Working Towards Safe Motherhood: Delays and Barriers to Prenatal Care for Women in Rural and Peri-Urban Areas of Georgia

Abstract

Objectives Georgia has the highest rate of maternal mortality in the United States, and ranks 40th for infant mortality. The Georgia Maternal and Infant Health Research Group was formed to investigate and address the shortage of obstetric care providers outside the Atlanta area. Because access to prenatal care (PNC) can improve maternal and infant health outcomes, we used qualitative methods to identify the access barriers experienced by women who live in rural and peri-urban areas of the state. Methods We conducted semi-structured, in-depth interviews with 24 mothers who gave birth between July and August 2013, and who live in either shortage or non-shortage obstetric care service areas. We also conducted key informant interviews with four perinatal case managers, and analyzed all data using applied thematic analysis. We then utilized Thaddeus and Maine's "Three Delays to Care" theoretical framework structure to describe the recognized barriers to care. Results We identified delays in a woman's decision to seek PNC (such as awareness of pregnancy and stigma); delays in accessing an appropriate healthcare facility (such as choosing a doctor and receiving insurance coverage); and delays in receiving adequate and appropriate care (such as continuity of care and communication). Moreover, many participants perceived low self-worth and believed this influenced their PNC exchanges. Conclusion As a means of supporting Georgia's pregnant women who face barriers and delays to PNC, these data provide a rationale for developing contextually relevant solutions to both mothers and their providers.

Midwifery Professional Stress and Its Sources: A Mixed‐Methods Study

“…Texas currently ranks first in the developed world for maternal mortality; one factor for this may be the lack of access to maternity and women's health care services because of the recent closures of many women's health clinics across the state . In Georgia, one of the states ranking highest in maternal mortality, women in rural and peri‐urban areas report the difficulty of finding a maternity care provider as a main reason for delays in seeking and receiving prenatal care . More research needs to be done to investigate if maternal health worker attrition is related to these negative patient outcomes, including maternal mortality.…”

“…31 In Georgia, one of the states ranking highest in maternal mortality, women in rural and peri-urban areas report the difficulty of finding a maternity care provider as a main reason for delays in seeking and receiving prenatal care. 32 More research needs to be done to investigate if maternal health worker attrition is related to these negative patient outcomes, including maternal mortality.…”

Geospatial variation in caesarean delivery

“…Family physicians were not included in the workforce calculations due to lack of a suitable data source, though few family physicians provide obstetrical care in Georgia. (Meyer et al, ) Because providers cluster in counties with maternity hospitals, but women travel to those hospitals from multiple counties, the providers per 1,000 live births were calculated for the primary care service area (PCSA) that encompasses the county. A PCSA is a group of counties that share primary care resources.…”

Maternal Mortality among African American Women in the State of Georgia, Causes, Policy, and Ethical Considerations

“…Several studies claimed that ineffective patient-provider communication was one of the critical factors in delaying prenatal care among pregnant women particularly multiparous women in the State of Georgia (Meyer et al, 2016;& Pacagnella et al, 2014). Miscommunication sometimes leads to a missed or late diagnosis that sometimes goes untreated throughout the pregnancy (Dahlem et al, 2015;Lori et al, 2017;& Prather et al, 2018).…”