Vulnerable Populations in the Caribbean: Exploring Women's Experiences of Pregnancy and Prenatal Care in St. Kitts and Nevis, West Indies

Infant mortality is one of the most important indicators of the health of a nation. It is associated with a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions, and public health practices (CDC, 2013). Globally, in 2011, three million infants died before their first birthday. Numerous studies have shown that quality prenatal care can have a positive effect on birth outcomes through prevention and early diagnosis of maternal chronic health issues that can then lead to a reduction in infant mortality and prematurity. Strategies must be identified that will help reduce the long-term consequences that poor maternal health has on pregnancy outcomes, such as prematurity, that puts infants at risk for dying. More research needs to be conducted in West Indian islands, where varying cultural beliefs and practices might play a large role in maternal health. Small West Indian islands, where there has been little to no health research, represent an important segment of the health disparities population. Aggregate Latin American and Caribbean health data signifies a lack of knowledge that results in greater health disparities. In St. Kitts and Nevis, critical changes in nursing education and scope of practice have drastically reduced the rate of infant mortality since the 1970’s, however, more progress is necessary to reach Millennium Development Goals. In a country where primary and preventative services are free, yet prenatal care services are still underutilized, understanding maternal behavioral intent may be the key to improving early access to prenatal care. In-depth interviews were conducted with pregnant and postpartum women (n=15) and healthcare providers (n=6) to better understand perceived issues surrounding lack of prenatal care uptake. Content analysis of interviews and health clinic observational data revealed that, while women did obtain the WHO minimum standard of four prenatal care visits, early access to care was mitigated by women’s desires for empowerment, perceptions of lack of confidentiality at community clinics, and limited collaboration between private physicians and community center nurses. Providers cited women’s lack of understanding of the need for early prenatal care as a major reason for service underutilization. Enhanced public promotion of community educational services, provider confidentiality training, and improvements in healthcare provider collaborative efforts, through policy changes and interprofessional education, may improve uptake of prenatal care services and lead to improvements in maternal-child outcomes.