Paper
Wednesday, 19 July 2006
This presentation is part of : Initiatives for Culturally Competent Care
Facilitating Women's Utilization of Prenatal Care
Tawna Cooksey-James, PhD, RN, College of Nursing, University of Iowa, Iowa City, IA, USA
Learning Objective #1: Appreciate the prenatal care system as it functions within the unique health care system in the U.S.V.I.
Learning Objective #2: Better understand the barriers perceived by women for the utilization of prenatal care and incorporate this knowledge into their areas of practice/education.
Within the United States Virgin Islands (USVI), a unique health care delivery system provides prenatal care with infant outcomes comparable to those of the United States (US). In 2001, while the IMR of 9.0 for the USVI was greater than the overall IMR of 6.9 for the US, the USVI IMR surpassed the IMR of five states and the District of Columbia. In the USVI, the government owns and operates its health care delivery system. Hence the legislature primarily directs subsidized U.S. federal monies received for health care toward its own hospitals and clinics and the people who need and use them, by funding Medicaid. And, since 1917, a formal focus on prenatal care began and was accompanied by local women being educated as nurse midwives. The continued funding of prenatal care coupled with this strong midwifery tradition continues to this day with midwives managing and delivering 80% of all infants. In this qualitative study, forty-two women who delivered at an island hospital signed letters of consent and were asked questions that focused on their perceived barriers to prenatal care utilization. Descriptive statistics of the demographic data indicated that the majority ethnicity and citizenship included 64.3% born and raised outside the USVI, 83.3% Caribbean, 88.1% Black, and 54.8% US citizens. Using Orem's Theory of Self-Care Deficits, interview data were placed into mutually exclusive categories of patient, system, and financial. Exemplars from the women for each of these categories are shared and provide evidence of their importance in the global quest to increase prenatal care utilization and decrease infant mortality. This study was partially funded by the Edward A. Dauer Scholarship Award and the U.S. Department of Health and Human Services, Public Health Service, Federal Nurse Traineeship Fund as implemented by the University of Miami, School of Nursing, Coral Gables, Florida.

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