Factors Affecting Adequate Prenatal Care and the Prenatal Care Visits of Immigrant Women to Taiwan

This paper investigates prenatal care utilization, identifies factors affecting the adequacy of prenatal care, and explores the effect of adequate initial timing of prenatal care on total prenatal care visits among Taiwan new immigrant females. Data was obtained from the 2008 Prenatal Care Utilization among Taiwan New Immigrant Females Survey on women who either had at least one preschool-aged child or had delivered their infants but were still hospitalized (N = 476). The Adequacy of Prenatal Care Utilization Index was applied to rate the prenatal care adequacy. The logistic regression model was used to investigate factors associated with the adequacy of prenatal care utilization, and the linear regression model was estimated to identify the impact of influential factors on the prenatal care usage. Females’ nationality, employment, and transportation convenience increased the likelihood of receiving adequate prenatal care. Having adequate initial timing of prenatal care was found to be positively related to the frequency of prenatal care visits. Prenatal care utilization can be affected by factors within the health care system and by characteristics of the population; therefore, a measure of prenatal care utilization cannot distinguish these factors but reflects the result of all of them in varying combinations.     

Barriers to Adequate Prenatal Care Utilization in American Samoa

The objective of this study is to describe the utilization of prenatal care in American Samoan women and to identify socio-demographic predictors of inadequate prenatal care utilization. Using data from prenatal clinic records, women (n = 692) were categorized according to the adequacy of prenatal care utilization index as having received adequate plus, adequate, intermediate or inadequate prenatal care during their pregnancy. Categorical socio-demographic predictors of the timing of initiation of prenatal care (week of gestation) and the adequacy of received services were identified using one way analysis of variance and independent samples t tests. Between 2001 and 2008 85.4 % of women received inadequate prenatal care. Parity (P = 0.02), maternal unemployment (P = 0.03), and both parents being unemployed (P = 0.03) were negatively associated with the timing of prenatal care initiation. Giving birth in 2007–2008, after a prenatal care incentive scheme had been introduced in the major hospital, was associated with earlier initiation of prenatal care (20.75 vs. 25.12 weeks; P < 0.01) and improved adequacy of received services (95.04 vs. 83.8 %; P = 0.02). The poor prenatal care utilization in American Samoa is a major concern. Improving healthcare accessibility will be key in encouraging women to attend prenatal care. The significant improvements in the adequacy of prenatal care seen in 2007–2008 suggest that the prenatal care incentive program implemented in 2006 may be a very positive step toward addressing issues of prenatal care utilization in this population.     

Improving prenatal care services for low-income African American women and infants

Increasing the level of prenatal care among African American women may be one method of improving the health and well-being of African American women and children. This article identifies factors influencing access to and use of prenatal care and strategies for increasing the use of prenatal care among low-income African American women. Barriers to prenatal care, the strengths and limitations of prenatal care in reducing infant mortality and improving infant outcomes, and the importance of providing more comprehensive prenatal care that addresses both the medical and psychosocial needs of the low-income African American mother and her infant are discussed. Changes in prenatal care services that include the medical and lay communities, public health organizations, public policy organizations, and medical financing institutions are identified.     

玉林社区围产保健现况的调查分析

目的 为了解围产保健服务的需求和现状，探讨提高服务质量、满足需求的先进服务模式和有效方法。方法 于2001年3月按分层整群的抽样方法抽取玉林社区1/10户家庭中在4年内有妊娠史的妇女，共86人，进行入户问卷调查。结果 调查显示：本社区孕妇产前检查的覆盖率为93.9%；围产保健手册建册率为76.1%。产前检查的覆盖率、检查次数及被调查妇女接爱孕期保健的程度与建立围产保健手册呈正相关；产后访视率为52.9%；产前检查服务的满意率为61.0%；产后访视满意率为50.0%。被调查妇女希望改善候诊条件、开设周末门诊并改进医务人员的服务态度。在产后访视方面提出增加访视次数、提早首访时间的建议。结论 玉林社区产前保健已获得较满意的覆盖率，但产后访视率和对服务的满意率尚需进一步提高。应利用社区卫生服务者这一新型服务模式的优势，增强围产保健服务及信息的连续性，进一步提高产后访视率；应加强围产保健档案的科学化、系统化管理，以提高围产保健的依从性。还应在围产保健方面加大健康教育的宣传力度、提高围产保健人员的技术水平和服务意识，为社区居民提供“以人为本”，便捷、质优的围产保健服务。     

Trends in prenatal care use and low birthweight in southeast Brazil

OBJECTIVES: We investigated trends in prenatal care use and its association with low birthweight in a developing country. METHODS: We examined data from 2 southeast Brazilian cohort surveys, 1 conducted in 1978-1979 and the other in 1994. RESULTS: Socioeconomic inequalities in prenatal care use increased during the 15-year period of 1979-1994. Although prenatal care use increases paralleled increases in low birthweight rate during this period, having no prenatal care was associated with higher risk of low birthweight in both surveys. Inadequate prenatal care use was also associated with higher risk of low birthweight in 1978-1979 only. CONCLUSIONS: Increasing low birthweight rates among women who adequately used prenatal care may be causing a bias by reducing the estimates of the effect of inadequate prenatal care use on low birthweight rates.     

