Barriers, motivators and facilitators related to prenatal care utilization among inner-city women in Winnipeg, Canada: a case¿control study

Heaman, Maureen I; Moffatt, Michael; Elliott, Lawrence; Sword, Wendy; Helewa, Michael E; Morris, Heather; Gregory, Patricia; Tjaden, Lynda; Cook, Catherine

Barriers, motivators and facilitators related to prenatal care utilization among inner-city women in Winnipeg, Canada: a case¿control study

dc.contributor.author	Heaman, Maureen I
dc.contributor.author	Moffatt, Michael
dc.contributor.author	Elliott, Lawrence
dc.contributor.author	Sword, Wendy
dc.contributor.author	Helewa, Michael E
dc.contributor.author	Morris, Heather
dc.contributor.author	Gregory, Patricia
dc.contributor.author	Tjaden, Lynda
dc.contributor.author	Cook, Catherine
dc.date.accessioned	2014-08-07T19:10:57Z
dc.date.available	2014-08-07T19:10:57Z
dc.date.issued	2014-07-15
dc.date.updated	2014-08-07T19:10:58Z
dc.description.abstract	Abstract Background The reasons why women do not obtain prenatal care even when it is available and accessible are complex. Despite Canada’s universally funded health care system, use of prenatal care varies widely across neighborhoods in Winnipeg, Manitoba, with the highest rates of inadequate prenatal care found in eight inner-city neighborhoods. The purpose of this study was to identify barriers, motivators and facilitators related to use of prenatal care among women living in these inner-city neighborhoods. Methods We conducted a case–control study with 202 cases (inadequate prenatal care) and 406 controls (adequate prenatal care), frequency matched 1:2 by neighborhood. Women were recruited during their postpartum hospital stay, and were interviewed using a structured questionnaire. Stratified analyses of barriers and motivators associated with inadequate prenatal care were conducted, and the Mantel-Haenszel common odds ratio (OR) was reported when the results were homogeneous across neighborhoods. Chi square analysis was used to test for differences in proportions of cases and controls reporting facilitators that would have helped them get more prenatal care. Results Of the 39 barriers assessed, 35 significantly increased the odds of inadequate prenatal care for inner-city women. Psychosocial issues that increased the likelihood of inadequate prenatal care included being under stress, having family problems, feeling depressed, “not thinking straight”, and being worried that the baby would be apprehended by the child welfare agency. Structural barriers included not knowing where to get prenatal care, having a long wait to get an appointment, and having problems with child care or transportation. Attitudinal barriers included not planning or knowing about the pregnancy, thinking of having an abortion, and believing they did not need prenatal care. Of the 10 motivators assessed, four had a protective effect, such as the desire to learn how to protect one’s health. Receiving incentives and getting help with transportation and child care would have facilitated women’s attendance at prenatal care visits. Conclusions Several psychosocial, attitudinal, economic and structural barriers increased the likelihood of inadequate prenatal care for women living in socioeconomically disadvantaged neighborhoods. Removing barriers to prenatal care and capitalizing on factors that motivate and facilitate women to seek prenatal care despite the challenges of their personal circumstances may help improve use of prenatal care by inner-city women.
dc.description.version	Peer Reviewed
dc.identifier.citation	BMC Pregnancy and Childbirth. 2014 Jul 15;14(1):227
dc.identifier.doi	http://dx.doi.org/10.1186/1471-2393-14-227
dc.identifier.uri	http://hdl.handle.net/1993/23743
dc.language.rfc3066	en
dc.rights	open access	en_US
dc.rights.holder	Maureen I Heaman et al.; licensee BioMed Central Ltd.
dc.title	Barriers, motivators and facilitators related to prenatal care utilization among inner-city women in Winnipeg, Canada: a case¿control study
dc.type	Journal Article