Barriers to timely prenatal care among women with insurance: The importance of prepregnancy factors

Objective: This study, designed to avoid methodologic limitations of previo us research, aimed to identify the important noninsurance barriers to timel y prenatal care. Methods: We identified a subsample of a cross-sectional statewide represent ative postpartum survey conducted in California during 1994-1995, focusing on 3071 low-income women with Medi-Cal or private coverage throughout pregn ancy. Results: Twenty-eight percent of those women had untimely care, although on ly 6% were unaware of their pregnancies during the first trimester. Control ling for numerous sociodemographic factors; knowledge, attitudes, beliefs, and behaviors; stressful life circumstances; and logistic obstacles that mi ght deter seeking or receiving care, the following risk factors for untimel y care were significant and experienced by more than one fifth of women: un wanted or unplanned pregnancy (affecting 43% and 66% of women, respectively ), no regular provider before pregnancy (affecting 22% of women), and no sc hooling beyond high school (affecting 76% of women). Transportation problem s, affecting 8% of women, appeared to be the only significant logistic barr ier to timely care. Conclusion: Improving timeliness of prenatal care among low-income women wi th third-party coverage is likely to require broad social and health polici es that focus on factors affecting women before pregnancy. Assistance with transportation could contribute to more timely care for some low-income wom en, but programs focusing primarily on other noninsurance barriers during p regnancy might not substantially improve the timeliness of care, at least a mong low-income women with third-party coverage. (Obstet Gynecol 2000;95:87 4-80. (C) 2000 by Obstetricians and Gynecologists).