Barriers to timely prenatal care among women with insurance: The importance of prepregnancy factors
Barriers to timely prenatal care among women with insurance: The importance of prepregnancy factors
复制标题
DOI：
10.1016/s0029-7844(00)00780-8
复制
发表时间：
2000-06-01
影响因子：
7.2
通讯作者：
Neuhaus, J
中科院分区：
文献类型：
--
作者：
Braveman, P;Marchi, K;Neuhaus, J
目的：这项研究，旨在避免以往的研究方法上的局限性，旨在确定重要的非保险障碍，及时产前护理。方法：我们确定了一个子样本的横断面全州代表性产后调查在加州在1994-1995年期间进行，侧重于3071低收入妇女与Medi-Cal或私人保险在整个孕期。这些妇女中有28%的人得到了不及时的护理，尽管只有6%的人在怀孕的头三个月不知道自己怀孕了。控制了许多社会人口因素;知识、态度、信仰和行为;紧张的生活环境;以及可能阻止寻求或接受护理的逻辑障碍，以下是不及时护理的重要风险因素，超过五分之一的妇女经历过：意外怀孕（分别影响43%和66%的妇女），怀孕前没有定期提供者（影响22%的妇女），高中以上没有受过教育（影响76%的妇女）。交通问题，影响8%的妇女，似乎是唯一显着的后勤障碍及时careers.Conclusion：改善低收入妇女与第三方覆盖的产前护理的及时性可能需要广泛的社会和卫生政策，重点关注影响妇女怀孕前的因素。交通援助可能有助于一些低收入妇女更及时地得到护理，但主要侧重于怀孕期间其他非保险障碍的方案可能不会大大提高护理的及时性，至少在有第三方保险的低收入妇女中是如此。（《妇产科》，2000年;95：874-80。(C)2000年由妇产科医生）。
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. (Obstet Gynecol 2000;95:874-80. (C) 2000 by Obstetricians and Gynecologists).