Identifying Barriers to Prenatal Healthcare in Rural Panama

INTRODUCTION: Maternal and fetal mortality and morbidity in rural areas compared to urban areas in Panama is almost ten times higher [1,2]. In search of possible explanations, a study in 2008 found that Panamanian women had... [ view full abstract ]

INTRODUCTION:
Maternal and fetal mortality and morbidity in rural areas compared to urban areas in Panama is almost ten times higher [1,2]. In search of possible explanations, a study in 2008 found that Panamanian women had less knowledge than Costa Rican women regarding most all of aspects of prenatal healthcare [3]. As it has been determined that introducing a daily prenatal vitamin in the first or second trimester can reduce risk of preterm delivery, low birth weight, and NTDs by over twofold [4], it is worth evaluating the use, knowledge, and accessibility of prenatal vitamins amongst Panamanian women. Currently, the Panamanian government provides prenatal vitamins to any pregnant women who requests them, however the use of prenatal vitamins still remains low in rural areas for unknown reasons. Taking a closer look at an indigenous community in Bocas Del Toro known as the Ngöbe, we aim to assess perceptions, cultural preferences, and prenatal care amongst this population. Our goal is to identify potential barriers to prenatal health, including evaluating the use and availability of prenatal vitamins and postpartum contraception. We hypothesize that some of the barriers may be accessibility as well as a lack of education and misconceptions about risks, benefits, and alternatives to prenatal vitamins and contraceptive modalities.

MATERIALS AND METHODS:
Partnering with Floating Doctors, a non-profit organization providing healthcare in Bocas Del Toro and surrounding islands, we aim to assess antepartum care by administering a two page questionnaire orally to pregnant women attending a medical appointment at a Floating Doctors clinic. The questionnaire surveys the women’s prenatal care prior to the current visit, their preferences in delivery location, and their knowledge, accessibility and use of prenatal vitamins during their pregnancy, as well as postpartum contraception. All patients completed the questionnaire with informed consent to participate in the study. Identifying information was kept confidential within ethical guidelines approved by the IRB.

RESULTS:
This study is ongoing and will build upon data collected in previous years, thus at the time of abstract submission, data collection is not complete. From the months of June to August 2015, 101 pregnant Ngӧbe women were surveyed, of which 47 planned to deliver at home versus in a clinic or hospital. Of these 47, 35 women reported preferring to deliver at home even if presented with the option to deliver at a healthcare facility. Forty-six of the 101 women used prenatal vitamins, yet only 3 of the 14 women surveyed in their first trimesters were taking prenatal vitamins. Furthermore, interest in postpartum contraception was related to number of living children in the household: 40 of 68 (58.8%) women with 0-4 children and 18 of 21 (85.7%) with 5+ children were interested in postpartum contraception (p=0.02). Just 14 of 89 women used contraception previously, while a majority (65.2%) reported interest in future contraception use.

CONCLUSION:
An understanding of a community’s access to and perception of prenatal care is essential in improving health. The study shows that almost half of the women surveyed preferred to deliver their baby in their home. This, along with the geographic isolation of these women’s communities and absence of consistent health care, underlines the great importance of knowledge surrounding prenatal care. The first eight weeks of pregnancy is a crucial period for folate supplementation to prevent NTDs. In spite of that, only a small number of women began taking prenatal vitamins in their first trimester. This suggests either a delay in confirmation of a pregnancy or a lack of timely access to prenatal vitamins. Moreover, this study demonstrates that although a majority of women were interested in contraception, only a small number had previously used contraception. This indicates that it is less likely religious or cultural beliefs, but instead a lack of contraceptive access, that acts as a key barrier to adequate family planning. Overall, this study provides an introductory understanding into the nature of prenatal care in this region, which can be expanded in efforts to educate and thus improve maternal and reproductive health.