Capstone Abstract--Devorah R. Wieder

Documenting Obstacles to Obstetrics Care Utilization Among Medicaid Recipients in Southeastern Pennsylvania: A Patient-Centered Perspective

Devorah R. Wieder, M.D., M.P.H., Capstone Advisor: Ian Bennett, M.D., Ph.D.

The purpose of this study was to explore attitudes, beliefs and perceived barriers to obtaining prenatal care among clients of a community outreach program for pregnant women. Semi-structured interviews were conducted with 12 female clients of Maternity Care Coalition. The investigator reviewed the interview field notes and identified the overall themes using a content analysis approach. Clients experienced a lag time between awareness of pregnancy and first prenatal visit of between 1-3 months sometimes postponing prenatal care until the second trimester. Reasons for late initiation included delayed awareness of pregnancy, delay in contacting provider, waiting list for appointments, closure of clinics, type or lack of insurance and requirement to document pregnancy for health insurance. Options for care available to low income women were limited by insurance type/status, proximity and access to transportation. Timely initiation and maintenance of prenatal care for low-income women is limited by availability of providers, insurance status, and client resources and priorities. Data relating to utilization of prenatal care by clients of outreach organizations can be used for surveillance of obstacles to accessing care.