title: Perspectives of family physicians on the care of uninsured pregnant women.
abstract: OBJECTIVE
  No official provisions are made for the medically uninsured under provincial public health programs in Canada. Studies have shown that uninsured pregnant women have inadequate access to prenatal and obstetrical services that favour healthy maternal and child outcomes. This qualitative study aimed to explore the perspectives of family physicians who provided care to uninsured pregnant women.
  
  
  METHODS
  Eight family physicians affiliated with two Montreal-based primary-care clinics and one tertiary care hospital between 2004 and 2007 were interviewed using a semi-structured interview guide. Data were assessed using thematic analysis.
  
  
  RESULTS
  Uninsured pregnant patients were characterized by physicians as socially vulnerable, with precarious immigration status that limited their access to health services. Uninsured patients were thought not to benefit from the same standard of perinatal care as their insured counterparts. Care of uninsured women was generally thought to be a professional obligation, regardless of the woman's ability to pay. Caring for this population was considered by family physicians to be challenging, engendering psychological stress, increased workload, and occasional tensions with other health care providers.
  
  
  CONCLUSIONS
  In the present context, family physicians are left to negotiate the health care system in an attempt to provide adequate perinatal care for uninsured pregnant patients. This situation has repercussions for physicians, for patients and, ultimately, for infants. Leadership is required to ensure that all pregnant women in Canada have access to appropriate health care during the perinatal period.
authors.affiliation: Université de Montréal, Montreal QC.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Munro
authors.affiliation: CLSC Côte-des-neiges, Montreal QC; Department of Family Medicine, McGill University, Montreal QC.
authors.forename: Catherine
authors.initials: C
authors.lastname: Jarvis
authors.affiliation: Faculty of Medicine, McGill University, Montreal QC.
authors.forename: Ling Yuan
authors.initials: LY
authors.lastname: Kong
authors.affiliation: Herzl Family Practice Centre, Jewish General Hospital, Montreal QC.
authors.forename: Vinita
authors.initials: V
authors.lastname: D'Souza
authors.affiliation: Northern Ontario School of Medicine, Sudbury ON.
authors.forename: Lisa
authors.initials: L
authors.lastname: Graves
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada / Q000453:epidemiology; D054242:Emigrants and Immigrants; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D007231:Infant, Newborn; D007398:Interpersonal Relations; D008429:Maternal Welfare / Q000191:economics / Q000208:ethnology / Q000523:psychology; D008489:Medical Indigency / Q000208:ethnology; D017057:Medically Uninsured / Q000208:ethnology / Q000523:psychology; D028681:Moral Obligations; D018743:Perinatal Care / Q000191:economics / Q000458:organization & administration; D010821:Physicians, Family / Q000458:organization & administration / Q000523:psychology; D011247:Pregnancy; D036301:Qualitative Research; D016526:Workload
keywords: family physicians; medically uninsured; pregnancy; qualitative study