Anguish, Yearning, and Identity

Abstract

The purpose of this phenomenological study was to seek a better understanding of needs and access issues among pregnant, low-income Hispanic women. Hispanic women who attended a community prenatal education program participated in follow-up focus groups to explore their experiences regarding prenatal education, pregnancy resources, access to, and satisfaction with, the care available to them. Focus groups were facilitated by a leader, bilingual in English and Spanish, with knowledge of the Hispanic culture. Sessions were audiotaped, then translated into English for transcription. Data were analyzed according to guidelines by Colaizzi and three themes emerged: pregnant Hispanic women experienced a sense of anguish (la angustia) from questions and unknowns rampant during pregnancy, leading to a yearning (el anhelo) to learn and understand more, but with a desire to do so without sacrificing native identity (la identidad). Implications of these themes for improving prenatal care for this population are explored.

A systematic review of the qualitative literature on barriers to high‐quality prenatal and postpartum care among low‐income women

“…28 In addition, communication challenges were common among the women interviewed. These included difficulty understanding the provider's advice as a non-native English speaker, 46,52 not being given all the information they requested, and not having enough time with providers to raise concerns. 25,28,30,31,40,42,51 Overall, women expressed frustration that after expending money, time, and energy to attend their appointments, they received little benefit.…”

“…I wasn't happy about that" 32 Not enough time with providers, especially in comparison to wait times 25,28,30,31,40,42,51 "It was kind of a waste of time, to sit there all that time, and then, you know, be rushed out; pretty much I did not get anything accomplishedwith that" 28 "You just get weighed. Other than that, paperwork and questions, and it's over" 28 Language barriers 46,52 "I'm worried about the day I go into labor. Will there be an interpreter there for me?…”

“…52 Lack of respect for cultural differences and preferences 24,45,46,52 "I had a male interpreter‚ in my situation‚ well, I wasn't going to get undressed in front of him because I want a woman, but a man, no. I am very modest and besides the fact that I'm a woman‚ I'm not going to show everything in front of a man" 52 Racism or discrimination from providers 24,27,28,30,39,46,48,52,53 "I told [my midwife] I did not like going to my appointments, and one day she just asked me, "do you do crack?" …Just because I do not want to come to my appointments, I gotta be a drug addict?… Why would she ask me if I smoke crack?…”

“…Many study participants who did overcome access barriers to attend prenatal or postpartum visits reported receiving low-quality care. Experiences of dismissal, 28,32,33,39,49,51 discrimination, 24,27,28,30,39,46,48,52,53 and disrespect 23,24,36,39,45,51 were common. Many participants attributed these negative experiences to their race, their insurance status, their age, or their substance use.…”

Identifying Barriers and Facilitators to Prenatal Care for Spanish-Speaking Women

“…Not only can accessing prenatal care be challenging, finding culturally competent, quality prenatal care is challenging for women of color specifically. Several studies of Latinx women have been conducted in several states including Texas, Florida, California, Kentucky, and Tennessee which found barriers including long wait times, dislike of exams, transportation, language barriers, cultural sensitivity, and undocumented status [9][10][11][12][13][14]. One study was performed in North Carolina, but it was more than 10 years ago [15].…”