Abstract
BackgroundThe reasons why women do not obtain prenatal care even when it is available and accessible are complex. Despite Canada’s universally funded health care system, use of prenatal care varies widely across neighborhoods in Winnipeg, Manitoba, with the highest rates of inadequate prenatal care found in eight inner-city neighborhoods. The purpose of this study was to identify barriers, motivators and facilitators related to use of prenatal care among women living in these inner-city neighborhoods.MethodsWe conducted a case–control study with 202 cases (inadequate prenatal care) and 406 controls (adequate prenatal care), frequency matched 1:2 by neighborhood. Women were recruited during their postpartum hospital stay, and were interviewed using a structured questionnaire. Stratified analyses of barriers and motivators associated with inadequate prenatal care were conducted, and the Mantel-Haenszel common odds ratio (OR) was reported when the results were homogeneous across neighborhoods. Chi square analysis was used to test for differences in proportions of cases and controls reporting facilitators that would have helped them get more prenatal care.ResultsOf the 39 barriers assessed, 35 significantly increased the odds of inadequate prenatal care for inner-city women. Psychosocial issues that increased the likelihood of inadequate prenatal care included being under stress, having family problems, feeling depressed, “not thinking straight”, and being worried that the baby would be apprehended by the child welfare agency. Structural barriers included not knowing where to get prenatal care, having a long wait to get an appointment, and having problems with child care or transportation. Attitudinal barriers included not planning or knowing about the pregnancy, thinking of having an abortion, and believing they did not need prenatal care. Of the 10 motivators assessed, four had a protective effect, such as the desire to learn how to protect one’s health. Receiving incentives and getting help with transportation and child care would have facilitated women’s attendance at prenatal care visits.ConclusionsSeveral psychosocial, attitudinal, economic and structural barriers increased the likelihood of inadequate prenatal care for women living in socioeconomically disadvantaged neighborhoods. Removing barriers to prenatal care and capitalizing on factors that motivate and facilitate women to seek prenatal care despite the challenges of their personal circumstances may help improve use of prenatal care by inner-city women.
Highlights
The reasons why women do not obtain prenatal care even when it is available and accessible are complex
Inadequate prenatal care was defined as (a) having no prenatal care; or (b) prenatal care that began in the third trimester, irrespective of the total number of prenatal care visits; or (c) prenatal care that began in the first or second trimester but with a low number of visits using the following criteria: women delivering at term or at 34+ weeks with 1–4 visits in total, those delivering at 32–33 weeks with 1–3 visits in total, those delivering at 30–31 weeks with 1–2 visits in total, or those delivering at ≤ weeks with only 1 visit
Psychosocial barriers that significantly increased the likelihood or odds of inadequate prenatal care included being under stress, having family problems, feeling depressed, “not thinking straight”, and being worried that the baby would be apprehended by the child welfare agency
Summary
The reasons why women do not obtain prenatal care even when it is available and accessible are complex. Despite Canada’s universally funded health care system, use of prenatal care varies widely across neighborhoods in Winnipeg, Manitoba, with the highest rates of inadequate prenatal care found in eight inner-city neighborhoods. The purpose of this study was to identify barriers, motivators and facilitators related to use of prenatal care among women living in these inner-city neighborhoods. Despite the emphasis placed on the value of this care [1,2], disparities in utilization of prenatal care persist even in countries with universal access to health care. Our previous research found wide variation in the proportion of women receiving inadequate prenatal care in the Canadian province of Manitoba, with rates ranging from 1.1% to 21.5% across the 25 neighborhoods of the capital city of Winnipeg [3]. Looking at health care broadly, Stewart has proposed that social, cultural, psychological and organizational barriers influence the complex, multivariate nature of access to care for economically disadvantaged Canadians [6]
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