Barriers to interconception health care for low-income women: A qualitative analysis

Objective: To assess barriers to interconception care among low-income women.

Methods: We conducted seven focus groups with 47 low-income postpartum women. Transcripts of discussions were analyzed for themes related to interconception care.

Results: Most participants viewed interconception care as important for preventive health and contraception. Some believed that interconception care was most important for first-time and “high-risk” mothers. Foreign-born Latinas in particular reported more comfort with home remedies and non-physician providers than with traditional, hospital-based care.

Nearly three-quarters of women reported a high likelihood of seeing a health provider in the coming year, but 55% reported uncertainty about having health insurance. Anticipated barriers to interconception care included a lack of insurance, time constraints, competing responsibilities, inadequate social support, and mistrust of the health care system. African-American mothers described the phenomenon of women “putting others first” as one reason why women are less likely to seek care. The structural barriers that women experienced and were concerned about for future care included long wait times, transportation issues, and difficulties making appointments, while appointment reminders were seen as facilitators. Home visits by public health nurses or midwives were cited as valuable, and many wished these services could continue beyond the postpartum period.

Conclusion: Low-income, postpartum women express attitudinal and structural barriers to receipt of interconception care. However, the majority of women believe that preventive care is important. Addressing these barriers and creating alternate modes of care are necessary to improve access to and quality of interconception health care.