Abstract

Postpartum in-hospital interviews with 496 low-income women in New York City revealed that attitudinal and motivational barriers as well as financial obstacles are significant impediments to timely initiation of prenatal care. The two most common reasons cited by these women in explaining why they had obtained prenatal care late or not at all were motivational items: "feeling depressed and not up to going for care" and "needing time and energy to deal with other problems." In logistic regression analyses, receipt of late or no prenatal care was significantly associated with the latter motivational barrier, along with the cost of care, having no health insurance, being Hispanic, being a substance abuser and holding negative attitudes toward the use of prenatal care.

PIP:

Interviewers questioned 496 low-income black and Hispanic women postpartum in New York City on attitudinal, motivational and financial barriers to prenatal care. Women who had little or no prenatal care were oversampled, so this study is not representative of the New York City population. Oversampling also fixes the distribution of the dependent variable which can bias the regression coefficients unless logistic regression is used. In this study, 54% of the women had received timely prenatal care, while 46% received late or no care. A questionnaire was used with both open-ended and closed questions to determine which barriers to prenatal care were most important. Age was a categorical variable for the descriptive analysis, and a continuous variable for the regression analyses. Health insurance was used as a series of dummy variables. The timely care group ranked depression, lack of energy, travel distance, and transportation problems among the top barriers to prenatal care. The late or no care group ranked lack of energy, depression, cost of care, travel distance, transportation problems, and lack of child care among the top barriers. Those who were most likely to receive timely care were those women with health insurance. Those women with regular doctors were also more likely to receive good prenatal care. Logistic regression according to 2 models showed that late or no prenatal care could be predicted. Lack of health insurance is a major predictor of timely prenatal care. Substance abuse also played an important role in the timeliness of prenatal care. Recommendations are made to reform maternity service financing, and to alleviate substance abuse among pregnant women.