TennCare women who dont get early prenatal care say pregnancy was mistimed or unwanted, study finds
TennCare Pregnancy Study
October 31, 1997
Women in a Tennessee Medicaid managed care plan who failed to seek early prenatal care often described their pregnancies as "unwanted" or "mistimed" or said they didn’t know that they were pregnant, concludes a new study by the Prudential Center for Health Care Research in Atlanta on barriers to prenatal care.
The association between late prenatal care and unwanted pregnancy is a "big problem to overcome," said Julie Gazmararian, director of scientific research at the Prudential Center for Health Care Research.
Adds TennCare medical director Wendy Long: "Adolescents are notorious for not knowing they are pregnant, or trying to conceal it. This is an education issue. It’s vital that they get into care early to ensure a healthy baby."
The study is based on in-depth interviews with 501 women from age 13 to 45 years old enrolled in the Prudential HealthCare Community plan, a TennCare HMO in Memphis. The findings concerning pregnancy care were based on responses from 200 of the women.
Women interviewed at home
Hour-long interviews with the respondents were conducted in the women’s homes by current TennCare members trained by researchers. Ms. Gazmararian said using TennCare recipients likely improved the validity of responses. The other interviews were conducted by college students, also in the women’s homes. Household surveys were conducted between March 1996 and April 1997.
Overall, 75% of respondents said they sought medical care during the first trimester. Ms. Gazmararian said the self-reported rate of early entry into prenatal seemed somewhat high and was being checked against medical records.
Women who did not seek out prenatal care until after the first trimester tended to be under 20 years old, single and carrying an unwanted baby. Three of four women described a pregnancy as either "mistimed" or "unwanted." Some 64% of women who didn’t seek early prenatal care said they didn’t recognize signs of pregnancy.
The findings suggest that states shifting Medicaid patients to HMOs will need to step up education and family planning efforts, "I think some of these things hold true anywhere," Ms. Gazmararian said.
Managed care confusing
Echoing the findings of other surveys, the study also showed that many women didn’t understand how to "negotiate the managed care environment," she said.
For instance, 21% said they didn’t fully understand they were entitled to free medical care and transportation to clinics, or they lacked the skills to set up or obtain early medical appointments. One in five said they could not get an earlier appointment.
Another discouraging finding for managed care executives is that the women overwhelmingly said that incentives, such as infant car seats or cash payments, would have no effect on their behavior.
TennCare medical director Dr. Long said Prudential’s findings were consistent with the state’s own studies. However, she stressed that TennCare has significantly improved women’s health care in key categories, including entry into care during the first trimester of pregnancy, birth weight, pre-term delivery and infant mortality.
Dr. Long praised Prudential for taking an "important step" in identifying barriers to care. "We’re really pleased to see them taking this on," she said, adding that the study showed a clear need to focus on improving family planning services. Most studies don’t dig so deeply into patient motivations, she said.
The household survey questions used in Prudential’s research were developed based on feedback from many focus groups with representatives of community organizations, providers, and groups of women, both teens and adults. Among the topics discussed during the enrollee focus groups were perceptions of pregnancy, interactions with medical care system and staff, perceived barriers to prenatal care and ideas for motivating expectant mothers to receive prenatal care.
A consortium of social service groups, health providers, enrollees and policy makers has been organized by Prudential to develop interventions to help providers better serve and educate the TennCare population. The consortium also advised researchers on the survey.
"We’re saying let’s work together and solve these problems," Ms. Gazmararian said.
Initial steps Prudential is taking include a simple "welcome call" to "reach out to our enrollees to make sure they are aware of the resources available to them." Other proposals include a telephone hotline and social support and referral services.
Women who did not seek out prenatal care until after the first trimester tended to be under 20 years old, single and carrying an unwanted baby.
Most of the women who completed the in-person interviews were black, single, high-school educated, employed, poor and living in crowded housing conditions.
Health profiles were fairly comparable to national data, Ms. Gazmararian said, though the percentages of pre-term and low-weight babies were somewhat higher. Just over half the women had delivered a preterm or low- birth-weight baby.
More than half described their health as excellent or very good, though about 20% reported suffering from depression or hypertension. Smoking was reported by 23.5%, and drinking by 42.1%.
—Fred Schulte
Contact Ms. Gazmararian at 770-801-7880.
TennCare women who dont get early prenatal care say pregnancy was mistimed or unwanted, study finds
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content
