Maternal and Child Health Journal

, Volume 20, Issue 7, pp 1358–1365

Working Towards Safe Motherhood: Delays and Barriers to Prenatal Care for Women in Rural and Peri-Urban Areas of Georgia

  • Erika Meyer
  • Monique Hennink
  • Roger Rochat
  • Zoë Julian
  • Meredith Pinto
  • Adrienne D. Zertuche
  • Bridget Spelke
  • Andrew Dott
  • Pat Cota
Article

Abstract

Objectives Georgia has the highest rate of maternal mortality in the United States, and ranks 40th for infant mortality. The Georgia Maternal and Infant Health Research Group was formed to investigate and address the shortage of obstetric care providers outside the Atlanta area. Because access to prenatal care (PNC) can improve maternal and infant health outcomes, we used qualitative methods to identify the access barriers experienced by women who live in rural and peri-urban areas of the state. Methods We conducted semi-structured, in-depth interviews with 24 mothers who gave birth between July and August 2013, and who live in either shortage or non-shortage obstetric care service areas. We also conducted key informant interviews with four perinatal case managers, and analyzed all data using applied thematic analysis. We then utilized Thaddeus and Maine’s “Three Delays to Care” theoretical framework structure to describe the recognized barriers to care. Results We identified delays in a woman’s decision to seek PNC (such as awareness of pregnancy and stigma); delays in accessing an appropriate healthcare facility (such as choosing a doctor and receiving insurance coverage); and delays in receiving adequate and appropriate care (such as continuity of care and communication). Moreover, many participants perceived low self-worth and believed this influenced their PNC exchanges. Conclusion As a means of supporting Georgia’s pregnant women who face barriers and delays to PNC, these data provide a rationale for developing contextually relevant solutions to both mothers and their providers.

Keywords

Prenatal care Rural Access Qualitative methods Medicaid 

References

  1. 1.
    Allen, H., Wright, B. J., & Baicker, K. (2014). New medicaid enrollees in oregon report health care successes and challenges. Health Affairs, 33(2), 292–299.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Bergman, A. A., & Connaughton, S. L. (2013). What is patient-centered care really? Voices of hispanic prenatal patients. Health Communications, 28(8), 789–799.CrossRefGoogle Scholar
  3. 3.
    Clement, S., Sikorski, J., Wilson, J., Das, S., & Smeeton, N. (1996). Women’s satisfaction with traditional and reduced antenatal visit schedules. Midwifery, 12(3), 120–128.CrossRefPubMedGoogle Scholar
  4. 4.
    Currie, D. H., & Weisenberg, S. E. (2003). Promoting women’s health-seeking behavior: Research and the empowerment of women. Health Care for Women International, 24(10), 880–889.CrossRefPubMedGoogle Scholar
  5. 5.
    Georgia Department of Public Health. (2015). Georgia Maternal Mortality: 2012 Case Review. www.dph.georgia.gov/sites/dph.georgia.gov/files/MCH/MMR_2012_Case_Review_June2015_final.pdf. Accessed 6 Sept 2015.
  6. 6.
    Guest, G. S. (2012). Applied thematic analysis. Thousand Oaks, CA: SAGE Publications Inc.CrossRefGoogle Scholar
  7. 7.
    Lori, J. R., Yi, C. H., & Martyn, K. K. (2011). Provider characteristics desired by African American women in prenatal care. Journal of Transcultural Nursing, 22, 71–76.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Partridge, S., Balayla, J., Holcroft, C. A., & Abenhaim, H. A. (2012). Inadequate prenatal care utilization and risks of infant mortality and poor birth outcome: A retrospective analysis of 28,729,765 U.S. deliveries over 8 years. American Journal of Perinatology, 29(10), 787–793.CrossRefPubMedGoogle Scholar
  9. 9.
    Phillippi, J. C. (2009). Women’s perceptions of access to prenatal care in the United States: A literature review. Journal of Midwifery and Women’s Health, 54(3), 219–225.CrossRefPubMedGoogle Scholar
  10. 10.
    Raine, R., Cartwright, M., Richens, Y., Mahamed, Z., & Smith, D. (2009). A qualitative study of women’s experiences of communication in antenatal care: Identifying areas for action. Journal of Maternal and Child Health, 14, 990–999.Google Scholar
  11. 11.
    Rowe, R. E., Garcia, J., Macfarlane, A. J., & Davidson, L. L. (2002). Improving communication between health professionals and women in maternity care: A structured review. Health Expectations, 5(1), 63–83.CrossRefPubMedGoogle Scholar
  12. 12.
    Schwalberg, R., Mathis, S.A., Giffen, M., Mohamadi, L., Zimmerman, B., & Sines, E. (2008). Medicaid coverage of family planning services: Results of a national survey (report). Retrieved January 2, 2014, from Kaiser Family Foundation website: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/medicaid-coverage-of-family-planning-services-results-of-a-national-survey-report.pdf.
  13. 13.
    Spelke, B., Zertuche, A., Cota, P., Rochat, R. W., & Dott, A. (2015). Obstetric provider shortage—Georgia. Atlanta: Emory University.Google Scholar
  14. 14.
    Thaddeus, S., & Maine, D. (1994). Too far to walk: Maternal mortality in context. Social Science Medicine, 38(8), 1091–1110.CrossRefPubMedGoogle Scholar
  15. 15.
    Wheatley, R. R., Kelley, M. A., Peacock, N., & Delgado, J. (2008). Women’s narratives on quality in prenatal care: A multicultural perspective. Qualitative Health Research, 18(11), 1586–1598.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Erika Meyer
    • 1
  • Monique Hennink
    • 1
  • Roger Rochat
    • 1
    • 2
  • Zoë Julian
    • 1
    • 2
  • Meredith Pinto
    • 1
  • Adrienne D. Zertuche
    • 1
    • 2
    • 3
  • Bridget Spelke
    • 1
    • 2
  • Andrew Dott
    • 4
  • Pat Cota
    • 4
  1. 1.Emory University Rollins School of Public HealthAtlantaUSA
  2. 2.Emory University School of MedicineAtlantaUSA
  3. 3.Department of Gynecology and ObstetricsEmory University School of MedicineAtlantaUSA
  4. 4.Georgia Obstetrical and Gynecological SocietyDuluthUSA

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