McCaw-Binns A, La Grenade J, Ashley D
Tropical Metabolism Research Unit, University of the West Indies, Mona, Kingston, Jamaica.
Soc Sci Med. 1995 Apr;40(7):1003-12. doi: 10.1016/0277-9536(94)00175-s.
Demographic, behavioural, environmental, economic and obstetric history data from the Jamaican Perinatal Morbidity and Mortality Survey were examined to identify characteristics of women who do not attend for antenatal care, or present late instead of early for care, using multiple logistic regression. Non-attenders were more likely to be teenagers, unmarried, in unions of very short duration, smokers and women who felt that friends and relatives were not supportive. Multigravid non-attenders often had short inter-pregnancy intervals and included women who had experienced a post neonatal death. They were often drawn from deprived environments (lack of sanitation, water supplies). Late attenders shared features common to non-attenders (teenagers, unmarried, multigravid). Many however were self employed and did not fit the depressed profile of the non-attender. Most multigravidae who attended late had had previously uneventful pregnancies, including this one. Early attenders had little in common with non-attenders or late attenders. They were older, many had a secondary or tertiary education, were married and were generally middle class women. The group however included high risk multigravidae who had previous pregnancy complications or bad outcomes. Programmes aimed at reaching non-attenders must focus on the wider social and economic needs of these women and must give them a sense of their own power to effect change in their lives. Reaching the late attender will be more difficult and may be unnecessary with the possible exception of the teenager. She needs to be treated in a more sympathetic and non-judgmental way as this is often a high risk pregnancy. More fundamental changes require improved educational and employment opportunities for women as the best consumer is an educated consumer.
对牙买加围产期发病率和死亡率调查中的人口统计学、行为学、环境、经济和产科病史数据进行了研究，采用多元逻辑回归分析来确定那些不进行产前检查、或延迟而非尽早进行检查的女性的特征。未进行产前检查的女性更有可能是青少年、未婚、同居时间很短、吸烟者，以及那些觉得朋友和亲戚不支持自己的女性。多孕次未进行产前检查的女性通常妊娠间隔时间短，包括那些经历过新生儿期后死亡的女性。她们往往来自贫困环境（缺乏卫生设施、供水）。延迟进行产前检查的女性具有与未进行产前检查的女性相同的一些特征（青少年、未婚、多孕次）。然而，其中许多人是个体经营者，并不符合未进行产前检查者那种沮丧的形象。大多数延迟进行产前检查的多孕次女性此前的妊娠过程都很顺利，包括此次妊娠。尽早进行产前检查的女性与未进行产前检查或延迟进行产前检查的女性几乎没有共同之处。她们年龄较大，许多人接受过中等或高等教育，已婚，通常是中产阶级女性。不过，这个群体包括有既往妊娠并发症或不良结局的高危多孕次女性。针对未进行产前检查者的项目必须关注这些女性更广泛的社会和经济需求，必须让她们感受到自己有能力改变生活。要接触到延迟进行产前检查者会更加困难，除了青少年可能是个例外，或许没有必要接触她们。对于青少年需要以更具同情心且不评判的方式来对待，因为这往往是高危妊娠。更根本的改变需要改善女性的教育和就业机会，因为最好的消费者是受过教育的消费者。
