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PubMed2001

Lack of prenatal care in a traditional society. Is it an obstetric hazard?

OBJECTIVE: To examine the association between lack of prenatal care (fewer than three visits at any prenatal care facility) and perinatal complications in the Bedouin parturient population where lack of prenatal care is not associated with absence of prenatal services, substance abuse or marital status. STUDY DESIGN: The study population consisted of all Bedouin women lacking prenatal care (n = 7,601) who gave birth between the years 1990-1997 in the Soroka University Medical Center. The analysis consisted of a comparison of labor and delivery outcomes in women without prenatal care to outcomes in women who had some prenatal care. RESULTS: During the years 1990-1997 there were 36,281 singleton deliveries to Bedouin women at our institution. Of those, 20.9% did not receive prenatal care. Mothers in the no-prenatal-care group tended to be in the extremes of their reproductive cycles (< 18 years, > 35 years) and were of higher parity (P < .001) than those receiving prenatal care. There were more deliveries prior to 32 weeks of gestation in the no-prenatal-care group (2.8%) in comparison to the prenatal care group (1.5%, P < .001) and fewer postterm deliveries (> 42 weeks, P < .01). The incidence of low birth weight (< 2,500 g) in the no-prenatal-care group was higher than in the prenatal-care group (11.2% vs. 8.4%, P < .001). Women who did not receive adequate prenatal care had statistically significantly higher rates of antepartum fetal death (OR = 1.8, 95% CI 1.4-2.3, P < .001), intrapartum fetal death (OR = 2.38, 95% CI 1.2-4.5, P < .03) and postpartum fetal death (OR = 1.60, 95% CI 1.2-2.1, P < .001). Multiple logistic regression models were used to analyze the independent contribution of lack of prenatal care to perinatal mortality and to very-low-birth-weight newborns. In both models lack of prenatal care was an independent contributing factor. CONCLUSION: Lack of prenatal care is an independent contributor to perinatal mortality and low birth weight in a traditional society. In light of the high percentage of lack of prenatal care in Bedouin society, special attempts should be made to encourage women to use the available prenatal services.

Adolescent↗

PubMed1998

Barriers to prenatal care: factors associated with late initiation of care in a middle-class midwestern community.

BACKGROUND: Barriers to prenatal care have been extensively investigated in low-income and inner-city communities. Less attention has been directed to the study of prenatal care among middle- and upper-class pregnant women. This study describes perceived barriers and factors associated with late initiation of prenatal care in a predominantly middle- to upper-class midwestern community. METHODS: Consenting women in Olmsted County, Minnesota, who were attending a clinic for their first obstetric visit completed a self-administered questionnaire that queried the presence of factors making it difficult to receive prenatal care, perception about the importance of prenatal care, expectations at the first prenatal care visit, and sociodemographic factors. RESULTS: Of the 813 women aged 14 to 47 years, 692 (86%) had their first prenatal visit within the first trimester of pregnancy. Only 98 (12%) women reported external barriers to receiving prenatal care. These factors included difficulty in getting an appointment (46.9%), problems finding child care (26.5%), and lack of transportation (14.3%). In multivariable logistic regression analyses, late initiation of care was associated with patient perception of prenatal care as being less than very important (odds ratio [OR] = 4.1, 95% confidence interval [CI], 1.7-9.7); external barriers to prenatal care (OR = 2.9, 95% CI, 1.6-5.4); annual income < $17,000 (OR = 2.9, 95% CI, 1.5-5.7); and an unintended pregnancy (OR = 2.1, 95% CI, 1.3-3.5). Multiparous women and women older than 35 years were more likely to perceive prenatal care as less than very important (OR = 3.9, 95% CI, 2.5-14.6 and OR = 2.9, 95% CI, 1.2-6.8, respectively). CONCLUSIONS: These findings suggest that perceptions about the importance of prenatal care may play a greater role in the initiation of care among this group of women than is recognized. Women with more experience with pregnancy appear to place slightly less importance on prenatal care.

