1. PRAMS: SC Residents Having a Live Birth, 2007
Barriers to prenatal care for women with limited English proficiency (LEP) in Greenville SC: a pilot study
Mary Keane, BS1, H. Lee Higdon, PhD2 , Deborah L. Billings, PhD3, and Amy Picklesimer, MD, MSPH2,
1University of South Carolina School of Medicine, Columbia, SC 2Department of Obstetrics and Gynecology, Greenville Hospital System University Medical Center, Greenville, SC, 3University of South Carolina Arnold School of Public Health, Columbia SC
Objectives
To determine the barriers to timely and adequate prenatal care for Hispanic Women with limited English proficiency (LEP) In Greenville County
Create a demographic sketch of the Hispanic women giving birth at the Greenville Memorial Hospital in Greenville, South Carolina.
Identify patient attitudes about prenatal care in order to inform possible outreach efforts and content of prenatal care.
Figure 1: Barriers to prenatal care
Results
Of 47 eligible women, 30 women were asked to participate; 28 accepted and 2 declined.
Average age was 27.6; 5 women had other living children and 23 did not.
Average length of residence in Greenville county was 49.4 months; range was months.
82% of women were from Mexico; 11% from Honduras; 7% fro m El Salvador
Rates of intended pregnancy were comparable to state-wide rates and possibly higher than other Hispanic South Carolina PRAMS respondents.
46% would come to more prenatal visits if there were a clinic closer to home; 64% would come to more prenatal visits if they knew how much it would cost.
64% heard about the clinic by word of mouth. Other sources of referral include WIC and New Horizons.
Background
From 1990 to 2007, the Hispanic population of Greenville County increased by 866%.
Members of the Hispanic population in Greenville have immigrated more recently than the national average.
The poverty rate for this population is twice the rate for Greenville County as a whole.
There is a high birth rate for Hispanic women in Greenville. Although 6.8% of the county’s population is Hispanic, 18% of all births are to Hispanic mothers.
The Hispanic community has unique barriers to prenatal care, including the language barrier as well as a more limited health literacy which may not include an understanding of the value of prenatal care
The Pregnancy Risk Assessment Monitoring System (PRAMS), a CDC survey performed by DHEC, provides state-wide data on prenatal care and pregnancy health outcomes, but these data do not reflect the new, diverse Hispanic population in Greenville.
Conclusion
Study strengths include a single interviewer and availability of a standardized control group (PRAMS 2007).
Limitations include small sample size, misunderstanding of questions, and use of de-identified data only
The most significant barriers to prenatal care reported by survey participants were distinct from those reported by women state-wide who report limited access to prenatal care, although real differences can only be detected with a larger sample size.
The spread of health information by word of mouth suggests a community strength that may be useful in delivering outreach services.
The unique barriers to prenatal care reported in Greenville’s Hispanic community compared to that of the entire state indicate the need for further data and point to changes our practice could make to offer more culturally appropriate care.
Possible outreach efforts could include satellite clinics in areas of Greenville county with concentrated Hispanic populations; prenatal visit structures that accommodate children; and streamlined billing structures.
Figure 2: Timeliness of entry to prenatal care
Figure 3: Economic indicators
Method
Prospective survey given as oral interview in Spanish by a single interviewer
June 21, 2009 – July 23, 2009
LEP women over 18 years of age delivered at a single hospital, Greenville Memorial Hospital
Questions from PRAMS and additional questions were used.
Patient demographic information, prenatal care data, and barriers to obtaining care including location, payment structure, and language barrier were collected by patient report.
Due to small sample size, descriptive statistics only.
PRAMS: SC Residents Having a Live Birth, 2007
GHS Survey, 2009
Non-Hispanic
n %
Hispanic
n %
PNC Entry <13 weeks
38759
78.7%
3331
51.8%  9
32.1%
PNC Entry ≥13 weeks
10459
21.3%
3105
48.2% 19
67.9%
No PNC
379
0.8%
139
2.1%
 0%
Economic Indicator
Frequency
Health Insurance (including Medicaid) 0%
Received WIC during pregnancy
78.5%
Lost a job during pregnancy
17.9%
Husband or partner lost a job during the pregnancy
35.7%
Could not pay “a lot of bills”
32.1%
Contact Information
Mary Kathryn Keane: