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Show tion were further asked to select items from a list of barriers to getting care as early as they wanted. Of women noted to have inadequate PNC due to late entry, 38.9%, about 2,200 Utah women, said they did not get PNC as early in their pregnancy as they wanted. Conversely, 61.1% of women who did not receive adequate PNC due to late entry said they received PNC as early as they wanted. It appears that many Utah women were not aware that first trimester PNC is important. Figure 3 illustrates self-reported PNC barriers for women with inadequate PNC due to late entry. The largest barrier to early PNC reported by Utah women with late entry was lack of money. Not knowing of the pregnancy and being too busy to get PNC were also barriers to first trimester PNC. SUMMARY/RECOMMENDATIONS There is definite need for improvement in the entry and adequacy of PNC hi Utah. At 82% for first trimester entry into PNC and 63.9% for early and adequate PNC, Utah falls short of the Healthy People 2010 goal of 90% for both categories. This study found that there are two aspects of the problem with adequate PNC in Utah; late entry and early entry with insufficient PNC visits. It also revealed that women who received inadequate care due to late entry are generally a higher risk group than those who had an insufficient number of PNC visits. The need to further explore the reasons for inadequate PNC led to the implementation of focus group testing among these women. A sample of 40 women who had inadequate prenatal care in 2001 was identified through birth certificate data. These women were convened into six focus groups to discuss issues related to prenatal care. Some of the conclusions reached through these discussions revealed the following: • Many women either don't understand the specifics of PNC or don't believe that it's important. • Strategies to ensure that women who qualify for assistance are aware of available programs need to be developed and implemented. • Suggestions to women who do not qualify for assistance but struggle with the cost of PNC need to be addressed. The Utah Department of Health is using these data to implement a new social marketing Baby Your Baby campaign which is focused on themes related to awareness and desire for women to access prenatal care. Further study is needed to look at health care system practices to determine what changes are needed that would enable more pregnant women to receive early and continuous PNC. A multi-disciplinary Prenatal Taskforce has been convened to further research ways to address financial and system barriers identified through this study. REFERENCES Baker, T. J. (1996). Factors related to the initiation of prenatal care in the adolescent nullipara. Nurse Pract, 21(2), 26, 29-32, 42. Braveman, P., Marchi, K., Egerter, S., Pearl, M., & Neuhaus, J. (2000). Barriers to timely prenatal care among women with insurance: the importance of prepregnancy factors. Obstet Gynecol, 95(6 Pt 1), 874-880. Division of Community and Family Health Services. (2001). CFHS Division Plan and Report. Salt Lake City: Utah Department of Health. Institute of Medicine (U.S.). Committee to Study the Prevention of Low Birthweight. (1985). Preventing low birthweight / Committee to Study the Prevention of Low Birthweight, Division of Health Promotion and Disease Prevention, Institute of Medicine^ Washington, DC: Institute of Medicine. Institute of Medicine (U.S.). Panel on Health Services Research. (\973).Infant death: an analysis by maternal risk and health care. Washington, D.C.: Institute of Medicine. Kotelchuck, M. (1994). An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health, 84(9), 1414-1420. National Commission to Prevent Infant Mortality. (1988). Infant Mortality: Care for Our Children, Care for Our Future. Washington, D.C. Pagnini, D. L., & Reichman, N. E. (2000). Psychosocial factors and the timing of prenatal care among women in New Jersey's HealthStart program. Fam Plann Perspect, 32(2), 56-64. Roberts, R. O., Yawn, B. P., Wickes, S. L., Field, C. S., Garretson, M., & Jacobsen, S. J. (1998). Barriers to prenatal care: factors associated with late initiation of care in a middle-class midwestern community. JFam Pract, 47(1), 53-61. UnitedHealthGroup. (2000). UnitedHealth Group State Health Rankings 2000 Edition. Minnetonka, MN. U.S. Department of Health and Human Services, H. P. (2000). With Understanding and Improving Health and Objectives for Improving Health (2nd ed. Vol. 2). Washington, D.C: U.S. Department of Health and Human Services. PUBLISHING INFORMATION This publication was supported by Grant Number U50/CCU817126-02 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. ABOUT THE AUTHORS Kirsten Davis is a Data Manager at the Centers for Disease Control and Prevention. Laurie Baksh is the PRAMS Data Manager at the Utah Department of Health. Lois Bloebaum is the Manager of Reproductive Health Program at Utah Department of Health. Nan Streeter is the Director of Bureau of Maternal Child Health at Utah Department of Health. Bob Rolfs is a State Epidemiologist at the Utah Department of Health. ; f ¦ -i Utah's Health: An Annual Review Volume DC |
