Heaman - barriers to prenatal care

Keeping in mind that these women all came from the same kind of disadvantaged neighbourhoods in the inner city, what we’ve found is that the women that had the lowest income levels, the youngest age, that were First Nations and that were abused by their partners or that used alcohol, who smoked or used drugs or who didn’t have a regular healthcare provider before pregnancy were some of the characteristics of the women who were more likely to have inadequate prenatal care. Then we asked them a number of questions about what they saw as the barriers to prenatal care and there were a number of personal barriers that came out.  They were experiencing a lot of stress in their lives; they had a lot of personal problems and crises; some of them the pregnancy was unplanned or unwanted; some of them were considering whether or not to have an abortion so that delayed their entry into prenatal care; some of them had had previous negative experiences with Child and Family Services or the child welfare agency related to apprehension of their child so they were reluctant to go for prenatal care because they were trying to avoid Child and Family Services finding out about the pregnancy.  So there were a number of personal factors.  Some of them said they were depressed or they weren’t thinking straight, which is an interesting response I think, and that a high number of them reported that.

So those were all factors in their life and trying to deal with all those crises and different things going on that perhaps inhibited them from getting prenatal care. Two other really important factors were transportation and childcare issues.  So for a lot of women getting to the prenatal care visit was a problem because they often lacked their own vehicle, they had to take public transportation.  So if you’re going on the bus in the middle of the winter and taking three kids with you, you know you really have to value prenatal care to think that it worth going in those circumstances.  And another reason was not having money to pay for transportation.  So and then also the childcare; if they didn’t have sufficient social support or someone to look after their children for them, their other children, they’d have to take them with them.