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Background: In the United States, infant mortality rates remain more than twice as high for African Americans as compared to other racial groups. Lack of adherence to prenatal care schedules in vulnerable, hard to reach, urban, poor women is associated with high infant mortality, particularly for women who abuse substances, are homeless, or live in communities having high poverty and high infant mortality. This issue is of concern to the women, their partners, and members of their communities. Because they are not part of the system, these womens' views are often not included in other studies.

A convenience sample of city-dwelling African American women (n=246) was interviewed during each woman's postpartum stay at one of five hospitals in Washington, D.C. to determine their perceptions of factors influencing their prenatal care utilization. The Kotelchuck Adequacy of Prenatal Care Utilization Index was used to classify prenatal care utilization as either adequate (Adequate Plus and Adequate groups combined) or inadequate (Intermediate and Inadequate groups combined). Of the 246 women studied, 40% (99) had adequate prenatal care utilization. Using Classification and Regression Trees analysis, the following risk groups for inadequate prenatal care utilization were identified: women who reported psychosocial problems as barriers and who were not participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) (percent adequate=8.8); women who reported psychosocial problems as barriers, were participants of the WIC program, and reported substance use (percent adequate=13.8); and women who reported psychosocial problems as barriers, were participants of the WIC program, denied substance use, and reported childcare problems as barriers (percent adequate=20.0).

The death of a child is a traumatic, nonnormative family life event. Although parental bereavement has received substantial attention, little research has focused on extended family members affected by a child's death, and still less on how multiple family members perceive and respond to one another following the loss. Guided by a life course perspective, this article examines social support between grandparents and their adult children in the aftermath of infant death. Through structured, open-ended interviews, 21 grandparents and 19 parents from 10 families described how they provided support to and received support from their intergenerational partners. Data were analyzed using a grounded theory approach. Six categories of support were identified: being present, acknowledgment, performing immediate tasks, information, unskilled support, and no support. Most support was provided by grandparents to adult children rather than from adult children to grandparents. All families reported significant support from at least one grandparent and nearly all families described ambivalent relationships that complicated support. Gender, family lineage, and family history were major influences. Multiple family perspectives about a significant life event contribute to our understanding about the intersection between individual and family life.

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