Open Access Highly Accessed Research article

Perceptions about prenatal care: views of urban vulnerable groups

Renee Milligan1, Barbara K Wingrove2*, Leslie Richards3, Margaret Rodan4, Lillie Monroe-Lord5, Velishie Jackson6, Barbara Hatcher7, Cynthia Harris8, Cassandra Henderson2 and Allan A Johnson8

Author Affiliations

1 School of Nursing and health studies, Georgetown University, Washington, D.C

2 Division of Epidemiology, Statistics & Prevention Research, National Institute of Child Health and Human Development, Rockville, MD

3 Department of Sociology, University of the District of Columbia, Washington, D.C, USA

4 Department of Family Medicine, Georgetown University, Washington, D.C

5 Community Extension Service, University of the District of Columbia, Washington, D.C

6 Department of Obstetrics and Gynecology, Georgetown University, Washington, D.C

7 American Public Health Association, Washington, D.C

8 Allied School of Nutrition, Howard University, Washington, D.C

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BMC Public Health 2002, 2:25  doi:10.1186/1471-2458-2-25

Published: 6 November 2002



In the United States, infant mortality rates remain more than twice as high for African Americans as compared to other racial groups. Lack of adherence to prenatal care schedules in vulnerable, hard to reach, urban, poor women is associated with high infant mortality, particularly for women who abuse substances, are homeless, or live in communities having high poverty and high infant mortality. This issue is of concern to the women, their partners, and members of their communities. Because they are not part of the system, these womens' views are often not included in other studies.


This qualitative study used focus groups with four distinct categories of people, to collect observations about prenatal care from various perspectives. The 169 subjects included homeless women; women with current or history of substance abuse; significant others of homeless women; and residents of a community with high infant mortality and poverty indices, and low incidence of adequate prenatal care. A process of coding and recoding using Ethnograph and counting ensured reliability and validity of the process of theme identification.


Barriers and motivators to prenatal care were identified in focus groups. Pervasive issues identified were drug lifestyle, negative attitudes of health care providers and staff, and non-inclusion of male partners in the prenatal experience.


Designing prenatal care relevant to vulnerable women in urban communities takes creativity, thoughtfulness, and sensitivity. System changes recommended include increased attention to substance abuse treatment/prenatal care interaction, focus on provider/staff attitudes, and commitment to inclusion of male partners.