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



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.


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.


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.


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

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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.

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Corresponding author

Correspondence to Mary C. Mazul.

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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.


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

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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.

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

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Mazul, M.C., Salm Ward, T.C. & Ngui, E.M. Anatomy of Good Prenatal Care: Perspectives of Low Income African-American Women on Barriers and Facilitators to Prenatal Care. J. Racial and Ethnic Health Disparities 4, 79–86 (2017).

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  • Prenatal care
  • Qualitative study
  • Infant mortality
  • Racial disparity