Multi-method approach to evaluate inequities in prenatal care access in haiti

In this pilot study for evaluating equity in services at a hospital in rural Haiti, we investigated whether topography, walking time to dispensary, and presence of a mobile clinic were related to disparities in prenatal care utilization, using quantitative hospital record data on 100 women pregnant in 2002, We also assessed whether additional factors contributed to prenatal care disparities using qualitative key informant interviews with local health agents in Haiti. In logistic regression analyses, we found that walking time to the dispensary was associated with disparities in prenatal care utilization (p=.039). Health agent responses demonstrated lack of acknowledgment of disparities and attribution of underutilization to women undervaluing educational messages. Reducing disparities in prenatal care utilization will require attention to walking time to a point of care, though attitudes and experiential factors should not be overlooked. Similar multi-method approaches should be explored in future studies of health inequities in other communities.