Abstract
Purpose
To identify the contribution of life stressors and barriers to the untimely initiation
of prenatal care for women with high-risk pregnancies living in rural and nonrural
areas.
Methods
Data collected in 10 U.S. states by the 2006–2008 Pregnancy Risk Assessment Monitoring
System (PRAMS) were used (n = 34,161). Data were weighted to reflect the PRAMS complex survey design. Separate
logistic regression models derived adjusted odds ratios for untimely prenatal care
initiation based on several life stressors and barriers.
Results
Women with high-risk pregnancies living in rural areas were more likely to report
late initiation of prenatal care (17.5% vs. 14.6%). The most frequently reported life
stressors were the same for both cohorts: Moving, having a very sick family member,
arguing more than usual with their partners, and having bills they could not pay.
The most frequently cited barriers were also the same for both groups: Not having
enough money or insurance for health care visits and not being able to get an appointment
when they wanted one. Having two or more barriers increased the risk of late prenatal
care initiation by 2.85-fold for rural women and 2.01-fold for nonrural women.
Conclusion
To increase timely prenatal care initiation, preconception interventions are needed
that address common life stressors and barriers shared by women living in rural and
nonrural areas.
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Biography
Panagiota Kitsantas, PhD, is an Associate Professor of Epidemiology/Biostatistics at George Mason University, Department of Health Administration and Policy. Her research focuses on maternal and child health.
Biography
Kathleen F. Gaffney, PhD, RN, F/PNP-BC, is a Professor of Nursing at George Mason University, Department of Health Administration and Policy. Her current studies examine the influence of maternal behaviors on infant health outcomes.
Biography
Jehanzeb Cheema, PhD, is a Graduate Research Assistant with a PhD in Economics.
Article info
Publication history
Published online: July 30, 2012
Accepted:
June 20,
2012
Received in revised form:
June 20,
2012
Received:
December 23,
2011
Identification
Copyright
© 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
