Working Towards Safe Motherhood: Delays and Barriers to Prenatal Care for Women in Rural and Peri-Urban Areas of Georgia
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.
KeywordsPrenatal care Rural Access Qualitative methods Medicaid
- 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.
- 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
- 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
- 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.Spelke, B., Zertuche, A., Cota, P., Rochat, R. W., & Dott, A. (2015). Obstetric provider shortage—Georgia. Atlanta: Emory University.Google Scholar