Despite substantial evidence linking improved pregnancy outcomes with receipt of prenatal care and recent improvements in prenatal care utilization, specific subpopulations continue to receive late prenatal care and experience adverse birth outcomes. This study will use the Health Belief Model and the Intersectionality Framework to examine the timing of prenatal care utilization, prenatal care compliance, and adverse birth outcomes within a group of low-income, black women in the South. Black women have worst rates of late prenatal care utilization and compliance than any other racial group. This late prenatal care utilization and compliance leads to adverse birth outcomes. A secondary data analysis was conducted using binary logistic regression and OLS regression to examine agency factors, structural factor, and risk health behavior in predicting timing of prenatal care utilization and compliance. In addition, this study also examines timing of prenatal care utilization and compliances and its effects on preterm birth and low birth weight. The results show that family size and knowledge/attitude significantly influences timing of prenatal care. Prenatal care compliance is influenced by church social support and low birth weight is influenced by private insurance. The results of this study show that although much is known in comparing different racial groups, more investigation is needed to explain why low income black women still experience less prenatal care use and compliance and worse adverse birth outcomes than any other racial group in the United States.

Dissertation submitted in compliance with the requirements for the Masters Degree in Technology: Nursing, Durban University of Technology, 2016. / Introduction Although the South African Government adopted a primary health care approach to health care service provision in order to ensure equitable access to and utilization of health care services to all communities, the country continues to face challenges regarding access and utilisation of health care services especially in the rural communities. Antenatal care which is mostly provided at primary health care level is regarded as the cornerstone for the success of the maternal and child health care programme. Therefore, poor access to and under-utilisation of health care services could potentially influence the success of this programme and pregnancy outcomes. Aim of the study The aim of the study was to determine whether pregnant women from KwaMkhizwana rural community had access to and were utilising antenatal care services. Methodology A qualitative, exploratory, descriptive and contextual study was conducted guided by Thaddeus and Maine’s three delays model. Purposive sampling of the pregnant women and all categories of nurses who were employed in the three health care facilities in the area was done. Data was collected in two phases through in-depth semi-structured interviews with both the pregnant women and the nurses respectively between February and March 2016. The sample size was guided by data saturation. All data were analysed using the Tesch’s method of data analysis. Study findings Six major themes and several sub-themes emerged from the interviews with both Phase 1 and Phase 2 participants. The major themes included: 1) access to health care and emergency services, 2) availability of human and material resources, 3) social and cultural beliefs, 4) past pregnancy experiences, 5) communication and transparency regarding health care service delivery and 6) quality of antenatal care services. Summary of the findings The pregnant women encountered several challenges which led to delays in seeking, reaching and receiving antenatal care. Most of the pregnant women participants related limited access to health care, with under-utilisation of antenatal services. They were unhappy about the antenatal care services they received in the three available health care facilities in the area, which made these facilities to be inaccessible and underutilised. The nurse participants recognised the challenges facing the pregnant women regarding the access and utilisation of antenatal care services, together with the challenges faced by the nurses while working in the three available health care facilities in the area. Recommendations The recommendations that were made included: to consider building a centrally located fixed primary health care clinic that would ensure equal access to health care services, strengthening the implementation of policies regarding the referral system and ambulance services, ensuring sustainable availability of human and material resources, developing strategies to ensure that the antenatal care services are delivered in line with the South African Department of Health policies and guidelines and strengthening community education. A further study on provision of antenatal care services in the area is also recommended. / M

Background: Pregnancy induced hypertension (PIH) is the leading cause of maternal mortality and a major contributor to preterm birth and neonatal mortality. Literature suggests that several modifiable psychosocial and health behavioral factors may play significant roles in the development of PIH. However, interrelationships among these factors and their collective impact on PIH are not well understood. Objectives: This study aims to: 1) Examine the relationship between pre-pregnancy physical activity and risk of PIH, 2) Determine the association between prepregnancy depression and PIH and the role of race/ethnicity in this association, 3) Evaluate the association between intimate partner violence (IPV) in women before and/or during pregnancy and PIH, and the role of utilization of prenatal care (PNC) as a mediator in this association. Methods: This study utilized the national Pregnancy Risk Assessment Monitoring System survey data (years 2009-2015). The outcome variable PIH was defined as a dichotomized variable (Yes; No) utilizing a birth certificate variable data. Domain-adjusted multiple logistic regression, multiple logistic regression with stratification, and structural equation modeling analyses were used to investigate the study aims. Results: No significant reduced risk of PIH was observed in women who were physically active prior to pregnancy compared to sedentary women. However, women with prepregnancy depression were more likely to have PIH compared to women without prepregnancy depression and this association was significant for non-Hispanic White women when stratified by race/ethnicity. Further, PNC utilization was a significant mediator in the association between IPV before and/or during pregnancy and PIH. However, IPV had no direct or total effect on PIH in this study. Conclusions: Public health professionals and health care providers should be aware of the relationships between prepregnancy depression, race/ethnicity, IPV, and prenatal care utilization, and PIH, and utilize the information in risk profiling, screening, early detection and intervention in women at risk of PIH.

The purpose of this study was to identify and describe factors that affect the utilisation of antenatal services by pregnant adolescents in Muheza district, Tanzania. Quantitative, descriptive study was used. The Andersen and Newman Framework of Health Services Utilisation were used as a conceptual framework. The study population consisted of 235 adolescents who delivered in the Muheza district while attending postnatal clinics and health centres providing reproductive health services between January 2012 and March 2012. The findings revealed a high percentage of under- utilisation of ANC due to low level of education, low individual and household income, inadequate knowledge about sexuality and poor attitudes towards reproductive health services as exemplified by low prevalence of contraceptive use. The distance from clinic, the use of family planning methods, source of antenatal care and having more than four children under 16 years were associated with adequate utilisation of antenatal services. Recommendations were made to promote antenatal services usage by pregnant adolescents in Tanzania. / Health Studies / M.A. (Public Health)

The purpose of this study was to identify and describe factors that affect the utilisation of antenatal services by pregnant adolescents in Muheza district, Tanzania. Quantitative, descriptive study was used. The Andersen and Newman Framework of Health Services Utilisation were used as a conceptual framework. The study population consisted of 235 adolescents who delivered in the Muheza district while attending postnatal clinics and health centres providing reproductive health services between January 2012 and March 2012. The findings revealed a high percentage of under- utilisation of ANC due to low level of education, low individual and household income, inadequate knowledge about sexuality and poor attitudes towards reproductive health services as exemplified by low prevalence of contraceptive use. The distance from clinic, the use of family planning methods, source of antenatal care and having more than four children under 16 years were associated with adequate utilisation of antenatal services. Recommendations were made to promote antenatal services usage by pregnant adolescents in Tanzania. / Health Studies / M.A. (Public Health)