BARRIERS TO PRENATAL-CARE - FACTORS ASSOCIATED WITH LATE INITIATION OF CARE IN A MIDDLE-CLASS MIDWESTERN COMMUNITY

BACKGROUND. Barriers to prenatal care have been extensively investigat ed in low-income and inner-city communities. Less attention has been d irected to the study of prenatal care among middle- and upper-class pr egnant women. This study describes perceived barriers and factors asso ciated with late initiation of prenatal care in a predominantly middle - to upper-class midwestern community. METHODS. Consenting women in Ol msted County, Minnesota, who were attending a clinic for their first o bstetric visit completed a self-administered questionnaire that querie d the presence of factors making it difficult to receive prenatal care , perception about the importance of prenatal care, expectations at th e first prenatal care visit, and sociodemographic factors. RESULTS. Of the 813 women aged 14 to 47 years, 692 (86%) had their first prenatal visit within the first trimester of pregnancy. Only 98 (12%) women re ported external barriers to receiving prenatal care. These factors inc luded difficulty in getting an appointment (46.9%), problems finding c hild care (26.5%), and lack of transportation (14.3%). In multivariabl e logistic regression analyses, late initiation of care was associated with patient perception of prenatal care as being less than very impo rtant (odds ratio [OR] = 4.1, 95% confidence interval [CI], 1.7 - 9.7) ; external barriers to prenatal care (OR = 2.9, 95% CI, 1.6 - 5.4); an nual income <$17,000 (OR = 2.9, 95% CI, 1.5 - 5.7); and an unintended pregnancy (OR = 2.1, 95% CI, 1.3 - 3.5). Multiparous women and women o lder than 35 years were more likely to perceive prenatal care as less than very important (OR = 3.9, 95% CI, 2.5 - 14.6 and OR = 2.9, 95% CI , 1.2 - 6.8, respectively). CONCLUSIONS. These findings suggest that p erceptions about the importance of prenatal care may play a greater ro le in the initiation of care among this group of women than is recogni zed. Women with more experience with pregnancy appear to place slightl y less importance on prenatal care.