The Biopsychosocial Model and Perinatal Health Care: Determinants of Perinatal Care in a Community Sample

Abstract

Insufficient care in the perinatal period is associated with poorer maternal health, poorer perinatal outcomes, infant mortality, and health inequalities. Identifying the sources of and reducing the rates of insufficient care is therefore a major clinical and public health objective. We propose a specific application of the biopsychosocial model that conceptualizes prenatal and postpartum care quality as health markers that are influenced by psychological factors and family and social context. Clinic attendance data were abstracted from the electronic medical records of N = 291 participants enrolled in a longitudinal pregnancy cohort study of healthy women who have been followed since the first trimester; the Kotelchuck Index (KI) was calculated as an index of perinatal care utilization. Detailed prenatal psychological, social, and sociodemographic data were collected from self-report questionnaire and interview. Bivariate analyses indicated socio-demographic (e.g., race), psychological (e.g., response to perceived racism, affective symptoms, trauma experience), and social and family context (e.g., social support, family size) significantly influenced pre- and post-natal care utilization. Multivariate logistic regression analyses, adjusting for medical complications, identified social and family context as robust predictors of perinatal care utilization. The findings underscore the need for biopsychosocial models of health care and highlight several potential strategies for improving health care utilization.

Mapping the intersection of social determinants of health, postpartum visit attendance, and pregnancy‐related deaths: A scoping review

“…Quantitative designs were employed in seven studies to analyze these interactions (Duberstein et al, 2021;Eliason, 2020;Gordon et al, 2020;Norton et al, 2019;Parlier-Ahmad et al, 2022;Wallace et al, 2021;Wang et al, 2022). Additionally, a mixed methods approach was chosen for one study (Ela et al, 2022).…”

“…Within the scope of these methodologies, seven studies examined the interplay between at least one social determinant variable and postpartum care utilization (Duberstein et al, 2021;Ela et al, 2022;Eliason, 2020;Gordon et al, 2020;Norton et al, 2019;Parlier-Ahmad et al, 2022;Wang et al, 2022). One study specifically investigated the correlation between a social determinant of health and pregnancyrelated deaths (Wallace et al, 2021).…”

“…Two studies found that women without a high school education were less likely to attend a postpartum visit (Norton et al, 2019;Wallace et al, 2021). Conversely, one study did not fined variance in postpartum visit attendance and a woman's level of education (Duberstein et al, 2021).…”

“…One study examined the impact of employment status, number of hours worked per week, and utilization of public assistance on postpartum visit attendance (Duberstein et al, 2021). Employment status emerged as a factor associated with postpartum visit attendance patterns.…”

“…The level of educational attainment was used to measure the relationship between education and postpartum visit attendance. Three studies examined the relationship between educational attainment and postpartum visit attendance (Duberstein et al, 2021;Norton et al, 2019;Wallace et al, 2021). Two studies found that women without a high school education were less likely to attend a postpartum visit (Norton et al, 2019;Wallace et al, 2021).…”