title: Initiation of prenatal care by low-income Hispanic women in Houston.
abstract: OBJECTIVE
  To understand why many Hispanic women begin prenatal care in the later stages of pregnancy.
  
  
  METHODS
  The authors compared the demographic profile, insurance status, and health beliefs--including the perceived benefits of and barriers to initiating prenatal care--of low-income Hispanic women who initiated prenatal care at different times during pregnancy or received no prenatal care.
  
  
  RESULTS
  A perception of many barriers to care was associated with later initiation of care and non-use of care. Perceiving more benefits of care for the baby was associated with earlier initiation of care, as was having an eligibility card for hospital district services. Several barriers to care were mentioned by women on open-ended questioning, including long waiting times, embarrassment the physical examination, and lack of transportation.
  
  
  CONCLUSIONS
  Recommendations for practice included decreasing the number of visits for women at low risk for poor pregnancy outcomes while increasing the time spent with the provider at each visit, decreasing the number of vaginal examinations for low risk women, increasing the use of midwives, training lay workers to do risk assessment, emphasizing specific messages about benefits to the baby, and increasing general health motivation to seek preventive care through community interventions.
authors.affiliation: School of Public Health, University of Texas-Houston, El Paso 79902, USA. tbyrd@mail.utep.edu
authors.forename: T L
authors.initials: TL
authors.lastname: Byrd
authors.forename: P D
authors.initials: PD
authors.lastname: Mullen
authors.forename: B J
authors.initials: BJ
authors.lastname: Selwyn
authors.forename: R
authors.initials: R
authors.lastname: Lorimor
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000523:psychology*; D006801:Humans; D007348:Insurance, Health; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013781:Texas; D014504:Urban Health