Health care system barriers and facilitators to early prenatal care among diverse women in Florida.

Abstract

Worldwide, women continue to experience barriers to accessing early prenatal care. Given the unique nature of the United States health care system, this study aimed to identify barriers and facilitators to early prenatal care reported by women in Florida. A mixed-methods study of postpartum women with entry to care after 14weeks' gestation was conducted at a tertiary care hospital in Florida. First, eligible women completed a survey including demographic characteristics and open-ended questions on prenatal care barriers. Second, a semi-structured interview was conducted to contextualize the conditions of access. The qualitative analysis was based on the combined theoretical frameworks of Phillippi and Khan. The majority of the 55 participants self-identified as Hispanic (n=28, 51%), non-Hispanic White (n=12, 22%), or non-Hispanic Black (n=9, 16%). Quantitative analysis identified frequent barriers, including the following: "couldn't get an appointment when wanted one" (n=24, 47%); "didn't have insurance" (n=21, 41%); and "not aware of pregnancy" (n=21, 41%). From the combined quantitative and qualitative analyses, three major themes emerged that help to explain barriers faced by birthing people in Florida: personal factors (mental health, awareness of pregnancy, considering abortion, tumultuous life), community conditions (transportation, stigma/fear, social support), and health care system (language barriers, delay at clinic level, cost of care). Barriers to early prenatal care are multifaceted and operate at personal, societal, and health care systems levels. Prenatal care practitioners have multiple potential targets for interventions at the clinic level to help mitigate barriers to early prenatal care. Strategies should include health care policy reforms to Medicaid access and interventions at the clinic level aimed at fast-tracking access to care.