Academic journal article Social Work

Access Barriers and the Use of Prenatal Care by Low-Income, Inner-City Women

Academic journal article Social Work

Access Barriers and the Use of Prenatal Care by Low-Income, Inner-City Women

Article excerpt

An important public health agenda in the United States is improving access to prenatal care, particularly for low-income women. The study discussed in this article was designed to determine which social, environmental, and psychological barriers are most likely to interfere with the early and regular use of prenatal health services. Low-income adult women hospitalized on the postpartum unit of a large urban medical center were interviewed about the barriers they experienced gaining access to prenatal care. Access barriers involving family and friends significantly increased the odds of receiving inadequate care, particularly not wanting anyone to know about the pregnancy and not having help getting to clinic appointments. Other important barriers included those related to the health care system and intrapersonal issues. Social workers are in an ideal position to help women eliminate barriers to access to prenatal care through clinical expertise in assessment, advocacy, outreach, and case management.

Key words: access barriers; prenatal care; social work practice; women's health

Despite advances in medical technology and the delivery of health services, nearly 30,000 infants in this country die because of low birthweight (LBW). The LBW infants who do live have a high probability of suffering from chronic and costly disabilities over the course of their lives (Lewitt, Baker, Corman, & Shiono, 1995). This unnecessary loss of human life and potential is even more pronounced for the children of low-income women. For poor people, infant mortality and morbidity rates often approximate those of Third World countries (Shiono et al., 1995).

Failure to receive early and regular prenatal care has long been associated with poor reproductive outcomes, particularly low birthweight, neonatal death, and postpartum complications (Gilbert & Harmon, 1986; Institute of Medicine, 1988; Pierson et al., 1994). Early and regular prenatal care optimizes maternal-child health because it facilitates health promotion and illness prevention, as well as the early diagnosis and treatment of medical problems. Despite the importance of prenatal care, the rate of inadequate care in this country exceeds acceptable limits, particularly among low-income African American women. Compared with their white counterparts, African American women are more likely to initiate prenatal care alter their first trimester, have fewer prenatal clinic visits, or receive no prenatal care at all (Brown, 1989; LaVeist, Keith, & Guitierrez, 1995). In 1991 the neonatal mortality rate for African Americans was 130 percent higher than for white people (Singh & Yu, 1995). In some low-income African American communities, infant mortality rates surpass the national average by nearly 20 percent (Chicago Department of Health, 1990).

An integral part of this country's public health agenda is to improve access to prenatal care, particularly for economically disadvantaged women (Public Health Service, 1990). Large-scale efforts, such as the expansion of Medicaid programs, have focused almost exclusively on the elimination of financial barriers to care. Unfortunately, there is evidence that the availability of health insurance and a regular source of care does not guarantee that pregnant women will receive adequate prenatal care (Krieger, Connell, & LoGerfo, 1992; Moore & Hepworth, 1994; Oberg, Lia-Hoagberg, Hodkinson, Skovholt, & Vanman, 1990; Pierson et al., 1994). This finding suggests that other contributing factors must be identified in efforts to develop more effective programs and services that facilitate the early and regular use of prenatal care.

Traditionally, the impact of social and environmental barriers on access to prenatal care has been overlooked by the health care delivery system (Krieger et al., 1992). Important, yet neglected, barriers include substandard living conditions, limited support from family and friends (Norbeck & Anderson, 1989), stressful life events (Williams, Williams, Griswold, & Holmes, 1975), language barriers, lack of housing, and insufficient transportation (Goldenberg, Patterson, & Freese, 1992). …

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