Open Access Research article

Barriers to women's participation in inter-conceptional care: a cross-sectional analysis

Vijaya K Hogan14*, M Ahinee Amamoo1, Althea D Anderson3, David Webb2, Leny Mathews2, Diane Rowley1 and Jennifer F Culhane2

Author Affiliations

1 Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

2 Children's Hospital of Philadelphia, Philadelphia, USA

3 Mailman School of Public Health, Columbia University, New York, NY, USA

4 Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CB# 7445, Room 425 Rosenau, 421 Pittsboro Street, Chapel Hill, NC 27599, USA

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BMC Public Health 2012, 12:93  doi:10.1186/1471-2458-12-93

Published: 1 February 2012



We describe participation rates in a special interconceptional care program that addressed all commonly known barriers to care, and identify predictors of the observed levels of participation in this preventive care service.


A secondary analysis of data from women in the intervention arm of an interconceptional care clinical trial in Philadelphia (n = 442). Gelberg-Andersen Behavioral Model for Vulnerable Populations to Health Services (herein called Andersen model) was used as a theoretical base. We used a multinomial logit model to analyze the factors influencing women's level of participation in this enhanced interconceptional care program.


Although common barriers were addressed, there was variable participation in the interconceptional interventions. The Andersen model did not explain the variation in interconceptional care participation (Wald ch sq = 49, p = 0.45). Enabling factors (p = 0.058), older maternal age (p = 0.03) and smoking (p = < 0.0001) were independently associated with participation.


Actively removing common barriers to care does not guarantee the long-term and consistent participation of vulnerable women in preventive care. There are unknown factors beyond known barriers that affect participation in interconceptional care. New paradigms are needed to identify the additional factors that serve as barriers to participation in preventive care for vulnerable women.

Prematurity; Preterm birth; African American women; Pregnancy; Perinatal periods of risk; Health care participation; Infant mortality; Preventive care; Access to care; Utilization of care; Preconception care