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Barriers to Timely Prenatal Care Among Women With Insurance: The Importance of Prepregnancy Factors

From the Departments of Family and Community Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.

Address reprint requests to: Paula Braveman, MD, MPH Department of Family and Community Medicine 500 Parnassus Avenue, Room MU-306E; Box 0900 University of California, San Francisco San Francisco, CA 94143-0900 E-mail: pbrave{at}itsa.ucsf.edu.

Objective: This study, designed to avoid methodologic limitations of previous research, aimed to identify the important noninsurance barriers to timely prenatal care.

Methods: We identified a subsample of a cross-sectional statewide representative postpartum survey conducted in California during 1994–1995, focusing on 3071 low-income women with Medi-Cal or private coverage throughout pregnancy.

Results: Twenty-eight percent of those women had untimely care, although only 6% were unaware of their pregnancies during the first trimester. Controlling for numerous sociodemographic factors; knowledge, attitudes, beliefs, and behaviors; stressful life circumstances; and logistic obstacles that might deter seeking or receiving care, the following risk factors for untimely care were significant and experienced by more than one fifth of women: unwanted or unplanned pregnancy (affecting 43% and 66% of women, respectively), no regular provider before pregnancy (affecting 22% of women), and no schooling beyond high school (affecting 76% of women). Transportation problems, affecting 8% of women, appeared to be the only significant logistic barrier to timely care.

Conclusion: Improving timeliness of prenatal care among low-income women with third-party coverage is likely to require broad social and health policies that focus on factors affecting women before pregnancy. Assistance with transportation could contribute to more timely care for some low-income women, but programs focusing primarily on other noninsurance barriers during pregnancy might not substantially improve the timeliness of care, at least among low-income women with third-party coverage.

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