title: Barriers to adequate prenatal care utilization in American Samoa.
abstract: The objective of this study is to describe the utilization of prenatal care in American Samoan women and to identify socio-demographic predictors of inadequate prenatal care utilization. Using data from prenatal clinic records, women (n = 692) were categorized according to the adequacy of prenatal care utilization index as having received adequate plus, adequate, intermediate or inadequate prenatal care during their pregnancy. Categorical socio-demographic predictors of the timing of initiation of prenatal care (week of gestation) and the adequacy of received services were identified using one way analysis of variance and independent samples t tests. Between 2001 and 2008 85.4 % of women received inadequate prenatal care. Parity (P = 0.02), maternal unemployment (P = 0.03), and both parents being unemployed (P = 0.03) were negatively associated with the timing of prenatal care initiation. Giving birth in 2007-2008, after a prenatal care incentive scheme had been introduced in the major hospital, was associated with earlier initiation of prenatal care (20.75 vs. 25.12 weeks; P < 0.01) and improved adequacy of received services (95.04 vs. 83.8 %; P = 0.02). The poor prenatal care utilization in American Samoa is a major concern. Improving healthcare accessibility will be key in encouraging women to attend prenatal care. The significant improvements in the adequacy of prenatal care seen in 2007-2008 suggest that the prenatal care incentive program implemented in 2006 may be a very positive step toward addressing issues of prenatal care utilization in this population.
authors.affiliation: The Alpert Medical School, Brown University, Providence, RI, USA, Nicola_Hawley@brown.edu.
authors.forename: Nicola L
authors.initials: NL
authors.lastname: Hawley
authors.forename: Carolyn
authors.initials: C
authors.lastname: Brown
authors.forename: Ofeira
authors.initials: O
authors.lastname: Nu'usolia
authors.forename: John
authors.initials: J
authors.lastname: Ah-Ching
authors.forename: Bethel
authors.initials: B
authors.lastname: Muasau-Howard
authors.forename: Stephen T
authors.initials: ST
authors.lastname: McGarvey
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018948:American Samoa; D001294:Attitude to Health; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D010298:Parity; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011320:Primary Health Care; D036301:Qualitative Research; D011787:Quality of Health Care; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
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