Obstacles to prenatal care following implementation of a community-based program to reduce financial barriers.

A study of women who gave birth in a rural Oregon county during 1988-1990 found that despite the establishment of a program to provide prenatal care to low-income women who could not afford it, the most common reasons cited for inadequate prenatal care were financial obstacles. All 13 financial, personal and organizational barriers studied were reported more frequently by the 236 women who received inadequate or no care than by the 246 women who received adequate care. Among the reasons most frequently cited by women who received inadequate care were difficulty paying for prenatal care (70%), difficulty with medical insurance (55%), ambivalence or fear about the pregnancy (46%) and transportation problems (42%). In a logistic regression analysis that controlled for social and demographic characteristics, six barriers were significant predictors of inadequate care: The odds of receiving inadequate care were 7.9 among women who had a poor understanding of or attached a low value to prenatal care compared with those who did not cite this barrier, 3.4 among those who cited financial difficulties, 3.4 among those who said they had difficulty scheduling appointments, 3.0 among those who suffered excessive physical or psychological stress, 2.7 among those who said they did not know where to go for prenatal care, and 1.8 among those who felt ambivalence or fear regarding the pregnancy.