The scale of the evidence base lends the findings considerable weight. The research team, led by Trishika Wickramarathne, searched five major databases—PubMed, MEDLINE, CINAHL, Scopus and Web of Science—for studies published over a decade, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, the international standard for ensuring such reviews are conducted and reported transparently. The review was prospectively registered with PROSPERO, the international prospective register of systematic reviews, under registration number CRD420251218875, a step designed to guard against selective reporting. By combining a quantitative meta-analysis with a structured qualitative synthesis in what the authors describe as a convergent segregated design, the study captures both the magnitude of the problem and the lived experiences behind the statistics.

Maternal health literacy, the central concept of the review, is more than the ability to read a pamphlet. Researchers define it as the cognitive and social skills that determine a woman’s motivation and ability to gain access to, understand and use information in ways that promote and maintain the health of herself and her child during pregnancy and early parenthood. It shapes whether a woman books timely antenatal appointments, recognises warning signs of complications, follows medical advice, and feels confident asking questions of clinicians. When health literacy falters, the consequences cascade: missed appointments, delayed presentation of complications, poorer birth outcomes and deepening distrust of health services. For migrant mothers, who often arrive with interrupted healthcare histories, unfamiliarity with local systems and varying proficiency in the host country’s language, the stakes are especially high.

The quantitative pooling relied on random-effects meta-analysis, a statistical technique that accounts for the fact that individual studies differ in their populations, settings and measurement tools. Rather than assuming a single true effect size, random-effects models estimate a distribution of effects and produce wider, more honest confidence intervals. Even so, the intervals in this review tell a consistent story. The pooled estimate for difficulty understanding health information, at 22.9 percent, carries a 95 percent confidence interval of 14.7 to 33.9 percent; language barriers cluster at 29.8 percent with an interval of 19.6 to 42.6 percent; and navigation difficulties reach 31.2 percent with an interval of 19.5 to 45.9 percent. The breadth of these intervals reflects genuine heterogeneity across countries and cohorts, yet every lower bound remains clinically meaningful, indicating that even under the most conservative reading, a substantial minority of migrant mothers faces each of these barriers.

The qualitative strand of the review dug into why these barriers persist. Using deductive framework analysis and hybrid content analysis, the researchers identified six key determinants of maternal health literacy among migrant women: language proficiency, access to interpreters, educational attainment, cultural beliefs, socioeconomic constraints and pre-migration experiences. Each factor interacts with the others in ways that can compound disadvantage. A mother with limited formal education who is also learning a new language faces a double burden when a clinician explains a gestational diabetes screening protocol in rapid, jargon-laden speech. Pre-migration experiences, including trauma or healthcare systems in countries of origin that function very differently, can shape expectations and trust in ways that mainstream services rarely anticipate.

Barriers to actually accessing care clustered into four recurring themes: discrimination by healthcare providers, difficulties navigating complex systems, social isolation, and unmet need for professional interpreters. The interpreter finding is particularly striking because it represents a failure of infrastructure rather than of individual knowledge. Many high-income countries have policies mandating interpreter access, yet the review suggests that in practice, women frequently attend appointments without qualified interpretation, relying instead on family members, bilingual staff pulled from other duties, or nothing at all. Ad hoc interpretation by relatives raises its own concerns, from inaccurate translation of clinical information to the suppression of sensitive disclosures, particularly around mental health or domestic circumstances, when a husband or in-law is acting as the intermediary.

Against these barriers, the review also catalogued what works. Culturally responsive providers emerged as the most frequently reported facilitator of care access, followed by community support networks and family support. Culturally responsive care is not a vague aspiration; in the literature it concretely means clinicians who take time to understand a patient’s health beliefs, who use professional interpreters consistently, who adapt communication to the patient’s literacy level, and who demonstrate respect for cultural practices around pregnancy and birth. Community networks, including migrant community organisations and peer support groups, appear to function as bridges that translate not just language but the unwritten rules of a foreign health system—when to call, where to go, what to expect at each stage of pregnancy.

The finding that migrant women face 2.66 times higher odds of suboptimal antenatal care utilisation matters because antenatal care is one of the most powerful preventive interventions in public health. Regular check-ups during pregnancy allow clinicians to detect hypertension, gestational diabetes, anaemia and fetal growth problems before they become emergencies. When a third of a population group struggles to navigate the system and nearly a third cannot fully understand the information they receive, the pipeline from risk to detection to treatment is compromised at every link. The elevated dissatisfaction odds, at 1.77, add a relational dimension: women who feel unheard or disrespected are less likely to return, creating a feedback loop in which poor experiences drive disengagement, which in turn worsens outcomes and reinforces stereotypes about non-compliance.

The authors frame their conclusions within the United Nations Sustainable Development Goals, specifically Goal 3 on health and well-being and Goal 10 on reduced inequalities, arguing that improving maternal health literacy among migrant populations is essential to advancing equitable maternity care. Their recommendations point toward culturally and linguistically responsive maternity services, strengthened communication strategies, and policies that address structural inequities rather than placing the burden of adaptation solely on migrant women themselves. In practical terms, that could mean routine professional interpreter provision funded as core infrastructure, health materials designed for low-literacy and multilingual audiences, navigation programs that pair migrant mothers with trained guides through the pregnancy pathway, and cultural competence embedded in clinician training rather than treated as an optional extra.

What makes this review resonate beyond academic circles is the universality of its underlying message: a health system is only as effective as its ability to communicate with the people it serves. High-income countries pride themselves on some of the safest maternity care in the world, yet this synthesis of 81 studies shows that safety is unevenly distributed along lines of language, culture and migration history. The statistics—nearly one in four unable to understand health information, nearly one in three blocked by language, one in three lost in the system—are not abstractions but the aggregated experiences of hundreds of thousands of women giving birth far from the contexts in which they grew up. As migration continues to shape the demographics of wealthy nations, the review suggests that the measure of a maternity service is not how well it performs for those who already know how to use it, but how well it reaches those who do not.

Subject of Research: Maternal health literacy and healthcare access among migrant mothers in high-income countries

Article Title: Maternal health literacy and access to maternal healthcare among migrant mothers in high-income countries: a systematic review and meta-analysis

Article References: Wickramarathne, T., Baten, A., Nedeljkovic, M., Apputhurai, P., & Bhowmik, J. (2026). Maternal health literacy and access to maternal healthcare among migrant mothers in high-income countries: a systematic review and meta-analysis. BMC Public Health. https://doi.org/10.1186/s12889-026-29851-3

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29851-3

Keywords: maternal health literacy, migrant mothers, maternity care, antenatal care, health inequities, language barriers, systematic review, meta-analysis, high-income countries, culturally responsive care, interpreter services, public health