Pre- and inter-conception health care: A qualitative study of the pre- and inter-conception healthcare needs and experiences of urban women

Infant mortality is a growing problem for the city of Milwaukee, Wisconsin and marked disparities exist in the infant mortality rates for different groups of women in the city. In 2004, non-Hispanic Black women had an infant mortality rate of 19.4 per 1,000 births compared to 5.3 for non-Hispanic white and 4.9 for Hispanic women. To address these disparities, the local healthcare systems formed the Pre- and Interconception Task Force and received funding to explore the issue of provider cultural competency in delivering pre/interconception care. Sixteen focus groups, each with women of different age categories (18-20 vs. 21+), race and ethnicities (African American, White, Hmong and Latina), and conception statuses (pre- and inter-) were held at various community locations. A guide was developed and questions were used across the groups. One focus of the groups was examining the weight with which women regard advice received from a provider when in conflict with their culture or traditions and which source ultimately directs their actions. Preliminary results suggest that the majority of women feel that they are not being asked about how their culture interacts with their healthcare, and that they all have experienced conflicts between provider advice and familial/cultural traditions when it comes to pre/interconception health care, yet have different ways of balancing the conflicting advice. The results will be used to guide future interventions targeted at increasing the cultural competence of local providers in order to improve the health of pre/interconception women and eliminate the disparities in infant mortality.