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Background: Antenatal care has been identified as pivotal to improving maternal and child health in Malawi. Though Malawian women consistently seek antenatal care, they rarely do so during their first trimester. The purpose of this study was to identify barriers to antenatal care uptake among Malawian women. This article adds to the literature by identifying common sociocultural barriers and their impact on ANC attendance. Methods: Two large tertiary care hospitals in the central and southern regions of Malawi were selected as study sites. Twenty pregnant mothers and eight health workers were recruited and interviewed. The interviews were transcribed verbatim and analyzed to identify themes. Posters in health facilities were also analyzed. Results: Results revealed many contributors to delayed antenatal attendance among Malawian mothers including: attitudes toward pregnancy, hospital inefficiencies, ANC promotion at the health facilities/communities, and spousal/significant other involvement all contributed to delayed antenatal attendance among urban Malawian women. Conclusions: Incorporating spouses/significant others in  antenatal care activities, providing a consistent message in promotion materials used with the women and addressing the inefficiencies within the health system could be targets to improve early antenatal attendance in Malawi. Keywords: Reproductive health; Pregnancy; Antenatal care; Prenatal care, Malawi, healthcare, access, barriers, clinic, spouse

Factors associated with delayed antenatal care attendance in Malawi: results from a qualitative study