Determinants of inadequate prenatal care utilization by African American women

Fewer African-American women living in urban communities are likely to get adequate prenatal care during their pregnancy than white women are, a new study finds, and the main reason could be their negative views about the need for such care.

The study appears in the August issue of the Journal of Health Care for the Poor and Underserved .

Researchers interviewed 246 African-American women during their postpartum hospitalization in Washington, D.C., in 1996 and 1997. They asked women when they began prenatal care visits, how often they kept appointments and what stopped them from keeping appointments.

Of the 246 women, 99 (40 percent) were considered to have “adequate” prenatal care use and 147 (60 percent) had “inadequate” use. Researchers defined care as adequate if the woman began prenatal visits by her fourth month of pregnancy and made at least 80 percent of the expected visits. Care was deemed inadequate if it started after the fourth month or if the woman made less than 50 percent of the visits.

Past research has shown that pregnant women who start prenatal care early and who keep the number of recommended visits are more likely to have higher–birth-weight babies and fewer infant deaths.

The authors found the pregnant women more likely than their counterparts to receive adequate prenatal care were those between the ages 20 to 29 years; those who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC); and those who did not smoke, drink alcohol or use drugs.

The women with inadequate prenatal care described the main barriers to seeking better care as their ambivalent attitudes toward the pregnancy or toward prenatal care. For example, they believed they could go to the emergency room or ask a family member for help if there was a problem as an alternative to regular prenatal care.

Lead author Allan Johnson, associate dean in the College of Pharmacy, Nursing and Allied Health Sciences at Howard University, and his colleagues suggested that since participation in the WIC program would “lead to earlier and more frequent” prenatal care, it provides the best opportunity to reach the underserved population. However, Johnson acknowledged the program needs additional funding to do this.

“Increased funding of the WIC Program would allow for more women to be served and, therefore, referrals of more women to health care,” he said. “In addition, WIC program participants should receive more intensive counseling and education on the importance of adequate prenatal care utilization and adherence to the prenatal advice received.”

Gloria Clark, the citywide WIC program director for the Department of Health, said that the District of Columbia is actually able to serve all its eligible applicants and provides them multiple health services.

“One out of every two children in America is on WIC at some point, [and the program] offers a system of support for pregnant and postpartum women, including nutrition education, breastfeeding support, nutritional food supplements and referrals to care,” she said. “In recent years, the federal government has recognized the program nationally and voted it one of the best managed programs in its arsenal.”

Journal of Health Care for the Poor and Underserved : Contact Editor Virginia M. Brennan at (615) 327-6819 or [email protected]. Online, visit http://www.press.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/

Johnson AA, et al. Determinants of inadequate prenatal care utilization by African American women. Journal of Health Care for the Poor and Underserved 18(3), 2007.