Ethnicity and sources of prenatal care: findings from a national survey

Unique challenges to preventing perinatal HIV transmission among Hispanic women in California: results of a needs assessment

To identify rates and factors associated with timely prenatal care (PNC) initiation, HIV test counseling, test offering, and test offer acceptance, we conducted a semistructured survey of a convenience sample of pregnant/recently delivered Hispanic women (n=453, 418 with analyzable data) in four California counties in 2000. Only 68.4% and 43.5% of Hispanic women reported receiving an HIV test offer and counseling, respectively, though 88.8% of those offered a test accepted. After controlling for the effects of age, education, years lived in the United States, health insurance coverage, delivery status, and parity, Hispanic women who initiated prenatal care in the first trimester were 1.7 times more likely to be offered an HIV test and almost 3 times more likely to receive counseling than women with a later prenatal care start or no prenatal care. Factors associated with timely PNC initiation on multivariate analysis were private/HMO insurance (OR=10.7, p < .001), Medi-Cal insurance (OR = 4.32, p < .001), being 25-30 years old (OR = 3.0, p = .008), and completion of high school (OR = 2.07, p = .01). Key opportunities to prevent perinatal HIV transmission are being lost for Hispanic women in California. Interventions to increase timely PNC initiation, and to improve test offering by health care providers, may help to improve counseling and testing rates for this population.

Prenatal cystic fibrosis screening in Mexican Americans: An economic analysis

OBJECTIVE

We evaluated the cost benefit of cystic fibrosis screening in Mexican American gravid women.

STUDY DESIGN

With the use of decisions analysis techniques, a cost-benefit analysis was performed. Baseline assumptions were based on published references. Sensitivity analyses were performed.

RESULTS

Under the baseline assumptions, screening was not cost beneficial. Threshold analysis showed that, if the test was priced under 53.00 dollars, screening became cost beneficial. Sensitivity analysis demonstrated that lower acceptance rates of amniocentesis or termination made the screening strategy less attractive. If the test sensitivity was raised to 90%, which required testing of >60 mutations, the cost of screening would need to be <100.00 dollars for the program to be cost beneficial.

CONCLUSION

Cystic fibrosis screening is not cost beneficial in Mexican American women over a wide range of assumptions. This is principally due to the poor sensitivity of the test in this population. Cultural factors, such as lower acceptance of amniocentesis and pregnancy termination of affected fetuses, further lower the cost-benefit ratio of screening.

The experiences of postpartum hospital stay and returning home among Thai mothers in Australia

OBJECTIVE

To describe the experience of postpartum care among Thai women in Melbourne, Australia.

DESIGN

Ethnographic interviews and participant observation with women in relation to postpartum care and practices.

SETTING

Melbourne Metropolitan Area, Victoria, Australia.

PARTICIPANTS

26 Thai born women who gave birth in Australia.

FINDINGS

The Thai women had varying views about the length of time they should spend in hospital and the care they received. Ten of the twelve women who had had a caesarean birth stayed in hospital for six or more days, consistent with the hospital practice. However, most of those who had had a vaginal delivery opted to go home earlier than the standard hospital practice of four days stay. This was because they were unhappy about specific hospital practices, the hospital environment, or because there are several Thai confinement customs, which, traditionally, a new mother must observe in order to maintain good health and avoid future ill health and which they were not able to follow in hospital. Nevertheless, most women were satisfied with their postpartum care. Most women were aware of the Thai cultural beliefs and practices. However, they showed varying ways of coping with the hospital environment in relation to their varying social situations.

IMPLICATIONS FOR PRACTICE

Thai women are diverse in their needs, perceptions and experience of postpartum care. Therefore, it is appropriate neither to stereotype all Thai women as requiring to follow traditional confinement practices nor to require them to adjust to standard hospital practices. Rather an environment of caring concern whereby each woman's individual needs can be solicited, understood and, where possible, attended to as required. The challenge is in achieving this.

Parental behavior after perinatal death: twelve years of observations

Perinatal death is a tragic occurrence, and parents vary in their needs and how they express grief. This prospective study describes choices parents made regarding contact with their baby following stillbirth or immediate neonatal death. Between 1 January 1979 and 1 March 1991, 808 consecutive families were enrolled in the Perinatal Mortality Counseling Program at the University of Florida. Following perinatal death, most parents wanted contact with their baby to personalize the event, information about the death and follow-up from their health care providers. However, no option was chosen by all parents. This large study strongly supports offering choices to all parents. Providers should neither bias parents nor make presumptions that would limit parental choices.