Working towards safe motherhood: Delays and barriers to prenatal care for women in rural and peri-urban areas of Georgia Open Access

Abstract

Objectives: Georgia has the second-highest rate of maternal mortality in the United States, and the 8th-highest infant mortality rate. The Georgia Maternal and Infant Health Research Group (GMIHRG) was formed to understand and address the severe shortage of obstetric care providers outside the Atlanta area. Since access to prenatal care 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-August 2013, and who live in areas classified as shortage or non-shortage areas of obstetric care services. We also conducted key informant interviews with 4 perinatal case managers, and analyzed all data using applied thematic analysis. Results: We used Thaddeus and Maine's "Three Delays to Care" theoretical framework structure to describe the barriers to care found in this study: delays in a woman's decision to seek prenatal care (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). In particular, participants consistently discussed that their perceptions of low self-worth influenced their prenatal care exchanges. Conclusion: These data provide a rationale for developing solutions to current barriers and delays to prenatal care for women in Georgia.

Table of Contents

Table of Contents

CHAPTER 1: INTRODUCTION 1
CHAPTER 2: LITERATURE REVIEW 5
Introduction to Prenatal Care 5
Linking Prenatal Care to Maternal and Infant Outcomes 6
The Problem: Access 7
Proposed Models of Care 13
Mothers' Perspectives 19
Conclusion 20
CHAPTER 3: MANUSCRIPT 21
Abstract 24
Objectives 25
Methods 28
Results 33
Discussion 42
Conclusion 45
CHAPTER 4: DISCUSSION, CONCLUSION AND RECOMMENDATIONS 46
References 49
Tables and Figures 54
Appendices 57
In-depth Interview Guide: Case Managers 57
In-depth Interview Guide: New Mothers 61

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Obstetrics and Gynecology
Keyword	prenatal care Georgia access rural qualitative methods
Committee Chair / Thesis Advisor	Rochat, Roger, Emory University Hennink, Monique, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Georgia state or local health department National or regional non-profit organization (e.g., American Cancer Society)

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