While there is an international trend toward lowering infant mortality, the United States ranks 19th among industrialized nations. In Arizona, as across the nation, a large and increasing number of low birth weight (LBW) infants are being delivered. This number is viewed with alarm as LBW is associated with infant mortality; however, LBW may be preventable in many cases if mothers receive adequate prenatal care. Despite recognition that absent or inadequate prenatal care is an important risk factor, a large number of women deliver without such care. In Arizona, the percentage of women delivering at a large metropolitan public hospital without prenatal care doubled in a 2-year period, reaching 14% (764 women). The majority of these women were of low socioeconomic status. The purpose of this study was to explore the reasons given by women delivering at this hospital for not seeking prenatal care. It was determined that a qualitative methodology was most appropriate; thus, an interview guide was developed with both demographic and open-ended probing questions. Fifteen respondents-5 Caucasian, 8 Latino (5 Spanish-speaking only), 1 Afro-American, and 1 Native American—participated in the interviews. The data were transcribed from taped interviews and studied using content analysis. Eleven barriers were identified and sorted into two categories: internal and external. Internal barriers identified by the women were attitudes associated with low motivation, knowledge deficits, fear, and fatigue. External barriers elicited were finances, transportation, system difficulties, lack of support, lack of child care, missed work, and insufficient time. These barriers are the same as those identified in other studies conducted over the past 10 years related to barriers to prenatal care. This study differs from prior ones in that it addresses programmatic and social issues related to these barriers.
Address correspondence to Jennal L. Johnson, RNC, MS, FNP, MLK Medical Clinic, 7617 S. Central Ave., Phoenix, AZ 85040.
The authors acknowledge Maricopa County Department of Health Services for facilitating this research project, as well as the women who participated. They also thank Dr. Jacqueline Taylor, May Bruner, and April Camelot for their invaluable input. This study was supported in part by a grant from the Arizona State University Graduate Student Association.
© 1994 John Wiley & Sons, Inc