Late Entry Into Prenatal Care in a Rural Setting

Abstract

Social support, behavioral risk, and structural or demographic variables as well as acceptance of pregnancy were tested as determinants of late entry into prenatal care in a sample of 176 women in a rural county in California. The respondents were all those over age 18 served by four obstetric practices during a 4-month period ending in February 2000. One nurse-midwifery practice was included. Late entry into prenatal care during the first trimester occurred in 27.3% of the cases overall. Statistically significant independent variables in bivariate analyses were modeled in multivariate logistic regression. Stress, lack of family and friend support. Medicaid enrollment, age under 20 or over 34, low acceptance of pregnancy, and lack of a high school diploma were all predictors of late entry. Lack of family and friend support modified the effects of stress and Medicaid as payer. Although the determinants of late entry were remarkably complex in this sample, they have potential for public health intervention.

Late initiation of antenatal care and its determinants: a hospital based cross-sectional study

“…14,19 However, studies conducted in developed countries revealed lower proportions (4.4% to 27.3% % in USA, about 15% in UK and 41% in Australia) whereas some African studies reported comparable or higher values (53% in Ethiopia, 61.1% in Rwanda, 70.3% in Zambia, 81% in Nigeria, more than 70% in Tanzania and Malawi). 5,[16][17][18][20][21][22][23][24][25] Utilization of different cut-off points in defining late initiation of ANC could explain these discrepancies (first trimester or 12 completed weeks was used in USA and UK studies, 16 weeks in Ethiopian, Zambian, Tanzanian and Malawi studies, and second/third trimester in some studies). 5,[16][17][18][19][20]22,24,25 The proportions of pregnant women who initiate ANC before 4 months of gestation among neighboring and ASEAN countries were 40.4% in Bangladesh, 32.2% in Cambodia, 56.9% in India, 78.6% in Indonesia, 37.5% in Nepal, 46.9% in Pakistan, 56.1% in the Philippines and 65% in Vietnam.…”

“…5,[16][17][18][20][21][22][23][24][25] Utilization of different cut-off points in defining late initiation of ANC could explain these discrepancies (first trimester or 12 completed weeks was used in USA and UK studies, 16 weeks in Ethiopian, Zambian, Tanzanian and Malawi studies, and second/third trimester in some studies). 5,[16][17][18][19][20]22,24,25 The proportions of pregnant women who initiate ANC before 4 months of gestation among neighboring and ASEAN countries were 40.4% in Bangladesh, 32.2% in Cambodia, 56.9% in India, 78.6% in Indonesia, 37.5% in Nepal, 46.9% in Pakistan, 56.1% in the Philippines and 65% in Vietnam. 26 Differences in culture or socioeconomic status or health knowledge including awareness on the importance of early booking for ANC or education level among study populations, or differences in time of study or study area whether urban or rural may also be responsible.…”

“…Independent studies conducted in USA and some African countries reported that there is significant relationship between late ANC and being planned pregnancy. [16][17][18]22,28 Parity is also reported as a significant predictor of late initiation of ANC in studies done in UK, 20 Zambia, 17 Rwanda 22 and Ethiopia. 28 Besides, similar studies conducted in USA and Malawi revealed that maternal education has significant effect on receiving late ANC.…”

“…The prevalence of receiving late ANC was estimated to be 30% with 95% confidence level and 5% absolute precision. 16 Therefore, the sample size requirement was 323. All pregnant women who received ANC at Pyin-Oo-Lwin General Hospital during study period were recruited after getting informed consent.…”

Association of preconceptional health care utilization and early initiation of prenatal care

“…1,2 The timing of prenatal care initiation can be influenced by numerous prepregnancy factors, including maternal educational attainment, [1][2][3][4][5][6] age, [1][2][3][4][5][6][7][8] parity, 2,6,7 ethnicity, 3 women's feeling about pregnancy and prenatal care, 6 and insurance. 2,[8][9][10][11] In the last two decades, some investigators have demonstrated the importance of preconceptional care to improve perinatal outcomes. For example, it has been demonstrated that addressing periconceptional folic acid use at a preconceptional consultation improves folate use among women planning to conceive.…”