Adolescent↗

PubMed2005

Hispanic women's perceptions of patient-centeredness during prenatal care: a mixed-method study.

BACKGROUND: Assessing the quality of prenatal care received by Hispanic women is particularly important, given the rapidly growing Hispanic population in the United States. The purpose of this study was threefold: to assess the prevalence of Hispanic mothers who perceived their prenatal care to be patient-centered, to determine whether Hispanic mothers were less likely to perceive their prenatal care to be patient-centered than non-Hispanic mothers, and to better understand Hispanic women's perceptions of the patient-centeredness of their prenatal care. METHODS: Semistructured interviews were conducted with a proportionate, stratified random sample of 359 women initiating prenatal care in their first trimester and 68 women initiating prenatal care in their third trimester who delivered at 10 Palm Beach County, Florida, maternity hospitals between May and December 2003. Interviews assessed three aspects of patient-centered prenatal care using quantitative and qualitative methods. RESULTS: Hispanic mothers were less likely than non-Hispanic mothers to perceive that doctors and nurses treated them with respect during their prenatal care appointments (adjusted OR, 0.29; 95% CI, 0.10-0.86), and to perceive that office staff treated them with respect during their prenatal care appointments (adjusted OR, 0.29; 95% CI, 0.12-0.73). Hispanic mothers were more likely to experience language or communication problems than non-Hispanic mothers (adjusted OR, 3.30; 95% CI, 1.40-7.76). Qualitative analyses found that lack of patient-centered care limited Hispanic mothers' ability to understand information given during prenatal visits, ability to ask questions about their prenatal care, and desire to return for subsequent appointments. CONCLUSIONS: Hispanic women could benefit from prenatal care that is more culturally and linguistically competent as well as care that is responsive to the group's cultural norms. One recommendation is the use of group prenatal care, which encourages groups of women with similar gestational ages to articulate and discuss cultural norms and attitudes about pregnancy during structured prenatal care sessions.

Adult↗

PubMed1993

Adequacy of prenatal care among inner-city women.

BACKGROUND: Lack of prenatal care is a well-recognized risk factor for infant mortality and low birthweight. This study was conducted to identify factors that facilitate or inhibit access to prenatal care among low-income inner-city women. METHODS: A case-control interview study was conducted with women during their postpartum hospitalization at a midwestern inner-city hospital. Fifty-eight women who had received no prenatal care and 71 women who had received markedly inadequate prenatal care were compared with 123 controls who had received intermediate or adequate prenatal care. RESULTS: The majority of subjects were minorities, single, had low incomes, and were in the Medicaid program. Subjects' median age was 23 years and median parity 2, and the majority had not completed high school. Inadequate prenatal care was independently associated with the following variables (adjusted odds ratios): lack of any insurance, including Medicaid (5.3), being a smoker (3.8), being homeless (2.7), being black (2.5), not being worried what the physician or nurse might say (2.4), not using contraception (2.1), having a household income of less than $400 a month (1.8), being ashamed or afraid of the pregnancy or the physician (1.4), having transportation problems (1.3), and level of education (0.8). CONCLUSIONS: Practical factors related to poverty are substantial barriers to obtaining prenatal care. Comprehensive approaches to prenatal services that address these barriers may be more effective in facilitating adequate prenatal care among low-income women.

Adolescent↗

PubMedDate not supplied

CenteringPregnancy group prenatal care: Promoting relationship-centered care.

CenteringPregnancy is an innovative model of group prenatal care that has been implemented at more than 100 prenatal care sites since 1995. CenteringPregnancy provides group prenatal care that is relationship centered, nurturing and transforming relationships among women, their families, and health care professionals. Complete prenatal care is provided in a group setting. Prenatal assessment, education, and support occur in a facilitative environment. The model offers effective and efficient care that is sustainable and can enhance the health of women, their families, health care providers, and communities.

