B.

Access to Care Prenatal care providers shall outreach to patients to reschedule missed appointments in a manner that maintains patient confidentiality. http://www.health.ny.gov/health_care/medicaid/standards/prenatal_care/ A. BARRIERS 17. Did you get prenatal care as early in your pregnancy as you wanted? No Yes

18. Did any of these things keep you from getting prenatal care at all or as early as you wanted? For each item, circle T (True) if it was a reason that you didnt get prenatal care when you wanted or circle F (False) if it was not a reason for you or if something does not apply to you. True a. b. c. d. e. f. g. h. i. j. False T T T T T T T T T T F F F F F F F F F F

I couldnt get an appointment when I wanted one............................................. I didnt have enough money or insurance to pay for my visits........................... I had no transportation to get to the clinic or doctors office .............................. The doctor or my health plan would not start care as early as I wanted............ I had too many other things going on ................................................................ I couldnt take time off from work or school ...................................................... I had no one to take care of my children ........................................................... I didnt know I was pregnant .............................................................................. I didnt want anyone else to know I was pregnant ............................................ I didnt want prenatal care................................................................................

34. STRESS A. GENERAL Core 33. This question is about things that may have happened during the 12 months before your new baby was born. For each item, circle Y (Yes) if it happened to you or circle N (No) if it did not. (It may help to look at the calendar when you answer these questions.) No Yes

a. A close family member was very sick and had to go into the hospital.....N Y b. I got separated or divorced from my husband or partner........................N Y c. I moved to a new address ......................................................................N Y d. I was homeless ......................................................................................N Y e. My husband or partner lost his job .........................................................N Y f. I lost my job even though I wanted to go on working ..............................N Y g. I argued with my husband or partner more than usual............................N Y h. My husband or partner said he didnt want me to be pregnant ...............N Y i. I had a lot of bills I couldnt pay ..............................................................N Y j. I was in a physical fight ..........................................................................N Y k. I or my husband or partner went to jail ...................................................N Y l. Someone very close to me had a problem with drinking or drugs...........N Y m.Someone very close to me died .............................................................N Y Standard P15. During the 12 months before your new baby was born, how often did you feel unsafe in the neighborhood where you lived? Always Often Sometimes Rarely Never P16. During the 12 months before your new baby was born, did you do any of the following things because you felt it was unsafe to leave or return to the neighborhood where you lived? For each item, circle Y (Yes) if you did it or circle N (No) if you did not.

No Yes a. I missed doctor or other appointments N Y b. I limited grocery or other shopping N Y c. I stayed with other family members or friends N Y http://www.cdc.gov/prams/PDF/Phase6_TopicsReference.pdf PRENATAL CARE APPOINTMENT SURVEY 2001: BARRIERS TO ACCESSING PRENATAL CARE IN NEW YORK CITY Barriers to Prenatal Care The Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based surveillance system that exists in many states, has identified several barriers to prenatal care. Analysis of PRAMS data from 13 states from 1989 to 1997 revealed that race/ethnicity, age, education, and parity are related to timing of entry into prenatal care. Specifically, Hispanic women, non-Hispanic black women, those less than 20 years of age, women with less than 12 years of education, and multiparous women are more likely to have delayed or no prenatal care. The top three reasons for delayed entry into prenatal in 1997 were: (1) I didnt know I was pregnant (2) I didnt have enough money or insurance to pay for my visits (this reason was even cited by 33% of

women whose prenatal care was paid for by Medicaid or state programs), and (3) inability to get an appointment. These data suggest that women face non-financial barriers to prenatal care. Depression and unhappiness about pregnancy, long waiting times at clinics, fatigue, transportation, and clinic overcrowding have been identified as additional barriers to prenatal care for low-income, urban pregnant women. Other issues that may hinder a womans ability to obtain prenatal care include lack of childcare, uncertainty as to whether to continue the pregnancy, substance abuse issues, and language or cultural barriers. For some pregnant women, basic issues such as trying to obtain food or shelter may take precedence over prenatal care. http://home.nyc.gov/html/doh/downloads/pdf/ms/ms-pncsurvey2001.pdf