title: Working Towards Safe Motherhood: Delays and Barriers to Prenatal Care for Women in Rural and Peri-Urban Areas of Georgia.
abstract: Objectives Georgia has the highest rate of maternal mortality in the United States, and ranks 40th for infant mortality. The Georgia Maternal and Infant Health Research Group was formed to investigate and address the shortage of obstetric care providers outside the Atlanta area. Because access to prenatal care (PNC) can improve maternal and infant health outcomes, we used qualitative methods to identify the access barriers experienced by women who live in rural and peri-urban areas of the state. Methods We conducted semi-structured, in-depth interviews with 24 mothers who gave birth between July and August 2013, and who live in either shortage or non-shortage obstetric care service areas. We also conducted key informant interviews with four perinatal case managers, and analyzed all data using applied thematic analysis. We then utilized Thaddeus and Maine's "Three Delays to Care" theoretical framework structure to describe the recognized barriers to care. Results We identified delays in a woman's decision to seek PNC (such as awareness of pregnancy and stigma); delays in accessing an appropriate healthcare facility (such as choosing a doctor and receiving insurance coverage); and delays in receiving adequate and appropriate care (such as continuity of care and communication). Moreover, many participants perceived low self-worth and believed this influenced their PNC exchanges. Conclusion As a means of supporting Georgia's pregnant women who face barriers and delays to PNC, these data provide a rationale for developing contextually relevant solutions to both mothers and their providers.
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, GA, USA. meyerev11@gmail.com.
authors.forename: Erika
authors.initials: E
authors.lastname: Meyer
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, GA, USA.
authors.forename: Monique
authors.initials: M
authors.lastname: Hennink
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, GA, USA.|Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Rochat
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, GA, USA.|Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Zoë
authors.initials: Z
authors.lastname: Julian
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, GA, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Pinto
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, GA, USA. adrienne.d.zertuche@emory.edu.|Emory University School of Medicine, Atlanta, GA, USA. adrienne.d.zertuche@emory.edu.|Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA. adrienne.d.zertuche@emory.edu.
authors.forename: Adrienne D
authors.initials: AD
authors.lastname: Zertuche
authors.affiliation: Emory University Rollins School of Public Health, Atlanta, GA, USA.|Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Bridget
authors.initials: B
authors.lastname: Spelke
authors.affiliation: Georgia Obstetrical and Gynecological Society, Duluth, GA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Dott
authors.affiliation: Georgia Obstetrical and Gynecological Society, Duluth, GA, USA.
authors.forename: Pat
authors.initials: P
authors.lastname: Cota
mesh_terms: D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D008428:Maternal Mortality; D009035:Mothers; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population; D019036:Suburban Health Services / Q000458:organization & administration*; D013383:Suburban Population
keywords: Access; Medicaid; Prenatal care; Qualitative methods; Rural