation and examination	Mean age 30.5 years; predominantly with secondary or higher education	Education, income, and number of pregnancies linked to higher satisfaction	Family medicine-led ANC programs can improve satisfaction by integrating education and continuous care, especially regarding consultations.
Alhazmi A et al.[10]	2025	Jazan	Cross-sectional	78.9% initiated ANC in the first trimester; maternal education and proximity to facilities were key factors	Mean age 30.4 years; 60% with multiple children	Geographical accessibility, maternal education	Family medicine-led interventions could potentially improve early initiation rates by addressing geographic and educational barriers.
Alkhamis A et al.[15]	2025	Alahsa	Cross-sectional	50.8% attended at least one postpartum visit; barriers included lack of awareness, childcare, and transportation	Mean age 30.5 years; 50% housewives	Lack of awareness, logistical barriers	Family medicine-led postpartum care could improve awareness and overcome logistical barriers by offering personalized follow-up.
Al Daajani M et al.[16]	2020	Jeddah	Cross-sectional	Structural and personal barriers (e.g., inconvenient clinic hours, fear of exams) for ANC use	Mean age 30.43 years; most unemployed housewives	Inconvenient clinic hours, transportation, fear of exams	Family medicine-led care could reduce barriers by providing more flexible hours, education, and continuous care.
Altraifi A et al.[17]	2024	Jazan	Cross-sectional	80% of mothers had ≤2 postnatal visits; barriers linked to health beliefs, logistical issues	95.9% Saudi nationals, 80% with ≤2 postnatal visits	Perceived barriers, cues to action	Family medicine-led care could address health beliefs and enhance PNC utilization by offering personalized care and continuous education.
AlSomali Z et al.[18]	2023	Jeddah	RCT	Antenatal education improved maternal self-efficacy; no structured antenatal education in Saudi healthcare	Primarily urban, 94.7% with university education	Lack of structured antenatal education, social media as a knowledge source	Structured antenatal education in family medicine settings can enhance maternal self-efficacy and improve childbirth confidence.
Habib F et al.[19]	2009	Medina	Cross-sectional	ANC services fair, with gaps in health promotion and personalized care	41.4% secondary education, 33.2% university educated	Lack of health promotion, inadequate task performance	Family medicine-led care could enhance the delivery of personalized care and health promotion to improve ANC services.

ANC: Antenatal care; PNC: Postnatal care; RCT: Randomized controlled trial

Conclusion

Ultimately, family medicine-led antenatal and PNC initiatives play a critical role in addressing the key barriers to maternal and newborn care in Saudi Arabia. By overcoming geographical challenges, enhancing maternal education, addressing health beliefs, and resolving practical difficulties, these initiatives can improve early initiation of care, increase postpartum care utilization, and enhance patient satisfaction. The inclusion of structured education programs can further strengthen mothers’ confidence in managing labor and delivery and improve overall self-efficacy. By providing individualized care, flexible service delivery, and comprehensive health promotion, family medicine has the potential to significantly improve maternal and neonatal health outcomes in Saudi Arabia and contribute to a more patient-centered, accessible, and efficient healthcare system.

This systematic review has several limitations. The number of included studies was relatively small, and there was heterogeneity in study designs, populations, and outcome measures, which limited direct comparisons and precluded meta-analysis. No funding was received for this study. All authors declare that there are no conflicts of interest and that there are no non-author contributions. No funding was needed for this study.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.