The impact of social determinants and marginalization on prenatal care in Saint John, New Brunswick
Ellis, Kate Elizabeth
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Subjectaccess; birth experience; marginalization; patient satisfaction; perinatal mental health; Prenatal care
People who have low incomes, less education, or are young in age may be susceptible to marginalization in prenatal care, experience poorer access, and less satisfaction with their care. The Canadian city of Saint John, New Brunswick, has limited perinatal resources and documented issues confirming health inequity. I conducted a triangulation based mixed-methods study, which consisted of an online questionnaire and one-on-one interviews, to determine how the above SDOH may impact prenatal care experiences. I wanted to determine if multiple levels of intersecting vulnerability could predict lower satisfaction, poorer access or increased perceptions of marginalization amongst prenatal patients. Although the predictive models were not significant, marginalization, access challenges, and satisfaction concerns were still present and important correlations were still present. Twenty-two percent of participants indicated they perceived marginalization in their care. Seventy percent of participants had scores indicative of high levels of satisfaction. Interestingly, higher levels of vulnerability were associated with lower satisfaction scores. Ninety-seven percent of participants had access to prenatal appointments congruent with the Society of Obstetrician and Gynecologists of Canada (SOGC) guidelines. Thematic analysis revealed that participants did experience marginalization, which spanned feelings of concern dismissal, stigma, and judgement. Participants also identified concerns regarding access that were characterized by difficulty accessing services and information gatekeeping. The manner in which resources were organized or if resources were available in the area was also discussed. Finally, participants expressed the birth experience could not be separated from their prenatal care and it had an impact on their overall perinatal care experience. This was important to the scope of this work as birth experiences of participants had significant negative connotations. Finally, an unexpected finding was the prominence of mental health issues within this population (29%). Participants indicated that mental health was inconsistently addressed. Further research into birth experiences and common practices in labour and delivery units in this area is warranted, as is an examination into perinatal mental health services. Practical solutions have been identified in this work and the broader literature that may help mitigate concerns related to access, marginalization and, satisfaction, which could improve the overall perinatal service model in Saint John.