Evidence-Based Medicine↗

PubMed1988

Predictors of prenatal care utilization.

Despite substantial evidence linking improved pregnancy outcomes with receipt of prenatal care and recent improvements in prenatal care utilization, specific subpopulations continue to receive inadequate or less than adequate care. The study reported here examined the predictive power of a set of variables describing the type of financial coverage available to the mother, attributes of the mother, father and family and characteristics of the health care system. A stratified random sample of mothers was generated from state birth certificate files and surveyed through the use of a mailed questionnaire. Stratification was designed to assure adequate representation of subgroups expected to receive less adequate prenatal care. The study findings indicate that there were deficiencies in prenatal care utilization and that these deficiencies were concentrated in specific areas and subpopulations within the state. While the majority of women in the study started prenatal care in the recommended first trimester, most did not maintain the recommended schedule of visits with their care provider. The following conditions were found to reduce the likelihood of receiving adequate care after controlling for service need: younger women (particularly adolescents); less educated (particularly those without a high school education); low income; longer travel time; Medicaid recipient; and rural resident. In addition, it was found that where one lives is a significant predictor of the adequacy of prenatal care even after controlling for all of the above variables. The authors conclude that it is important in assessing potential policy and program options for reducing differentials in prenatal care use to distinguish between economic and noneconomic barriers to utilization. Receipt of Medicaid does not assure adequate prenatal care use.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Unplanned pregnancy as a major determinant in inadequate use of prenatal care.

BACKGROUND: Previous reports have stressed the importance of social class and education in prenatal care use. Unplanned pregnancy as a determinant of prenatal care use has been insufficiently studied. The objective of this report was to assess whether unplanned pregnancy is an independent predictor of inadequate use of prenatal care. METHODS: A 5% sample of women delivering at a hospital (409 women in the study population) was selected. Data on pregnancy were obtained by personal interview and from clinical charts. Prenatal care was considered inadequate according to the Kessner index. Relative risk (RR) and 95% confidence intervals (CI) were estimated. Stepwise logistic regression analysis was applied to select the independent predictors of inadequate prenatal care use. RESULTS: Prenatal care use was inadequate among 16.4% of the women. Pregnancy was unplanned among 42.8% of the women. Twenty-two percent of women with an unplanned pregnancy used prenatal care inadequately, while 12% of those with planned pregnancies used prenatal care inadequately (RR = 1.9, 95% CI = 1.2-2.9). In crude analysis, inadequate prenatal care use was also related to lower social class, lower education level, no employment outside the home, and multiparity. After adjustment was made for other predictors that were included in a stepwise logistic regression model (maternal education, social class, maternal occupation, parity, and pregnancy-induced hypertension), unplanned pregnancy was a significant risk factor for inadequate use of prenatal care (odds ratio = 2.1, 95% CI = 1.2-3.7) and it was an independent predictor for a delayed first prenatal care visit and for a reduced number of visits. CONCLUSIONS: The results suggest that unplanned pregnancy is a major determinant for inadequate use of prenatal care.

Adult↗

PubMed2003

Barriers to utilization of prenatal care services in Turkey.

PURPOSE: To identify barriers to utilization of prenatal care services in Turkey, including pregnant women's attitudes toward pregnancy and prenatal care. DESIGN: Descriptive. The population was Turkish women who lived in Erzurum and had delivered their infants but were still hospitalised. METHODS: The sample of 446 women had or had not received prenatal care, had no complications during pregnancy, carried their pregnancies to term, and were considered to have normal deliveries. Attitudes toward pregnancy and prenatal care and barriers to prenatal care services were measured by use of a questionnaire. FINDINGS: Low education of pregnant women and unwanted pregnancy were barriers to use of prenatal care services. Additional barriers were negative attitudes toward pregnancy and attitudes toward prenatal care. These barriers decreased frequency of use and delayed early initiation of prenatal care. The most important barrier reported by the women was being too busy at home to seek care. CONCLUSIONS: Although this sample was limited, the findings indicate barriers for attention by health care providers to ensure appropriate prenatal care and maternal and infant health.

