The relationship among barriers and facilitators to prenatal care access and birth outcomes in a rural county

Upstate New York lags behind national averages and Healthy People 2010 goals for early access to prenatal care with only 76.1% of pregnant women accessing prenatal care during the first trimester. Most research on barriers to early access to prenatal care was conducted in urban or suburban settings. Research conducted in rural populations especially with pregnant women is limited. Although interventions such as the expansion of Medicaid have been implemented, access to prenatal care in the first trimester has not improved.;The purpose of this study was to examine the barriers and facilitators regarding access to prenatal care in a rural county without a hospital or birthing center within its geographical boundaries and with few health care providers who provided obstetrical care. Prenatal care in Tioga County was studied in depth using variables found in the 2008 Electronic Birth Certificate (EBC) data base and the Prenatal Risk Assessment Monitoring System (PRAMS) questionnaire, which was distributed and collected from Tioga County women. A systems approach model created by Anderson and Aday (1998) Behavioral Model of Health Service Utilization was used to explain the interrelationships that result in access to prenatal care among women who lived in a rural county.;The sample consisted of all the women who lived in Tioga County and who gave birth in 2008 (n=522). Out of the 502 PRAMS surveys mailed out, 187 surveys were completed and returned; with a 40.1%. The sample was primarily Caucasian (97.5%). This study utilized a descriptive correlational design.;The most significant barriers to access to prenatal care during the first trimester are women: 14-19 years of age, who are single, who have Medicaid or self-pay as a source of payment, and/or who want to keep their pregnancy a secret for women. While the most significant facilitators to early access to prenatal care are women: between the ages of 20-29 years, who are married, who have private health insurance, and/or did not want to conceal their pregnancy.