Understanding the impact of antenatal care policies in Georgia (USA) and Scotland (UK): A textual synthesis

Objectives: This study aims to (1) understand the role of policy in maternal health outcomes, and (2) establish any differences or similarities between health systems, providing benchmarks for future maternal and infant care policies in Georgia and Scotland. Methods: Guided by JBI methodology, a textual review of policies and public health interventions that have influenced the antenatal care process in both health systems was conducted. Inclusion criteria for this review were classified using the 'PCC' mnemonic: Population- Pregnant women and mothers; Concept- Policies and strategies that supports prenatal and maternal health; and Context- Relevant to Scotland and Georgia. Published primary and secondary research, and grey literature (guidelines, reports, and legislation from authoritative sources) were included. Results: Overall, 60 sources contributed to the report on maternal health system topics. Findings of the textual synthesis presented a regionalized system of maternity care led by physician-provided care models in Georgia compared to the nationalized health system in Scotland with an extended scope for midwife-led care models. On a secondary, organizational level, Scotland also widely operates on protocolized, standardized care informed by clinical guidelines such as NICE. The Georgia health systems also follow national guidelines for care, but extent of standardization may vary based on a mixed system of private and public insurance coverage. Discussion/Conclusion: This is the first study to comprehensively examine maternal health policies in the distinct contexts of Georgia and Scotland, shedding light on the diverse approaches within their respective healthcare systems. These observed variations stem from historical, cultural, and policy contexts unique to each region. As the United States continue to prioritize maternal and child health through public health initiatives, our findings feature crucial considerations for maternal antenatal care policies. Specifically, there is a discernible need to increase access to antenatal care and invest in the maternity care provider workforce, revealing opportunities for targeted improvements in support of maternal health. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by Augusta University through their intramural grant. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript.