Academic journal article Health and Social Work

The Role of Perceived Stress on Prenatal Care Utilization: Implications for Social Work Practice

Academic journal article Health and Social Work

The Role of Perceived Stress on Prenatal Care Utilization: Implications for Social Work Practice

Article excerpt

Although infant mortality rates have declined during the past decade, the United States is 23rd lowest in international ranking in infant mortality, below most other industrialized countries (MacDorman et al., 1994). Low birthweight is the leading cause of infant mortality (Kiely, Brett, Yu, & Rowley, 1994). Numerous studies have documented the positive effect of prenatal care on birth outcome (Institute of Medicine, 1985; Kiely & Kogan, 1994). Women who receive early and continuous prenatal care have lower numbers of low-birthweight babies than women who enter prenatal care late and who do not make the recommended number of prenatal visits.

The Institute of Medicine (1988) identified several types of barriers to the use of prenatal care, including sociodemographic factors such as poverty, inner-city or rural residence, ethnic minority status, young maternal age, lower education levels (less than high school completion), unmarried marital status, and high parity (more than three births), which have all been associated with inadequate prenatal care utilization. Financial and system-related factors associated with inadequate prenatal care utilization include financial barriers: lack of medical insurance, difficulty obtaining child care, problems with transportation, and issues associated with prenatal clinic, such as long waits to see the doctor and negative attitudes of clinic personnel to low-income women. Finally, the Institute of Medicine identified several attitudinal barriers to prenatal care, including issues related to unplanned pregnancy (denial or apathy, ambivalence towards pregnancy, fear of parental discovery, and concealment), issues related to lifestyle (including drug and alcohol abuse), issues related to inadequate social support, and issues related to excessive stress. Maternal psychological or emotional stress may affect a woman's prenatal care utilization by reducing her ability to gain access to and to negotiate the system or by decreasing prenatal care as a priority in her life.

Although there have been numerous studies of prenatal care utilization (see for example Bedics, 1994; Giblin, Poland, & Ager, 1990; Joyce, Diffenbacher, Greene, & Sorokin, 1983; Kelley, Perloff, Morris, & Liu, 1992; Lia-Hoagberg et al., 1990; McDonald & Coburn, 1988; Moss & Hensleigh, 1989; Poland, Ager, & Olson, 1987; Sable, Stockbauer, Schramm, & Land, 1990; Sable & Wilkinson, 1998; St Clair, Smeriglio, Alexander, Connell, & Niebyl, 1990; Watkins, 1968), the effects of stress have rarely been investigated explicitly. Most of these studies focused on internal (emotional and social) and external (structural) factors as barriers to prenatal care use. Both sets of factors can in fact be used as proxy measures of stress.

Two studies posited that stress would be related to delayed entry to care; however, the findings from both were unable to support the hypothesis. In Watkins's (1968) historical study, 120 married African American mothers were interviewed about their prenatal care use. Watkins created a stress proxy from several problem situations but found that there was no difference in stress between the women who began care early and those who delayed care. Moss and Hensleigh (1989) in their study of adolescents examined the effects of stress, social support, and Hispanic ethnicity on entrance into care. Late entry to care was correlated with lower levels of stress, but when additional factors were included in the model, the effects of stress were not significant.

In contrast, Bedics (1994) interviewed 44 women who did not receive prenatal care and found that the majority had experienced stressful life events during their pregnancy. She concluded that stressful life events make negotiating a difficult service system nearly impossible for women who face financial and other structural barriers. Others who have interviewed women about prenatal care use also have found that emotional and social concerns that indicate stress interfere with their ability to obtain care (Giblin et al. …

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