Marshall Deanna, Perez Mikaela, Wang Xi, Matone Meredith, Montoya-Williams Diana
PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA.
Womens Health Rep (New Rochelle). 2023 May 17;4(1):241-250. doi: 10.1089/whr.2022.0112. eCollection 2023.
The peak of the COVID-19 pandemic led to decreased maternal and child health care engagement, especially among marginalized populations. Existing disparities in prenatal care access and quality faced by pregnant immigrant people are likely to be amplified by the pandemic.
We conducted a study with direct service providers (DSPs) at community-based organizations (CBOs) serving pregnant immigrant families in the Philadelphia region. Semistructured interviews addressed barriers and facilitators to prenatal health care access and engagement among immigrant families both before and then after the onset of the pandemic in March 2020. Additional questions elicited context about the demographics of service populations, organizational connectedness to health care providers, and pandemic-related operational changes.
Between June and November 2021, 10 interviews were conducted in English and Spanish with DSPs at 5 CBOs. Primary themes included diminished access and quality of care received due to decreased language accessibility, increased restrictions around support persons, shifts to telemedicine, and changes to appointment scheduling. Additional themes included heightened hesitancy engaging with services due to documentation status, confusion around legal rights, financial strain, and health insurance status. Interviewees provided suggestions for improving service access during and postpandemic for immigrant pregnant people, including implementation of culturally responsive group prenatal care, institutional policies to improve understanding of legal rights, and increased financial supports.
Understanding emergent and exacerbated barriers to prenatal care access and quality during the COVID-19 pandemic provides context for how to improve health equity for immigrant pregnant people through public health and health care policies as the pandemic continues, and once it has subsided.
新冠疫情高峰期导致母婴保健服务参与度下降，尤其是在边缘化人群中。怀孕移民在获得产前护理的机会和质量方面现有的差距可能因疫情而扩大。
我们对费城地区为怀孕移民家庭服务的社区组织（CBO）中的直接服务提供者（DSP）进行了一项研究。半结构化访谈探讨了2020年3月疫情爆发前后移民家庭获得产前保健服务的障碍和促进因素。其他问题引出了有关服务人群人口统计学、组织与医疗服务提供者的联系以及与疫情相关的运营变化的背景信息。
2021年6月至11月期间，我们用英语和西班牙语对5个社区组织的直接服务提供者进行了10次访谈。主要主题包括由于语言可及性降低、对陪产人员的限制增加、向远程医疗的转变以及预约安排的变化，导致获得的护理服务机会和质量下降。其他主题包括由于文件状态、对法律权利的困惑、经济压力和健康保险状态，人们对接受服务的犹豫加剧。受访者为改善疫情期间及疫情后移民孕妇获得服务的情况提供了建议，包括实施具有文化适应性的集体产前护理、制定提高对法律权利理解的机构政策以及增加财政支持。
了解新冠疫情期间产前护理服务可及性和质量方面出现的以及加剧的障碍，为在疫情持续期间及疫情消退后如何通过公共卫生和医疗政策改善移民孕妇的健康公平性提供了背景信息。
