Maternal and Child Health Journal

, Volume 18, Issue 10, pp 2284–2292 | Cite as

Barriers to Adequate Prenatal Care Utilization in American Samoa

  • Nicola L. Hawley
  • Carolyn Brown
  • Ofeira Nu’usolia
  • John Ah-Ching
  • Bethel Muasau-Howard
  • Stephen T. McGarvey


The objective of this study is to describe the utilization of prenatal care in American Samoan women and to identify socio-demographic predictors of inadequate prenatal care utilization. Using data from prenatal clinic records, women (n = 692) were categorized according to the adequacy of prenatal care utilization index as having received adequate plus, adequate, intermediate or inadequate prenatal care during their pregnancy. Categorical socio-demographic predictors of the timing of initiation of prenatal care (week of gestation) and the adequacy of received services were identified using one way analysis of variance and independent samples t tests. Between 2001 and 2008 85.4 % of women received inadequate prenatal care. Parity (P = 0.02), maternal unemployment (P = 0.03), and both parents being unemployed (P = 0.03) were negatively associated with the timing of prenatal care initiation. Giving birth in 2007–2008, after a prenatal care incentive scheme had been introduced in the major hospital, was associated with earlier initiation of prenatal care (20.75 vs. 25.12 weeks; P < 0.01) and improved adequacy of received services (95.04 vs. 83.8 %; P = 0.02). The poor prenatal care utilization in American Samoa is a major concern. Improving healthcare accessibility will be key in encouraging women to attend prenatal care. The significant improvements in the adequacy of prenatal care seen in 2007–2008 suggest that the prenatal care incentive program implemented in 2006 may be a very positive step toward addressing issues of prenatal care utilization in this population.


Pregnancy Prenatal care Kotelchuck index American Samoa 



Financial support was partially provided by US NIH Grant R18-DK075371 and the Brown University Undergraduate Teaching and Research Assistantship program. We acknowledge the Tafuna Clinic, American Samoa Community Health Centers, Department of Health, and the American Samoa Community College Community and Natural Resources program for providing resources and assistance in the field. We thank the LBJ Tropical Medical Center prenatal clinic health care workers for their cooperation and the women who participated in the qualitative research for their cooperation and trust.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Nicola L. Hawley
    • 2
    • 1
  • Carolyn Brown
    • 3
  • Ofeira Nu’usolia
    • 4
  • John Ah-Ching
    • 5
  • Bethel Muasau-Howard
    • 5
  • Stephen T. McGarvey
    • 3
  1. 1.Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceUSA
  2. 2.The Alpert Medical SchoolBrown UniversityProvidenceUSA
  3. 3.International Health Institute, Department of EpidemiologyBrown UniversityProvidenceUSA
  4. 4.Tafuna Clinic, American Samoa Community Health Centers, Department of HealthAmerican Samoa GovernmentPago PagoAmerican Samoa
  5. 5.LBJ Tropical Medical CenterPago PagoAmerican Samoa

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