Open Access Research article

Barriers, motivators and facilitators related to prenatal care utilization among inner-city women in Winnipeg, Canada: a case–control study

Maureen I Heaman123*, Michael Moffatt24, Lawrence Elliott25, Wendy Sword6, Michael E Helewa3, Heather Morris7, Patricia Gregory8, Lynda Tjaden9 and Catherine Cook10

Author Affiliations

1 College of Nursing, Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3T 2N2, Canada

2 Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada

3 Department of Obstetrics, Gynecology & Reproductive Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0L8, Canada

4 Department of Pediatrics and Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1S1, Canada

5 Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada

6 School of Nursing and Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8N 3Z5, Canada

7 Faculty of Nursing, University of Alberta, Edmonton, AB T5G1C9, Canada

8 Women’s Health Program, Winnipeg Regional Health Authority, Winnipeg, MB R3E 0L8, Canada

9 Public Health, Winnipeg Regional Health Authority, Winnipeg, MB R3A 0X7, Canada

10 Population and Aboriginal Health, Winnipeg Regional Health Authority, Winnipeg, MB R3B 1E2, Canada

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BMC Pregnancy and Childbirth 2014, 14:227  doi:10.1186/1471-2393-14-227

Published: 15 July 2014

Abstract

Background

The reasons why women do not obtain prenatal care even when it is available and accessible are complex. 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 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.

Methods

We conducted a case–control study with 202 cases (inadequate prenatal care) and 406 controls (adequate prenatal care), frequency matched 1:2 by neighborhood. Women were recruited during their postpartum hospital stay, and were interviewed using a structured questionnaire. 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. 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.

Results

Of the 39 barriers assessed, 35 significantly increased the odds of inadequate prenatal care for inner-city women. 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. 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. Attitudinal barriers included not planning or knowing about the pregnancy, thinking of having an abortion, and believing they did not need prenatal care. Of the 10 motivators assessed, four had a protective effect, such as the desire to learn how to protect one’s health. Receiving incentives and getting help with transportation and child care would have facilitated women’s attendance at prenatal care visits.

Conclusions

Several psychosocial, attitudinal, economic and structural barriers increased the likelihood of inadequate prenatal care for women living in socioeconomically disadvantaged neighborhoods. Removing barriers to prenatal care and capitalizing on factors that motivate and facilitate women to seek prenatal care despite the challenges of their personal circumstances may help improve use of prenatal care by inner-city women.

Keywords:
Pregnancy; Prenatal care; Access to care; Barriers; Motivators; Facilitators; Inner-city women; Health care utilization