Advertisement

Anatomy of Good Prenatal Care: Perspectives of Low Income African-American Women on Barriers and Facilitators to Prenatal Care

  • Mary C. MazulEmail author
  • Trina C. Salm Ward
  • Emmanuel M. Ngui
Article
First Online:

Abstract

Background

Although early, consistent prenatal care (PNC) can be helpful in improving poor birth outcomes, rates of PNC use tend to be lower among African-American women compared to Whites. This study examines low-income African-American women’s perspectives on barriers and facilitators to receiving PNC in an urban setting.

Methods

We conducted six focus groups with 29 women and individual structured interviews with two women. Transcripts were coded to identify barriers and facilitators to obtaining PNC; codes were reviewed to identify emergent themes.

Results

Barriers to obtaining PNC included structural barriers such as transportation and insurance, negative attitudes towards PNC, perceived poor quality of care, unintended pregnancy, and psychosocial stressors such as overall life stress and chaos. Facilitators of PNC included positive experiences such as trusting relationships with providers, respectful staff and providers, and social support.

Conclusions

Findings suggest important components in an ideal PNC model to engage low-income African-American women.

Keywords

Prenatal care Qualitative study Infant mortality Racial disparity 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

We gratefully acknowledge the generous women who were willing to share their stories with us; Samantha J. Perry, MPH, CHES; Farrin Bridgewater, MA; David Frazer, MPH; and Amy Harley, PhD for their contributions to this project; funding from the Children’s Community Health Plan; and resources from the Center for Urban Population Health and the YWCA of Southeast Wisconsin.

Compliance with Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding

This study was funded in part by Children’s Community Health Plan.