农村地区重度子痫前期/子痫病例产前检查服务质量现状分析

目的:探讨农村地区重度子痫前期/子痫产前检查服务质量,针对存在的问题提出改进措施。方法:收集孕产妇死亡率较高的河南省某县2005年7月～2007年8月所有开展助产技术服务的医疗保健机构中重度子痫前期/子痫住院病例,对其病历资料进行调查研究,评价其产前检查服务质量,分析产前检查与妊娠结局及并发症的关系。结果:257例研究对象中,有168例(65.37%)做过产前检查。记录产前检查次数的69例中,最少的1次,最多的6次,≥5次的只有8例(11.59%)。做过产前检查的患者其并发症的发生率(12.50%)要低于未做产前检查的患者(27.27%),差异有统计学意义(P<0.05)。结论:该地区产前检查服务质量有待进一步提高,以促进母婴健康。     

The Adequacy of Prenatal Care Utilization Index: its US distribution and association with low birthweight.

The proposed Adequacy of Prenatal Care Utilization Index is applied to data from the 1980 National Natality Survey to assess the adequacy of prenatal care utilization and its association with low birthweight in the United States. The index suggests that only 61.1% of women received adequate prenatal care, including 17.7% with more intensive care; 16.7% received inadequate care. More White women (63.4%) than Black women (51.9%) received adequate prenatal care. Low-birthweight rates were elevated among women with inadequate prenatal care and among those who received more intensive prenatal care.     

How much money can early prenatal care for teen pregnancies save?: a cost-benefit analysis.

BACKGROUND: Pregnant teens in the United States are at high risk for not obtaining prenatal care and for having low-birth weight deliveries. This observation suggests that significant cost savings might be realized if teens were able to obtain prenatal care in a timely fashion. METHODS: To determine the optimal time for teens to start prenatal care, we conducted a cost-benefit analysis from the perspective of Medicaid, the predominant payer for pregnancy-related services for teens. Cost projections were based on current recommended prenatal care testing, the cost of vaginal and cesarean deliveries, and the estimated costs for care of the child in the first year of life. We then compared average cost per person and performed sensitivity analyses based on when prenatal care would have started. RESULTS: Compared with no prenatal care, any prenatal care saves between $2,369 and $3,242 per person, depending on when care is initiated. All savings are related to reductions in the cost of caring for low-birth weight babies. We found no cost advantage to starting prenatal care earlier compared with later months. CONCLUSION: If prenatal care does reduce the rate of low-birth weight babies, prenatal care is cost beneficial. If a program was developed to improve access for teens and applied to all pregnant teens not in care by 6 months' gestation, the program would have to average $95 or less per person to be cost beneficial if it reduced the number of low-birth weight deliveries by 50%.     

Prenatal Care Utilization and the Implementation of Prophylaxis to Prevent Perinatal HIV-1 Transmission

OBJECTIVES: To describe prenatal care utilization among women with HIV-1 in 4 US states, and to determine whether the adequacy of prenatal care utilization is associated with the implementation of prenatal, intrapartum, and postnatal HIV antiretroviral therapy (ARV). METHODS: Three-hundred three women completed a prenatal interview. Prenatal, labor and delivery, and infant medical records were reviewed. RESULTS: Thirty-nine percent of women did not receive adequate prenatal care; nearly one quarter of women did not begin care within the recommended timeframe, and approximately one-fifth of women received fewer than the recommended number of prenatal care visits from the time of entry into care until delivery. Those classified as less than adequate in terms of receipt of recommended visits were at increased risk for not receiving ARV during the prenatal care period and during labor and delivery, and were more likely to have had an infant subsequently diagnosed with HIV infection. CONCLUSION: Although women with HIV require adequate prenatal care for their own health as well as to improve perinatal outcomes, many are at risk for not receiving this care. Lower adherence to prenatal care appointments is an important risk factor for not receiving full HIV prophylactic regimens.     

