Contrary to common perceptions, psychological factors, rather than the liabilities of migration from Puerto Rico, bar Puerto Rican women living in the United States from access to adequate prenatal health care, according to a team of Penn State researchers.
"Our data reveal that, for Puerto Rican women seeking prenatal care in a hospital or clinic, the paramount concerns are not the cost of care or cultural barriers to care," says Dr. Nancy S. Landale, professor of sociology in the College of the Liberal Arts.
"Instead, among the most frequently mentioned barriers to adequate prenatal care are those that signal psychological uncertainty about the pregnancy itself," notes Dr. R.S. Oropesa, associate professor of sociology. "These include the consideration of abortion, the desire to keep the pregnancy secret and the lack of awareness of the pregnancy. Aspects of the health care delivery system are relatively minor in importance."
Landale, Oropesa and doctoral students in sociology Michelle Inkley and Bridget K. Gorman are co-authors of the paper, "Prenatal Care among Mainland Puerto Ricans," presented today (Aug. 7) at the annual American Sociological Association meeting.
Their data are derived from the Puerto Rican Maternal and Infant Health Survey of mothers of infants sampled from 1994-95 birth and death certificates. The actual sample used by the researchers consisted of 1,255 Puerto Rican women residing in Connecticut, Florida, Massachusetts, New Jersey, Pennsylvania and New York City.
"Puerto Rican migrants in the United States, compared to the population at large, are admittedly at greater risk of low birth weights and infant mortality," says Oropesa. "Indeed, the baseline infant mortality rate for Puerto Rican infants stood at 12.9 per 1,000 births, compared to 10.1. for the U.S. population as a whole in 1984."
Landale notes, "Approximately 56 percent of our respondents indicated they had received adequate prenatal care; 25 percent reported care as somewhat less than adequate; and 19 percent indicated care that was clearly inadequate. Forty-eight percent of the respondents mentioned at least one barrier to adequate care and one-fifth mentioned at least two types of barriers."
"Nevertheless, migration does not automatically raise barriers to health care or reduce the adequacy of care among Puerto Ricans," Oropesa says. "Puerto Rican women rate finding a provider as the least of their problems, and only a small percentage cite difficulties caused by lack of money or transportation. Neither does lack of education or imperfect English appear to create significant obstacles."
Furthermore, Puerto Rican migrants to the United States, unlike most other immigrants, enjoy the benefit of being U.S. citizens by birth who come from a setting already well integrated into the Medicaid program.
It is the psychological factors, especially those related to unwanted pregnancies, which are the most frequented cited barriers to seeking adequate prenatal health care. Puerto Rican women who migrate to the United States have relatively few complaints about the level of their prenatal care as long as their pregnancy is something they want. They are more likely to report inadequate care in the event of an undesired pregnancy, Landale says.
"A major implication of this study is that efforts to reduce unwanted pregnancies will affect positively how well Puerto Rican women make use of prenatal health care," Oropesa notes.
This research was supported by a grant from the National Institute of Child Health and Human Development.
EDITORS: Dr. Landale is at 814-863-7276 or at landale@pop.psu.edu by email; Dr. Oropesa is at 814-865-1577 or oropesa@pop.psu.edu by email; Ms. Gorman is at 814-863-9571 or at bgorman@pop.psu.edu by email.