The impact of personal problems on accessing prenatal care in low-income urban African American women.
OBJECTIVE
The purpose of this study was to investigate the nature and contribution of personal factors related to the use of prenatal care in a sample of high-risk women residing in an urban environment where care was accessible and free.


METHODS
The sample consisted of 297 African American women with low socioeconomic status and a high school education or less who were newly delivered of neonates. The level of prenatal care was classified according to the Kessner 3 Parameter Index (adequate, intermediate, inadequate). Women who received no prenatal care made up a fourth group. Subjects responded to the "Ten-Item Checklist" of Richwald. Rhodes, and Kersey and an in-person interview that queried their reasons for obtaining different levels of prenatal care.


RESULTS
Both personal and structural reasons were described by women for not obtaining care earlier in pregnancy or at all. The mean number of personal and structural problems reported per subject was inversely correlated to the level of prenatal care obtained. However, personal problems were the single most important reason cited by these women. Personal problems that were statistically significant different among the groups were drug use and desire for an abortion. The structural barriers that exhibited statistically significant differences among the groups were trouble scheduling an appointment, access totransportation, dislike of health care professionals and institutions, access to child care, and not knowing where to go.


CONCLUSIONS
Both personal and structural problems were cited as reasons for not obtaining adequate prenatal care. Structural barriers to prenatal care have been identified and extensively studied. These barriers to care continue to persist, despite innovations in program delivery and access. This study demonstrates that the significance of personal problems has not been adequately considered as a major factor associated with insufficient prenatal care.
York
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R
Division of Women's Health and Childbearing, University of Pennsylvania School of Nursing, Philadelphia 19104-6096, USA.
Grant
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C
Tulman
L
L
Rothman
R H
RH
Chalk
L
L
Perlman
D
D
D000328:Adult; D001741:Black or African American; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D012940:Social Problems; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000458:organization & administration*; D014505:Urban Population