The Interactive Effects of Race and Ethnicity and Mother's Residence on the Adequacy of Prenatal Care

Abstract: Adequate prenatal care is known to reduce the risks of low birth weight and neonatal death, yet nearly one quarter of all women giving birth in the United States receive delayed, inadequate or no prenatal care. This suboptimal use of prenatal care has contributed to rates of low birth weight and neonatal mortality higher than those in most other industrialized nations. This paper examines the relationships among race/ethnicity, residence, maternal sociodemographic and medical risk characteristics, and use of prenatal care in the United States. Using data from the National Maternal and Infant Health Survey, this study found important differences in prenatal care use by race/ethnicity and residence, as well as interactive effects of these variables. Single marital status, non metropolitan residence, poverty, low level of education, and no insurance were more strongly associated with inadequate prenatal care for whites and Hispanics than for blacks. Nonmetropolitan residents were more likely to receive inadequate care, regardless of race/ethnicity or sociodemographic characteristics. Predicted probabilities of prenatal care use by race/ethnicity and residence showed that, regardless of risk, nonmetropolitan Hispanic women had the highest probability of obtaining inadequate prenatal care. Results highlight the continued importance of race/ethnicity and rural residence in determining prenatal care use and the need to design interventions targeted to these populations.     

Associations of government health expenditures,the supply of health care professionals,and country literacy with prenatal care use in ten West African countries

Social and health care context may influence prenatal care use. We studied associations of government health expenditures, supply of health care professionals, and country literacy rates with prenatal care use in ten West African countries, controlling for individual factors. We used data from Demographic and Health Surveys (n = 58,512) and random effect logistic regression models to estimate the likelihood of having any prenatal care and adequate prenatal care. Each percentage increase in the literacy rate was associated with 4% higher odds of having adequate prenatal care (p = .029). Higher literacy rates among women may help to promote adequate prenatal care.     

Prenatal care initiation among pregnant teens in the United States: an analysis over 25 years.

PURPOSE: To examine changes in the initiation of prenatal care by teenage girls in the United States between 1978 and 2003. METHODS: Using birth certificate data collected by the National Center for Health Statistics from 1978, 1983, 1988, 1993, 1998, and 2003 we described initiation of prenatal care in preteens (aged 10-14 years), young adolescents (aged 15-16), and older adolescents (aged 17-19) by the trimester in which care began. RESULTS: Although all three age groups showed trends toward earlier prenatal care, shifts to earlier prenatal care were mainly the result of more girls starting care in the first trimester and fewer in the second trimester. Younger teens were more likely to delay prenatal care or to receive no prenatal care for every year studied. Less education and prior births were also associated with increased likelihood of receiving delayed care. CONCLUSIONS: Shifts in timing of prenatal care initiation occurred in the U.S from 1978 to 2003. Much of the change corresponded to expanded eligibility in Medicaid coverage, suggesting that lack of health care coverage was a significant impediment to early prenatal care.     

Maternal drug use and the timing of prenatal care

This paper explores the role of maternal drug use and the timing of prenatal care. The study data were collected from women delivering live births at eight participating hospitals in the Washington, D.C., Metropolitan Area Drug Study. An estimated 16.9 percent of the women in this sample initiated prenatal care in their third trimester or received no prenatal care. After adjusting for age, race/ethnicity, education, parity, and attitude toward pregnancy, cocaine use was strongly associated with the timing of prenatal care. Using multivariable ordinal logistic regression, the data suggest significant barriers to prenatal care for substance abusers, especially cocaine users. Increasing access to prenatal care continues to be an important public health policy objective, particularly in urban areas where substance abuse is prevalent. Health services research must test strategies that address the timing of prenatal care among drug-dependent, urban women.     

Barriers and motivators to prenatal care among low-income women

Substantial evidence exists which links prenatal care to improved birth outcomes. However, low-income and nonwhite women in the United States, who are at greatest risk for poor birth outcomes, continue to receive the poorest prenatal care. The purpose of this study was to identify and compare barriers and motivators to prenatal care among women who lived in low-income census tracts. The stratified sample included recently delivered white, black and American Indian women who received adequate, intermediate, and inadequate prenatal care. Interviews were conducted which focused primarily on the women's perceptions of problems in obtaining prenatal care and getting to appointments. Results indicated that women with inadequate care identified a greater number of barriers and perceived them as more severe. Psychosocial, structural, and socio-demographic factors were the major barriers, while the mother's beliefs and support from others were important motivators. The predictive power of selected barrier variables was examined by a regression analysis. These variables accounted for 50% of the variance in prenatal care use. The results affirm the complexity of prenatal care participation behavior among low-income women and the dominant influence of psychosocial factors. Comprehensive, coordinated and multidisciplinary outreach and services which address psychosocial and structural barriers are needed to improve prenatal care for low-income women.     

