An Equity-Focused Exploration of Care During Pregnancy

Le résumé fourni par la source

Prenatal health is defined as encompassing overall maternal health during pregnancy from conception up to delivery. Globally, evidence suggests that equitable and timely access to care, adequacy of care, and the equity-oriented nature of care during pregnancy influences health outcomes during this life-stage, and after, for both mother and newborn. Using an equity-focused approach, this multi-methods dissertation aims to explore care during pregnancy and its impact on maternal and newborn health in Canada.Study one consisted of an umbrella review that included systematic reviews from 1975 to 2022. This study explored barriers and facilitators of how equity influenced the patient experience or health outcomes when accessing services globally. The review included 68 systematic reviews across 20 countries. Barriers to equity in prenatal care included travel and financial burden, culturally insensitive practices that deterred care engagement and continuity, and discriminatory behaviour that reduced care access and satisfaction. Facilitators to achieve equity included innovations such as community health workers, home visitation programs, conditional cash transfer programs, virtual care, and cross-cultural training, to enhance patient experiences and increase their access to, and use of health services. Study two was a retrospective cohort study including livebirths in Ontario from 2012 to 2020. This study determined whether adequacy of prenatal care was associated with maternal and newborn 1) emergency department use after birth, and 2) severe morbidity and mortality (MM). A total of 924,773 mothers received sufficient prenatal care, and 31,041 (3.2%) did not. Mothers with insufficient care had a higher rate of ED use postpartum and severe maternal MM (10.8% and 3.3%) than those receiving sufficient care (9.5% and 2.9%); the adjusted relative risks (aRR) were 1.07 (95% CI 1.03-1.10) and 1.12 (95% CI 1.05 to 1.19), respectively. The corresponding rates of newborn ED use were 10.9% (insufficient) and 10.0% (sufficient); aRR 1.05 (95% CI 1.02-1.09). The rates of severe neonatal MM were insignificant when comparing insufficient vs sufficient prenatal care. Study three involved a qualitative interview approach to explore prenatal care experiences of 18 patients and the impact of inequities on their experiences in Ontario from 2023 to 2025. Participants shared their experiences in accessing prenatal care ranging from powerlessness to continuity of care challenges, influenced by geographical and financial barriers. The expectation of patient-centered care was consistent across experiences and encompassed empathetic practitioners, validation of concerns, and power dynamics, influenced by discrimination and advocacy for personalized support. Study findings offered potential areas of focus to improve the care experience including access to care in remote areas, patient-provider hierarchies, culturally sensitive approaches to care, and community engagement in prenatal healthcare. Together, these findings make a meaningful contribution to academic literature by identifying target areas for future interventions to improve care experiences during pregnancy, from a patient-centered and equity-focused perspective.

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