An inner-city community's perspective on infant mortality and prenatal care.

Neither expanded Medicaid eligibility nor case-finding approaches have significantly increased use of early prenatal care. Failure to improve use points to the importance of further study of the broader community's perspectives on prenatal care and perinatal health issues. A convenience sample of 380 low-income, inner-city, black adults were interviewed with respect to their understanding of infant mortality, perceived barriers to and importance of prenatal care, and recommended numbers of prenatal visits. All respondents reside in a community with negative indexes of perinatal health as measured by infant mortality, low birthweight, and average number of prenatal visits. Fifty percent of the sample could correctly define the term infant mortality. The majority believed that prenatal care is very important and should begin in the first trimester of pregnancy. Respondents recommending the least number of prenatal visits (0-6) perceived financial, institutional, and attitudinal factors as barriers to care. Pregnant women's fear of detection of drug use was the most salient barrier regardless of the recommended number of prenatal visits, age, sex, employment status, or number of children. Changing health problems mandate continued monitoring of community perceptions and expectations of services such as prenatal care. Public health nursing is ideally positioned to articulate community values to policy makers and health care professionals concerned with perinatal health.