INITIATION OF PRENATAL-CARE BY LOW-INCOME HISPANIC WOMEN IN HOUSTON

Objective. To understand why many Hispanic women begin prenatal care i n the later stages of pregnancy. Methods. The authors compared the dem ographic profile, insurance status, and health beliefs - including the perceived benefits of and barriers to initiating prenatal care - of l ow-income Hispanic women who initiated prenatal care at different time s during pregnancy or received no prenatal care. Results. A perception of many barriers to care was associated with later initiation of care and non-use of care. Perceiving more benefits of care for the baby wa s associated with earlier initiation of care, as was having an eligibi lity card for hospital district services. Several barriers to care wer e mentioned by women on open-ended questioning, including long wafting times, embarrassment the physical examination, and lack of transporta tion. Conclusions. Recommendations for practice included decreasing th e number of visits for women at low risk for poor pregnancy outcomes w hile increasing the time spent with the provider at each visit, decrea sing the number of vaginal examinations for low risk women, increasing the use of midwives, training lay workers to do risk assessment, emph asizing specific messages about benefits to the baby, and increasing g eneral health motivation to seek preventive care through community int erventions.