Barriers to Adequate Prenatal Care Utilization in American Samoa
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.
KeywordsPregnancy 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.
- 1.United Nations. (2001). Road map towards the implementation of the United Nations Millennium Declaration: Report of the Secretary General. http://www.un.org/documents/ga/docs/56/a56326.pdf. Accessed 29 Jan 2013.
- 3.World Health Organization (2012) Maternal Mortality. Fact Sheet No348. http://www.who.int/mediacentre/factsheets/fs348/en/index.html. Accessed 29 Jan 2013.
- 6.US Central Intelligence Agency. (2013). The World Factbook. https://www.cia.gov/library/publications/the-world-factbook/geos/aq.html. Accessed 30 Jan 2013.
- 7.American Samoa Department of Commerce. (2006). American Samoa at-a-glance. www.spc.int/prism/country/as/stats/At_A_Glance_2006.pdf. Accessed 30 Jan 2013.
- 10.Health Services and Resource Administration. (2013). Designated health professional shortage areas. http://bhpr.hrsa.gov/shortage/. Accessed 29 Jan 2013.
- 11.Low, P., Paterson, J., Wouldes, T., et al. (2005). Factors affecting antenatal care attendance by mothers of Pacific infants living in New Zealand. New Zeal Med J, 118(1216), 1489–1499.Google Scholar
- 12.U.S. Census Bureau (2010). Census population count data note 1—American Samoa. http://www.2010.census.gov/news/doc/errata_note.doc. Accessed 29 Jun 2012.
- 13.Hawley, N.L., Johnson, W., Nu’usolia, O. et al. (2013). The contribution of feeding mode to obesogenic growth trajectories in American Samoan infants. Pediatric Obesity (in press).Google Scholar
- 14.American College of Obstetricians and Gynecologists. (1965). Manual of standards in obstetric-gynecologic practice (2nd ed.). Chicago, IL: American College of Obstetricians and Gynecologists.Google Scholar
- 15.Brown, C. (2011). Barriers to prenatal care in American Samoa. Unpublished undergraduate thesis, Brown University, Providence, RI, USA.Google Scholar
- 21.World Health Organization. (2011). Western Pacific country health information profiles. 2011 Revision. http://www.wpro.who.int/health_information_evidence/documents/CHIPS2011.pdf. Accessed 30 Jan 2013.
- 22.World Health Organization Representative Office in the South Pacific. (2008). Health sector development. http://www2.wpro.who.int/southpacific/sites/hsd/. Accessed 30 Jan 2013.
- 23.Office of Women’s Health. U.S. Department of Health and Human Services. (2000). Women of color health data book. http://www.4woman.gov/owh/pub/woc/toc.htm. Accessed 13 Jan 2013.
- 24.Utah Department of Health. (2009). Utah Health Disparities Summary 2009: Pacific Islanders. http://health.utah.gov/disparities/data/disparitiessummary/PacificIslanderFactSheet.pdf. Accessed 30 Jan 2013.
- 25.American Samoa MCH Program. (2010) Assets and needs assessment—2010. https://mchdata.hrsa.gov/tvisreports/Documents/NeedsAssessments/2011/AS-NeedsAssessment.pdf. Accessed 30 Jan 2013.
- 31.American College of Obstetricians and Gynecologists. (2011). Screening and diagnosis of gestational diabetes mellitus. Committee Opinion No. 504. Obstetrics and Gynecology, 118(3), 751–753.Google Scholar
- 32.Institute of Medicine. (2009). Weight gain during pregnancy: Reexamining the guidelines. Washington, DC: The National Academies Press.Google Scholar
- 34.Nehring, I., Lehmann, S., von Kries, R. (2013). Gestational weight gain in accordance to the IOM/NRC criteria and the risk for childhood overweight: A meta-analysis. Pediatric Obesity. doi: 10.1111/j.2047-6310.2012.00110.x.