Primary care physicians' perceptions of barriers to preventive reproductive health care in rural communities.
BACKGROUND
Women residing in rural areas are less likely than urban women to receive preventive reproductive health care, but reasons for this disparity remain largely unexplored.


METHODS
In 2010, semistructured interviews were conducted with 19 rural primary care physicians in central Pennsylvania regarding their experiences in two domains of preventive reproductive health-contraceptive care and preconception care. Major themes were identified using a modified grounded theory approach.


RESULTS
Physicians perceived that they had a greater role in providing contraceptive care than did nonrural physicians and that contraceptives were widely accessible to patients in their communities; however, the scope of contraceptive services they provided varied widely. Participants were aware of the importance of optimal health prior to pregnancy, but most did not routinely initiate preconception counseling. Physicians perceived rural community norms of unintended pregnancies, large families, and indifference toward career and educational goals for young women as the biggest barriers to both contraceptive and preconception care, as these attitudes resulted in a lack of patient interest in family planning. Lack of time and resources were identified as additional barriers to providing preconception care.


CONCLUSIONS
Rural women's low use of contraceptive and preconception care services may reflect that preventive reproductive health care is not a priority in rural communities, rather than that it is inaccessible. Efforts to motivate rural women to engage in reproductive life planning, including more proactive counseling by providers, merit examination as ways to improve use of services.
Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA. cchuang@hmc.psu.edu
Cynthia H
CH
Chuang
Sandra W
SW
Hwang
Jennifer S
JS
McCall-Hosenfeld
Lara
L
Rosenwasser
Marianne M
MM
Hillemeier
Carol S
CS
Weisman
D000328:Adult; D003144:Communication Barriers; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010353:Patient Education as Topic; D010414:Pennsylvania; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D060728:Reproductive Health / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D016387:Women's Health; D055815:Young Adult