Adequacy of prenatal care among inner-city women.
BACKGROUND
Lack of prenatal care is a well-recognized risk factor for infant mortality and low birthweight. This study was conducted to identify factors that facilitate or inhibit access to prenatal care among low-income inner-city women.


METHODS
A case-control interview study was conducted with women during their postpartum hospitalization at a midwestern inner-city hospital. Fifty-eight women who had received no prenatal care and 71 women who had received markedly inadequate prenatal care were compared with 123 controls who had received intermediate or adequate prenatal care.


RESULTS
The majority of subjects were minorities, single, had low incomes, and were in the Medicaid program. Subjects' median age was 23 years and median parity 2, and the majority had not completed high school. Inadequate prenatal care was independently associated with the following variables (adjusted odds ratios): lack of any insurance, including Medicaid (5.3), being a smoker (3.8), being homeless (2.7), being black (2.5), not being worried what the physician or nurse might say (2.4), not using contraception (2.1), having a household income of less than $400 a month (1.8), being ashamed or afraid of the pregnancy or the physician (1.4), having transportation problems (1.3), and level of education (0.8).


CONCLUSIONS
Practical factors related to poverty are substantial barriers to obtaining prenatal care. Comprehensive approaches to prenatal services that address these barriers may be more effective in facilitating adequate prenatal care among low-income women.
Melnikow
J
J
Department of Family Practice, MetroHealth Medical Center, Cleveland, OH.
Alemagno
S
S
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D009035:Mothers / Q000523:psychology; D010349:Patient Compliance; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000191:economics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D014504:Urban Health