Health System Barriers and Predictors of Prenatal Care Utilization at a Large Academic Medical Center

Abstract Introduction Prenatal care (PNC) is one of the most utilized preventative services in the United States, and access to PNC is associated with improved pregnancy outcomes. Despite known benefits, access to PNC is limited by psychosocial and health system barriers. Racial, ethnic, and socioeconomic disparities negatively impact access to prenatal care and maternal and fetal health. Methods In a medically underserved area, this study analyzed nine health system barriers to PNC using a mixed-methods approach. Over three months, postpartum women were surveyed. Retrospective chart reviews were conducted for PNC utilization, pregnancy comorbidities and outcomes, and demographic information. Data underwent Fischer analyses, chi-squared analyses, and ANOVAs. Institutional Review Board-approved, participants consented for research and quality improvement, including medical record data use. Results Among 194 women, average reported barriers to PNC were 2.14, with “scheduling difficulty” (39.6%) and “work/school constraints” (30.2%) most common. Despite most women reporting a similar number of barriers, timing disparities based race and ethnicity, education, and income were observed. Hispanic women initiated PNC later than non-Hispanic White women (13w6d vs. 10w5d; p=0.009). Twelfth-grade education or less initiated PNC bachelor's degree holders (16w vs. 11w; p140k (13w3d vs. 9w1d; p=0.02). Conclusions Lower socioeconomic status and ethnic minority women exhibit delayed PNC start, linked to adverse outcomes. Noteworthy discrepancies within the surveyed cohorts, despite comparable reported barriers, hint at the existence of supplementary, interconnected obstacles specific to these women. Future efforts should tackle common issues to reduce socioeconomic disparities in pregnancy outcomes. Significance: Our results indicate the necessity for interventions aimed at enhancing timely and consistent prenatal care access.