Prenatal Care

A variety of barriers to the use of prenatal care have been identified. In 1988 the Institute of Medicine cited four groups of barriers: financial; inadequate systems capacity; organization, practices, and atmosphere of prenatal services; and cultural/personal. Financial barriers have largely, but not completely, been addressed by the recent expansions of Medicaid eligibility and by reforms in health insurance, which have mandated pregnancy coverage. Immigration status and enrollment barriers, however, still influence access to Medicaid coverage. Transportation remains a major structural barrier to care in both urban and rural areas. Teens generally start prenatal care late. Organizational and personal factors, such as disrespect by providers, lack of planned pregnancy, not valuing prenatal care, and fear of detection of drug usage, remain substantial barriers to early and continuous prenatal care.

The content of care should be equal for all women, regardless of the source of their care, but this may not be the case. In general, prenatal care is more comprehensive in public clinics (including that among equally low-income women, public clinics make more referrals to the federal Women, Infants, and Children (WIC) nutrition program than private doctor's offices do). There is some evidence that providers offer different prenatal care content depending on the race and social class of their clients. And white women participate in childbirth education classes much more often than do African-American women.