经济欠发达地区农村产前保健项目中间结果评价

目的:对经济欠发达地区农村开展的产前保健项目的中间结果进行评价.方法:由县卫生局组织有关产前保健专家对乡镇卫生院产科医务人员进行业务培训;由县卫生局和乡镇领导协调卫生与计划生育部门开展农村社区产前保健的健康教育;由乡镇卫生院产科助产士负责开展产前检查.应用整群随机分组的设计及做干预前后测量的方法进行评价.评价的指标包括初次产前检查孕周、产前检查次数和产前检查率.结果:干预使孕妇初次产前检查的时间提前.干预提高了产前检查率.干预提高了高危妊娠妇女的产前检查次数.结论:卫生与计划生育部门合作开展产前保健是促进经济欠发过地区农村母婴保健工作可行与有效的途径.     

Prenatal care utilization in rural areas and urban areas of Haiti.

OBJECTIVES: This study is based on the 2000 Demographic and Health Survey (DHS) conducted in Haiti. Using the DHS information on women aged 15 to 49 who had given birth during the three years preceding the survey interview, this study was intended to: (1) examine the determinants of the likelihood of the women using prenatal care in the rural areas and in the urban areas of the country and (2) for the women who made at least one prenatal care visit, examine the determinants of the number of prenatal visits in the rural areas and the urban areas. METHODS: The multivariate analysis used logistic models to identify which factors explained the decision to seek prenatal care, and negative binomial models were used to determine how many prenatal visits were conducted by the subgroup of women who did make prenatal care visits. RESULTS: Estimated at the mean values of the control variables, the expected probability of using prenatal care services in rural Haiti was 77.16%, compared to 85.83% in urban Haiti. Among users of prenatal care services, mothers in rural areas made an expected number of 3.78 prenatal care visits, compared to 5.06 visits for the women in urban areas. CONCLUSIONS: A substantial percentage of pregnant women have access to prenatal care services in Haiti, but mothers in rural areas who decided to seek care still fell slightly below the four visits recommended by the World Health Organization. The education levels of both mothers and their partners is a dominant predictor of prenatal care use. Longer travel times and greater distances to health centers in rural areas constituted barriers to repeated visits. Policymakers and health care providers need to take these findings into consideration as they decide on the delivery and management of health care services in Haiti.     

Factors associated with rates of participation in WIC by eligible pregnant women.

The relationship between sociodemographic, biological, and prenatal care characteristics, and participation rates of pregnant women in the Special Supplemental Food Program For Women, Infants, and Children (WIC) was studied by interviewing 200 postpartum patients in a Buffalo, NY, hospital between October 1988 and January 1989. Among the 136 women eligible for the program, 94 (69 percent) participated during their index pregnancies. WIC participation was found to be highly associated with source of prenatal care and having made more frequent prenatal visits. WIC was related to having fewer children and earlier initiation of prenatal care. Multivariate analysis showed that program participation remained highly associated with the source of prenatal care and the number of prenatal visits, when combined with other factors considered, such as age, education, marital status, number of living children, and timing of initial prenatal visit. The results suggest the need for a WIC enrollment effort directed to providers of prenatal care, who would be urged to encourage women to seek early and adequate prenatal care through the program.     

Does Rural Residence Affect Access to Prenatal Care in Oregon?

ABSTRACT:  Context: Identifying how maternal residential location affects late initiation of prenatal care is important for policy planning and allocation of resources for intervention. Purpose: To determine how rural residence and other social and demographic characteristics affect late initiation of prenatal care, and how residence status is associated with self-reported barriers to accessing early prenatal care. Methods: This observational study used data from the 2003 Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) (N = 1,508), with late initiation of prenatal care (after the first trimester) as the primary outcome. We used Rural-Urban Commuting Area (RUCA) codes to categorize maternal residence as urban, large rural, or small/isolated rural. Multivariate logistic regression was used to evaluate whether category of residence was associated with late initiation of prenatal care after adjusting for other maternal factors. Association between categories of barriers to prenatal care and maternal category of residence were determined using the Cochran-Mantel-Haenszel test of association. Findings: We found no significant association between residence category and late initiation of prenatal care, or residence category and barriers to prenatal care initiation. Urban women tended to be over age 34 or nonwhite. Women from large rural areas were more likely to be younger than 18 years, unmarried, and have an unintended pregnancy. Women from small rural areas were more likely to use tobacco during pregnancy. Conclusions: Maternal residence category is not associated with late initiation of prenatal care or with barriers to initiation of prenatal care. Differences in maternal risk profiles by location suggest possible new foci for programs, such as tobacco education in small rural areas .