Adolescent↗

PubMed1993

Maternal factors that influence inadequate prenatal care.

Fifty-seven pregnant women who received inadequate prenatal care identified the factors that influenced their decisions related to prenatal care. Data were collected in an institution that serves neighborhood clinics that offer free prenatal care and can be reached by public transportation. Women were interviewed either prenatally (n = 23) or postnatally (n = 34). The interview questions were drawn from the literature on the adequacy of prenatal care. The women identified 22 personal reasons and structural barriers for receiving inadequate prenatal care. The five most frequently cited reasons were small children at home, no medical assistance card, didn't know reason, sadness or ambivalence about the pregnancy, and just moved to the area. Despite demographic risk and facing the similar barriers, some women manage to receive sufficient care and others do not. Presently, government and other policy-making groups often believe that public insurance, Medicaid, or socialized medicine is the answer to our high infant mortality rate. However, in some geographic areas where financial barriers are not factors and where services are available that meet pregnant women's needs, some women still do not enter care early and remain in care. Data that expand knowledge on why women receive inadequate prenatal care will be useful in developing community outreach programs, preparing public service announcements, and designing prenatal services.

Adolescent↗

PubMed1997

Prenatal care.

Available evidence suggests that prenatal care has played an important role in reducing maternal and infant mortality. Medical surveillance throughout pregnancy is the foundation of prenatal care and should be enhanced by psychosocial support. Only tests and procedures shown to be useful should be performed. Patient education includes promotion of healthy behaviors, nutritional advice, and preparation for childbirth.

Female↗

PubMed1991

Caring for our future: a report by the expert panel on the content of prenatal care.

The report of the Expert Panel on Prenatal Care entitled Caring for Our Future: The Content of Prenatal Care was presented to the Assistant Secretary for Health, James Mason, MD, on October 2, 1989. The Panel noted the need for attention not only to the mother and fetus, but also to the infant and family. Besides traditional medical care concerns, the importance of psychosocial and environmental patient and family needs was emphasized. The Panel felt that the addition of the pre-conception visit to routine prenatal care made care more effective. Suggestions as to visit timing and content were made. The Panel noted the need for further understanding of many of the activities performed routinely in prenatal care.

Female↗

PubMed1994

Clerical staff attitudes toward patients in 19 prenatal care clinics in New York City.

It is widely believed that prenatal care is essential if women are to have healthy pregnancies and infants. Yet many low income women do not initiate care early in their pregnancies or make sufficient visits for prenatal care. Although financial difficulties are usually considered the main reason why prenatal care is not sought, other barriers have also been identified, such as problems with transportation, child care, and understanding English. A possibly unrecognized barrier to obtaining prenatal care is the frontline clerical staff attitudes toward patients. We surveyed 102 frontline staff in 19 prenatal care clinics serving low-income pregnant women in New York City. We explored staff attitudes toward patients, the benefits patients receive, and staff job satisfaction. The survey revealed that many frontline staff questioned whether patients should receive some prenatal care benefits offered. The staff members felt that their needs were attended to less than those of patients or other health care personnel. The attitudes of frontline staff concerning patients, patient benefits, and perceived lack of recognition at work may influence their interactions with patients and be a factor in patients' satisfaction with prenatal care services. Recognizing and changing factors fostering employee dissatisfaction may improve the "user friendliness" of prenatal care clinics and remove a barrier for low-income women.

Adult↗

PubMed2003

[Factors associated with inadequacy of prenatal care utilization].

