Abstract
Few studies have examined factors associated with compliance with a postpartum visit (PPV). The identification of such factors is of particular importance in populations with high rates of unintended pregnancies and medical complications of pregnancy. This study seeks to determine factors associated with compliance with a PPV among low-income women in the population served by fourteen Healthy Start sites. Data from the Healthy Start Survey of Postpartum Women were reviewed to identify variables associated with compliance with a PPV at or beyond 6 weeks. Multiple logistic regression models were created, based on a sociobehavioral model of health services use, to examine which types of factors (demographic, social, enabling or need) are most strongly associated with the use of a PPV. The study population consisted of survey respondents interviewed six weeks or more following delivery. Eighty-five percent of respondents had had a PPV at time of interview. In a multiple regression analysis, enabling factors such as multiple moves (OR (95% CI)=0.34 (0.18, 0.67)), trouble understanding the provider (OR (95% CI)=0.65 (0.43, 0.99)) and appointment reminders (OR (95% CI)=2.37 (1.40, 4.02)) were most strongly associated with a PPV. This work finds that women with unstable housing, transportation barriers, and difficulties communicating with providers are at risk for not receiving a PPV. This suggests that access to postpartum health services in the Healthy Start communities studied may not be entirely equitable. Policies aimed at improving interconception care will need to address these barriers to accessing health services.
Highlights
To date, few studies have examined rates of utilization of the six-week postpartum medical visit
This work finds that women with unstable housing, transportation barriers, and difficulties communicating with providers are at risk for not receiving a PPV. This suggests that access to postpartum health services in the Healthy Start communities studied may not be entirely equitable
The objectives of the survey were three-fold; “to examine the experiences of the Healthy Start participants, including such factors as client satisfaction, barriers to and facilitators of receiving prenatal care, case management services received, other Healthy Start services received, and infant health care; to examine the experiences of women living in Healthy Start project areas who do not receive Healthy Start services; and to assess how the experiences of Healthy Start participants compare with those of nonparticipants.” (4) Between December 1995 and April 1996, face-to-face interviews were conducted with 1,447 Healthy Start participants and 1,404 non-participants living in Healthy Start project areas nationwide
Summary
Few studies have examined rates of utilization of the six-week postpartum medical visit. The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics recommend routine medical follow up four to six weeks postpartum, at which time a general assessment of physical and mental well-being is performed, with particular emphasis upon screening for postpartum depression, evaluation of breastfeeding and issues related to family planning (1). The postpartum visit provides an opportunity for an evaluation of maternal health status and allows for referrals for follow-up of chronic or pregnancy-related medical conditions. Compliance with the postpartum visit is likely related to a number of patient-, provider- and systemslevel factors. Patients must perceive a need for and benefit from the visit, must be able to overcome any barriers to care (e.g. related to insurance, transportation, child care, safety) and must have access to a health care system equipped to provide appropriate care
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