Sampling and recruitment

In each governorate, we employed purposive sampling to recruit the women from four randomly selected private clinics (from the list of private practices issued in 2009 by the Syrian Society of Obstetrics and Gynecology) and four randomly selected Public Health Centers (PHCs) (from the list issued in 2009 by the Ministry of Health). Please refer to Appendix B (Additional File 1) for a detailed description of the sampling process).

We contacted the doctor working at each health facility, explained the study and if they consented, we arranged to approach women at their health facilities. If doctors declined, we selected an alternative clinic/health center below them on the list. We approached pregnant women in the waiting areas at the health facilities independently of the health providers and emphasized that their decision to participate would not affect the health care they were receiving at this health facility. We gave them the option to be interviewed at a private room at the health facility after their appointment or at their homes at a time that is convenient for them. Women who preferred to be interviewed at their home shared their contact details. We contacted them the second day to arrange for their interview at home. None of the women we approached refused to participate.

To recruit women attending ANC with midwives who provide ANC independently, we obtained the phone numbers of midwives from the health officials in Aleppo who worked at the health directorate. We contacted the midwives, explained the study and approached women at the clinics of those who agreed to participate using the same method of recruitment as the other facilities. No midwives provided ANC independently in Latakia.

Women who did not attend ANC were recruited using the snowball technique of purposive sampling, with the help of women participating in our study. It was reflective of the regional differences in the pattern of ANC use that we were unable to locate and recruit women who did not attend ANC in Latakia. Our experience was confirmed by doctors and women in Latakia who confirmed that almost all women in Latakia attended ANC at least once. MICS survey data in 2006 shows that 97% of women in Latakia attended ANC and this percentage may have increased by the time we conducted our interviews in 2010 [21, 22].

We recruited 13 women attending ANC and 5 women not attending ANC in Aleppo, and 12 women attending ANC in Latakia (Table ​(Table22).