Conflict of Interest

Author A declares that he/she has no conflict of interest. Author B declares that he/she has no conflict of interest. Author C declares that he/she has no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Mathews TJ, MacDorman MF, Thoman EB. Infant mortality statistics from the 2013 period linked birth/infant death data set. Natl Vital Stat Rep. 2015;64(9):1–30.Google Scholar
  2. 2.
    Creanga AA, Berg CJ, Syverson C, Seed K, Bruce FC, Callaghan WM. Pregnancy-related mortality in the United States, 2006–2010. Obstet Gynecol. 2015;125(1):5–12.CrossRefPubMedGoogle Scholar
  3. 3.
    King JC. Maternal mortality in the United States—why is it important and what are we doing about it? Semin Perinatol. 2012;36(1):14–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Byrd DR, Katcher ML, Peppard P, Durkin M, Remington PL. Infant mortality: explaining black/white disparities in Wisconsin. Matern Child Health J. 2007;11(4):219–326.CrossRefGoogle Scholar
  5. 5.
    Alexander GR, Kotelchuck ML. Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research. Public Health Rep. 2001;116:306.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Bloch JR, Dawley K, Suplee PD. Application of the Kessner and Kotelchuck prenatal care adequacy indices in a preterm birth population. Public Health Nurs. 2009;26(5):449–59.CrossRefPubMedGoogle Scholar
  7. 7.
    Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. Am J Obstet Gynecol. 2010;202(4):335–43.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Cox RG, Zhang L, Zotti ME, Graham J. Prenatal care utilization in Mississippi: racial disparities and implications for unfavorable birth outcomes. Matern Child Health J. 2011;15(7):931–42.CrossRefPubMedGoogle Scholar
  9. 9.
    Minino AM, Murphy SL. Death in the United States, 2010. NCHS Data Brief. 2012;99:1–8.Google Scholar
  10. 10.
    Partridge S, Balayla J, Holcroft CA, Abenhaim HA. 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. Am J Perinatol. 2012;29(10):787–93.CrossRefPubMedGoogle Scholar
  11. 11.
    Conway KS, Kutinova A. Maternal health: does prenatal care make a difference? Health Econ. 2006;15(5):461–88.CrossRefPubMedGoogle Scholar
  12. 12.
    Cabacungan ET, Ngui EM, McGinley EL. Racial/ethnic disparities in maternal morbidities: a statewide study of labor and delivery hospitalizations in Wisconsin. Matern Child Health J. 2012;16(7):1455–67.CrossRefPubMedGoogle Scholar
  13. 13.
    Ngui E, Cortright A, Blair K. An investigation of paternity status and other factors associated with racial and ethnic disparities in birth outcomes in Milwaukee, Wisconsin. Matern Child Health J. 2009;13:467–78.CrossRefPubMedGoogle Scholar
  14. 14.
    Johnson AA, Hatcher BJ, El-Khorazaty MN, et al. Determinants of inadequate prenatal care utilization by African American women. J Health Care Poor Underserved. 2007;18:620–36.CrossRefPubMedGoogle Scholar
  15. 15.
    Chen XK, Wen SW, Yang Q, Walker MC. Adequacy of prenatal care and neonatal mortality in infants born to mothers with and without antenatal high-risk conditions. Aust N Z J Obstet Gynaecol. 2007;47(2):122–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Krueger PM, Scholl TO. Adequacy of prenatal care and pregnancy outcome. J Am Osteopath Assoc. 2000;100(8):485–92.PubMedGoogle Scholar
  17. 17.
    Laditka SB, Laditka JN, Bennett KJ, Probst JC. Delivery complications associated with prenatal care access for Medicaid-insured mothers in rural and urban hospitals. J Rural Health. 2005;21(2):158–66.CrossRefPubMedGoogle Scholar
  18. 18.
    Riley L, Stark A. Guidelines for perinatal care. 7th ed. AAP Committee on Fetus and Newborn and ACOG Committee on Obstetric Practice; 2012.Google Scholar
  19. 19.
    Department of Health & Human Services. Healthy people 2020. 2013.Google Scholar
  20. 20.
    Alexander GR, Kogan MD, Nabukera S. Racial differences in prenatal care use in the United States: are disparities decreasing? Am J Public Health. 2002;92(12):1970–5.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Frisbie WP, Echevarria S, Hummer RA. Prenatal care utilization among non-Hispanic Whites, African-Americans, and Mexican Americans. Matern Child Health J. 2001;5(1):21–33.CrossRefPubMedGoogle Scholar
  22. 22.
    Kogan MD, Kotelchuck M, Johnson S. Racial differences in late prenatal care visits. J Perinatol. 1993;13(1):14–21.PubMedGoogle Scholar
  23. 23.
    U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Child health USA 2014. 2014.Google Scholar
  24. 24.
    Boyatzis RE. Transforming qualitative information: thematic analysis and code development. Thousand Oaks: SAGE; 1998.Google Scholar
  25. 25.
    Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. 4th ed. Los Angeles: SAGE; 2014.Google Scholar
  26. 26.
    Rodgers BL, Cowles KV. The qualitative research audit trail: a complex collection of documentation. Res Nurs Health. 1993;16:219–26.CrossRefPubMedGoogle Scholar
  27. 27.
    Salm Ward TC, Mazul M, Ngui EM, Bridgewater FD, Harley AE. “You Learn to Go Last”: prenatal care experiences in a sample of low-income African-American women in Milwaukee. Matern Child Health J. 2013;17(10):1753–9.Google Scholar
  28. 28.
    Sable MR, Stockbauer JW, Schramm WF, Land GH. Differentiating the barriers to adequate prenatal care in Missouri, 1987–88. Public Health Rep. 1990;105(6):549–55.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Kalmuss D, Fennelly K. Barriers to prenatal-care among low-income women in New York City. Fam Plan Perspect. 1990;22(5):215-218-231.Google Scholar
