Summary of findings 4. Summary of qualitative findings ‐ What matters to women and staff (information and safety).

WHAT MATTERS TO WOMEN and STAFF b. Information and safety
Summary of review finding		Studies contributing to the review finding	CERQual assessment of confidence in the evidence	Explanation of CERQual assessment
ANC as a source of information
Women	W27. ANC as a source of knowledge and information In many countries women visit ANC providers to acquire knowledge and information about their pregnancy and birth. In situations where this is provided in a useful, appropriate and culturally sensitive manner, sometimes through the use of pictures and stories, it can generate a sense of empowerment and acts as a facilitator to further engagement. In situations where this approach is not adopted, e.g. where tests are not explained properly or information is infused with medical jargon or is outdated and irrelevant, it acts as a barrier and limits further access	25 studiesa	High confidence	Finding likely to be a factor in a range of settings and contexts
	W28. Unaware of pregnancy In some instances women were unaware of the signs and symptoms of pregnancy and accessed ANC services late	3 studiesb	Very low confidence	Finding downgraded because of concerns around adequacy of data, methodology and coherence
	W29. Alternative sources of information When women's informational needs were not met by ANC providers they looked for alternative sources of information. For women in HICs this kind of knowledge was usually acquired through the Internet, whilst women in LMICs tended to turn to friends, relatives or TBAs	9 studiesc	Moderate confidence	Finding downgraded because of concerns around, relevance and coherence
ANC as a context for clinical safety
Women	W30. Influence of pregnancy complications The development of pregnancy‐related problems or complications prompted some women to seek advice and assistance from ANC providers, and for these women acted as an incentive to attend early and regularly in subsequent pregnancies	7 studiesd	Low confidence	Finding downgraded because of concerns around adequacy of data, methodology and coherence. Limited to LMICs.
	W31. ANC as a source of medical safety For women in a variety of different resource settings the availability of medicines, medical tests and screening procedures (e.g. HIV tests and ultrasound) offered safety and reassurance during pregnancy and encouraged ANC attendance	23 studiese	High confidence	Finding likely to be a factor in a range of settings and contexts
Providers	P21. Specific components of/incentives for ANC Providers believed the availability of iron supplements, the opportunity to offer health promotion information and the opportunity for women to take an active role in tests and screening were all attractive components of ANC. The use of ANC cards to monitor pregnancy progress were not viewed as favourably, as they covered a limited number of the FANC recommendations, meaning women missed out on a number of recommended tests and procedures.	7 studiesf	Low confidence	Finding downgraded because of concerns around adequacy of data, relevance and coherence

ANC: antenatal care: FANC: focused antenatal care; HIC: high‐income countries; HMICs: high‐ and ‐middle‐income countries: LIC: low‐income country; LMICs: low‐ and middle‐income countries

^aAbrahams 2001 (South Africa); Ayiasi 2013 (Uganada); Cabral 2013 (Brazil); Cardelli 2016 (Brazil); Conrad 2012 (Uganda); De Castro 2010 (Brazil); Docherty 2011 (UK); Duarte 2012 (Brazil); Graner 2013 (Vietnam); Heberlein 2016 (USA); Kabakian‐Khasholian 2000 (Lebanon); Kraschnewski 2014 (USA); Lasso Toro 2012 (Colombia); Maputle 2013 (South AFrica); McNeil 2012 (Canada); Mrisho 2009 (Tanazania); Mumtaz 2007 (Pakistan); Myer 2003 (South Africa); Neves 2013 (Brazil); Rath 2010 (India); Santos 2010 (Brazil); Shabila 2014 (Iraq); Sword 2003 (Canada); Sword 2012 (Canada); Worley 2004 (New Zealand).

^bAbrahams 2001 (South Africa); Haddrill 2014 (UK); Myer 2003 (South Africa).

^cAgus 2012 (Indonesia); Ayiasi 2013 (Uganda); Cardelli 2016 (Brazil); Chowdhury 2003 (Bangladesh); Dako‐Gyeke 2013 (Ghana); Family Care International 2003 (Kenya); Heberlein 2016 (USA); Kraschnewski 2014 (USA); Lagan 2011 (5 HICs: USA, Can, Aus, NZ, UK).

^dAbrahams 2001 (South Africa); Chapman 2003 (Mozambique); Chowdhury 2003 (Bangladesh); Family Care International 2003 (Kenya); Griffiths 2001 (India); Khoso 2016(Pakistan); Munguambe 2016 (Mozambique).

^eAgus 2012 (Indonesia); Andrew 2014 (PNG); Ayala 2013 (Peru); Cardelli 2016 (Brazil); Conrad 2012 (Uganda); Dako‐Gyeke 2013 (Ghana); De Castro 2010 (Brazil); Earle 2000 (UK); Family Care International 2003 (Kenya); Graner 2013 (Vietnam); Griffiths 2001 (India); Heberlein 2016 (USA); Hunter 2017 (Ireland); Larsson 2017 (Sweden);Mahiti 2015 (Tanzania); Mrisho 2009 (Tanzania); Munguambe 2016 (Mozambique); Pretorius 2004 (South Africa); Spindola 2012 (Brazil); Stokes 2008 (Uganda); Sword 2012 (Canada); Sychareun 2016 (Laos); Umeora 2008 (Uganda).

^fGraner 2010 (Vietnam); Gross 2011 (Tanzania); Heaman 2015 (Canada); Hunter 2017 (Ireland); Leal 2018 (Brazil); Saftner 2017 (USA); Sword 2012 (Canada).