Of the 10 motivators assessed, four had a protective effect, such as the desire to learn how to protect one’s health. Attitudinal barriers included not planning or knowing about the pregnancy, thinking of having an abortion, and believing they did not need prenatal care. Structural barriers included not knowing where to get prenatal care, having a long wait to get an appointment, and having problems with child care or transportation.
Psychosocial issues that increased the likelihood of inadequate prenatal care included being under stress, having family problems, feeling depressed, “not thinking straight”, and being worried that the baby would be apprehended by the child welfare agency. Of the 39 barriers assessed, 35 significantly increased the odds of inadequate prenatal care for inner-city women. Chi square analysis was used to test for differences in proportions of cases and controls reporting facilitators that would have helped them get more prenatal care. Stratified analyses of barriers and motivators associated with inadequate prenatal care were conducted, and the Mantel-Haenszel common odds ratio (OR) was reported when the results were homogeneous across neighborhoods. Women were recruited during their postpartum hospital stay, and were interviewed using a structured questionnaire. We conducted a case–control study with 202 cases (inadequate prenatal care) and 406 controls (adequate prenatal care), frequency matched 1:2 by neighborhood.
The purpose of this study was to identify barriers, motivators and facilitators related to use of prenatal care among women living in these inner-city neighborhoods. Despite Canada’s universally funded health care system, use of prenatal care varies widely across neighborhoods in Winnipeg, Manitoba, with the highest rates of inadequate prenatal care found in eight inner-city neighborhoods. The reasons why women do not obtain prenatal care even when it is available and accessible are complex.
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