  30. 30.
    McDonald TP, Coburn AF. Predictors of prenatal-care utilization. Soc Sci Med. 1988;27(2):167–72.CrossRefPubMedGoogle Scholar
  31. 31.
    Poland ML, Ager JW, Olson JM. Barriers to receiving adequate prenatal care. Am J Obstet Gynecol. 1987;157(2):297–303.CrossRefPubMedGoogle Scholar
  32. 32.
    Brown SS. Drawing women into prenatal care. Fam Plan Perspect. 1989;21(2):73–80.CrossRefGoogle Scholar
  33. 33.
    Rosenberg D, Handler A, Rankin KM, Zimbeck M, Adams EK. Prenatal care initiation among very low-income women in the aftermath of welfare reform: does pre-pregnancy Medicaid coverage make a difference? Matern Child Health J. 2007;11(1):11–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Cokkinides V, American Cancer Society. Health insurance coverage-enrollment and adequacy of prenatal care utilization. J Health Care Poor Underserved. 2001;12(4):461–73.CrossRefPubMedGoogle Scholar
  35. 35.
    Lia-Hoagberg B, Rode P, Skovholt CJ, et al. Barriers and motivators to prenatal care among low-income women. Soc Sci Med. 1990;30(4):487–94.CrossRefPubMedGoogle Scholar
  36. 36.
    Mikhail B. Prenatal care utilization among low-income African-American women. J Community Health Nurs. 2000;17(4):235–46.CrossRefPubMedGoogle Scholar
  37. 37.
    Daniels P, Noe GF, Mayberry R. Barriers to prenatal care among Black women of low socioeconomic status. Am J Health Behav. 2006;30(2):188–98.CrossRefPubMedGoogle Scholar
  38. 38.
    Heaman MI, Moffatt M, Elliott L, et al. Barriers, motivators and facilitators related to prenatal care utilization among inner-city women in Winnipeg, Canada. BMC Pregnancy Childbirth. 2014;14:227.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Adams EK, Gavin NI, Benedict MB. Access for pregnant women on Medicaid: variation by race and ethnicity. J Health Care Poor Underserved. 2005;16(1):74–95.CrossRefPubMedGoogle Scholar
  40. 40.
    Johnson AA, Wesley BD, El-Khorazaty MN, et al. African American and Latino patient versus provider perceptions of determinants of prenatal care initiation. Matern Child Health J. 2011;15 Suppl 1:S27–34.CrossRefPubMedGoogle Scholar
  41. 41.
    Krans EE, Davis MM, Palladino CL. Disparate patterns of prenatal care utilization stratified by medical and psychosocial risk. Matern Child Health J. 2013;17:639–45.CrossRefPubMedGoogle Scholar
  42. 42.
    Pawasarat J, Quinn LM. Wisconsin’s mass incarceration of African American males: Workforce challenges for 2013. 2013.Google Scholar
  43. 43.
    Wilson V. Projected decline in unemployment in 2015 won’t lift Blacks out of the recession-carved crater. 2015;393.Google Scholar
  44. 44.
    Spatial Structures in the Social Sciences, Brown University. US2010 segregation sorting. http://www.s4.brown.edu/us2010/SegSorting/Default.aspx. Updated 2010.
  45. 45.
    Lori JR, Yi CH, Martyn KK. Provider characteristics desired by African American women in prenatal care. J Transcult Nurs. 2011;22(1):71–6.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Wheatley RR, Kelley MA, Peacock N, Delgado J. Women’s narratives on quality in prenatal care: a multicultural perspective. Qual Health Res. 2008;18(11):1586–98.CrossRefPubMedGoogle Scholar
  47. 47.
    Schindler Rising S, Powell Kennedy H, Klima CS. Redesigning prenatal care through CenteringPregnancy. J Midwifery Womens Health. 2004;49(5):398–404.CrossRefGoogle Scholar
  48. 48.
    Krans EE, Davis MM. Strong start for mothers and newborns: implications for prenatal care delivery. Curr Opin Obstet Gynecol. 2014;26(6):511–5.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Milligan R, Wingrove BK, Richards L, et al. Perceptions about prenatal care: views of urban vulnerable groups. BMC Public Health. 2002;2:25.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Magriples U, Kershaw TS, Rising SS, Massey Z, Ickovics JR. Prenatal health care beyond the obstetrics service: utilization and predictors of unscheduled care. Am J Obstet Gynecol. 2008;198(1):75.e1–7.CrossRefGoogle Scholar
  51. 51.
    Bennett I, Switzer J, Aguirre A, Evans K, Barg F. ‘Breaking it down’: patient-clinician communication and prenatal care among African American women of low and higher literacy. Ann Fam Med. 2006;4(4):334–40.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Fraser MR. Bringing it all together: effective maternal and child health practice as a means to improve public health. Matern Child Health J. 2013;17(5):767–75.CrossRefPubMedGoogle Scholar
  53. 53.
    Laditka SB, Laditka JN, Probst JC. Racial and ethnic disparities in potentially avoidable delivery complications among pregnant Medicaid beneficiaries in South Carolina. Matern Child Health J. 2006;10(4):339–50.CrossRefPubMedGoogle Scholar
  54. 54.
    Lu MC, Kotelchuck ML, Hogan V, Jones L, Wright K, Halfon N. Closing the Black-White gap in birth outcomes: a life-course approach. Ethn Dis. 2010;20(1 Suppl 2):62–76.Google Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2016

Authors and Affiliations

  • Mary C. Mazul
    • 1
    • 2
    Email author
  • Trina C. Salm Ward
    • 3
    • 4
  • Emmanuel M. Ngui
    • 1
    • 4
  1. 1.Joseph J Zilber School of Public HealthUniversity of Wisconsin-MilwaukeeMilwaukeeUSA
  2. 2.Wheaton Franciscan HealthcareGlendaleUSA
  3. 3.The University of GeorgiaAthensUSA
  4. 4.Center for Urban Population HealthMilwaukeeUSA

Personalised recommendations

Cite article

Buy options