OBJECTIVE: To identify factors associated with inadequacy of prenatal care utilization in urban community. METHODS: A cross-sectional study of a systematic sample stratified by maternity hospital, consisting of hospital births in the municipality of São Luís, Brazil, was carried out from March 1997 to February 1998. Socioeconomic and demographic factors, reproductive health, morbidity during pregnancy, and utilization of prenatal care services were studied. Mothers answered a standardized questionnaire before hospital discharge. The adequacy of prenatal care utilization was analyzed by means of two indexes: APNCU (Adequacy of Prenatal Care Utilization) and a new index based on the recommendations of the Brazilian Ministry of Health. RESULTS: There were interviewed 2,831 women who delivered at 10 public and private maternity hospitals. The inadequacy of prenatal care utilization was 49.2% according to the APNCU index and 24.5% when determined by the Brazilian index. Prenatal care at public services, low maternal schooling, low income, having no partner, and absence of maternal diseases during pregnancy were associated with inadequacy of prenatal care use according to both indexes. High parity and maternal age of 35 years or more were also associated with inadequacy, whereas primiparity, morbidity, and young maternal age (<20 years) seemed to protect from inadequacy when the Brazilian index was used. CONCLUSIONS: Prenatal care showed low coverage in the municipality of São Luís. The inadequacy of prenatal care utilization was associated with several factors linked to social inequality.

Adolescent↗

PubMed1996

Early versus late prenatal care in New Mexico: barriers and motivators.

BACKGROUND: Adequate prenatal care is important for ensuring a good outcome for pregnant women and their children, and its initiation in the first trimester is a major component. We investigated barriers and motivators for women receiving early versus late prenatal care. METHODS: A self-administered questionnaire was distributed to 205 women who began prenatal care at the University of New Mexico Hospital Obstetrics Clinic in Albuquerque, New Mexico. The questionnaire assessed demographic information, insurance status, feelings about the pregnancy, health behaviors, and barriers and motivators to initiating prenatal care. The participants were Hispanic (41%) and non-Hispanic white (46%), low-income women with Medicaid (42%) or no health insurance (41%). They were divided into early (1st trimester 67%) and late (after 1st trimester 33%) care groups. RESULTS: Ethnicity, education, income, and age did not predict initiation of prenatal care. Late initiators cited financial problems (26%), not being aware of the pregnancy (15%), and dislike of going to doctors (14%) as reasons for the delay in seeking prenatal care. Over two-thirds of the pregnancies were unplanned, but 82 percent of the women felt positive about the pregnancy. CONCLUSIONS: Our study documents the continuing need for public health efforts to encourage women to seek early prenatal care. Specific attention should be directed toward women's perceived reasons for not initiating early care.

Adolescent↗

PubMed2001

Health insurance coverage-enrollment and adequacy of prenatal care utilization.

Most studies have concluded that good prenatal care plays an essential role in improving birth outcomes, and numerous reports have documented barriers to adequate prenatal care. The relationship between health care insurance eligibility and enrollment procedures and adequacy of prenatal care, however, has not been suitably investigated. This study used data from a statewide representative sample of recently delivered women in South Carolina to assess (1) patterns of health care insurance source and (2) the independent effects of Medicaid enrollment and application procedures on receipt of prenatal care. Health insurance during pregnancy varied by sociodemographic characteristics. Black women's experiences with Medicaid enrollment and application procedures were associated with less than adequate prenatal care. Programmatic efforts and policies should emphasize further improvement in the systems of health care access and delivery to disadvantaged women.

Adult↗

PubMed1992

Does prenatal care decrease the incidence and cost of neonatal intensive care admissions?

