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Inadequate prenatal care (PNC) is a well-known health risk for both infant and mother. Women who receive inadequate PNC are at risk for adverse pregnancy outcomes (e.g. low birthweight and preterm delivery) and decreased use of pediatric care after birth. The objective of the mixed-methods, community-based participatory, pilot study was to determine the barriers to PNC among Latina migrant and seasonal farmworkers (MSFWs) or wives of MSFWs in rural eastern North Carolina.
METHODS:
The mixed-methods study included focus groups and surveys. The project team conducted 2 focus groups of Latina MSFW or wives/partners of MSFWs to identify thematic data regarding barriers to PNC. The focus groups were conducted in Spanish by a trained, bilingual facilitator. The focus groups were recorded, transcribed, translated, and analyzed for themes. The quantitative survey instruments were created using results from the focus groups and from previously validated instruments. Project staff administered surveys to eligible respondents at a local clinic and flea market. Eligible respondents in the convenience sample were Latina, delivered a liveborn infant in the U.S. within the past 5 years, MSFW or married to or living with a MSFW, and ≥18 years. Researchers entered data into a database, imported into Stata, and conducted descriptive statistics.
RESULTS:
The two focus groups consisted of six and seven eligible women, respectively. Four themes emerged from the transcripts regarding barriers to PNC: 1) difficulty arranging appointments around work schedules; 2) lack of health insurance and high out-of-pocket costs; 3) lack of transportation; and 4) dissatisfaction with empathy of health care providers and availability of interpreters. Ninety eligible women completed the survey. Over 95% were foreign-born and, of these, the average number of years in the U.S. was 11.3. Respondents reported lack of money or insurance (34.4%), lack of transportation (30.0%), long wait at doctor’s office (26.7%), inconvenient appointment times (23.3%), fear of constant medical visits (17.8%), and ineffective communication with physician in English (15.6%) as primary barriers to PNC.
CONCLUSIONS:
The two components of the mixed-methods project identified similar barriers to PNC among the largely immigrant Latina population. Namely, transportation, scheduling conflicts, lack of health insurance and/or money, and communication in English are barriers to PNC. Public health officials can use these results to design culturally competent interventions to increase PNC among this population. Future work will validate the findings among a more representative population-based sample.