The social pregnancy interaction model: conceptualizing cognitive, social and cultural barriers to prenatal care

Abstract

Although prenatal care appears to improve perinatal outcome, many women fail to seek care. Research has established the importance of removing structural barriers for women by improving financial access, establishing providers of care, and providing transportation. Such steps are essential, but not sufficient to ensure that all women receive adequate prenatal care. Individual experiences, attitudes, beliefs, social setting, and culture are important in the decision to seek prenatal care. Most research on these nonstructural barriers to prenatal care, however, has been limited by the use of inadequate instruments and retrospective and cross-sectional collection of data. More importantly, this field of inquiry lacks a comprehensive theoretical framework to guide its research agenda. In this paper, we propose the social pregnancy interaction model (SPIM), a theoretical model for predicting the utilization of prenatal care which incorporates the theory of reasoned action and the concept of social pregnancy from symbolic interaction theory. The SPIM illustrates that a woman's decision to initiate prenatal care occurs within a social, cultural, and historical context that depends on social interpretations. If validated, this model has the potential to increase our understanding of the process of initiating prenatal care, to provide much greater predictive power in anticipating the use of prenatal care, and to facilitate the development and evaluation of effective approaches to increase the early utilization and continuation of prenatal care in a variety of cultural, social, and economic settings. The model also may be useful for studying other issues surrounding pregnancy such as family planning, contraceptive behavior, infertility, and elective abortion. We conclude by framing a research agenda and posing a series of research questions that emerge from this model.