This study was conducted to examine the potential effects of expanded Medicaid coverage for low income women. Statewide birth data for 1983 to 1985 were examined to determine the relationship between prenatal care and admissions to neonatal intensive care units (NICUs) and the costs of this care. An NICU sample was constituted from infants who were discharged live following more than 7 NICU days, were referred to an out of state tertiary center, or died following NICU admission. Inadequate care (no prenatal care, only last trimester care, or less than five visits) was received by 11% of the total birth cohort and by 18% of the infants in the NICU sample (p less than 0.001). Infants with inadequate care had a NICU admission rate of 5.10% versus 2.86% for those with adequate prenatal care (p less than 0.001). The hospital billings for infants in the NICU sample with inadequate care were significantly higher than were those for infants with adequate care (p less than 0.05). Assuming that economic resources limit access to prenatal care, the projection can be made that had all women with inadequate prenatal care received Medicaid-covered adequate prenatal care, expenditure for this care would yield more than a two to one return in savings in NICU costs.

Adolescent↗

PubMed2001

Barriers to prenatal care in Europe.

BACKGROUND: In Europe, it is sometimes assumed that few barriers to prenatal care exist because extensive programs of health insurance and initiatives to promote participation in prenatal care have been established for many decades. METHODS: A case-control study was performed in ten European countries (Austria, Denmark, Germany, Greece, Hungary, Ireland, Italy, Portugal, Spain, and Sweden). Postpartum interviews were conducted between 1995 and 1996. A total of 1283 women with inadequate prenatal care (i.e., with 0, 1, or 2 prenatal care visits or a first prenatal care visit after 15 completed weeks of pregnancy) and 1280 controls with adequate prenatal care were included in the analysis combining data from the ten countries. RESULTS: Based on combined data of the ten countries, lack of health insurance was found to be an important risk factor for inadequate prenatal care (crude odds ratio [OR] at 95% confidence interval [CI]: 30.1 [20.1-47.1]). Women with inadequate prenatal care were more likely to be aged < 20 years (16.4% vs 4.8%) and with higher parity (number of children previously borne) than controls. They were more likely to be foreign nationals, unmarried, and with an unplanned pregnancy. Women with inadequate care were also more likely to have less education and no regular income. They had more difficulties dealing with health services organization and child care. Cultural and financial barriers were present, but after adjusting for confounders by logistic regression, perceived financial difficulty was not a significant factor for inadequate prenatal care (adjusted OR [95% CI]: 0.7 [0.4-1.3]). CONCLUSIONS: Personal, socioeconomic, organizational, and cultural barriers to prenatal care exist in Europe.

Adult↗

PubMed2000

Elimination of public funding of prenatal care for undocumented immigrants in California: a cost/benefit analysis.

OBJECTIVE: We compared the perinatal outcomes and costs of undocumented women with and without prenatal care and inferred the impact of denial of prenatal benefits to undocumented immigrants in California. STUDY DESIGN: We retrospectively reviewed the delivery records of a cohort of 970 undocumented immigrants. The effects of prenatal care on low birth weight and prematurity were evaluated by means of logistic regression. The difference in the costs of postnatal care between neonates with and without prenatal care was compared with the cost of prenatal care. This ratio was extrapolated to calculate the net cost to the state. Long-term morbidity costs were also considered. RESULTS: Nearly 10% of undocumented women had no prenatal care. These women were nearly 4 times as likely to be delivered of low birth weight infants (relative risk, 3.8; 95% confidence interval, 2.03-7.05) and >7 times as likely to be delivered of premature infants (relative risk, 7.4; 95% confidence interval, 4.35-12.59) as were undocumented women who had prenatal care. The cost of postnatal care for a neonate without prenatal care was $2341 more initially and $3247 more when incremental long-term morbidity cost was added than that for a neonate with prenatal care. For every dollar cut from prenatal care we expect an increase of $3. 33 in the cost of postnatal care and $4.63 in incremental long-term cost. Elimination of publicly funded prenatal care for undocumented women could save the state $58 million in direct prenatal care costs but could cost taxpayers as much as $194 million more in postnatal care, resulting in a net cost of $136 million initially and $211 million in long-term costs. CONCLUSIONS: Elimination of public funding of prenatal care for undocumented immigrants in California could substantially increase low birth weight, prematurity, and postnatal costs.

California↗