Providers' perspectives of barriers experienced in maternal health care among Marshallese women

Women Birth. 2018 Oct;31(5):e294-e301. doi: 10.1016/j.wombi.2017.10.006. Epub 2017 Nov 7.


Problem: Pacific Islanders are disproportionately burdened by poorer maternal health outcomes with higher rates of pre-term births, low birth weight babies, infant mortality, and inadequate or no prenatal care.

Purpose: The purpose of this study was twofold: (1) to explore maternal health care providers' perceptions and experiences of barriers in providing care to Marshallese women, and (2) providers perceived barriers of access to care among Marshallese women. This is the first paper to explore perceived barriers to maternal health care among a Marshallese community from maternal health care providers' perspectives in the United States.

Methods: A phenomenological, qualitative design, using a focus group and in-depth interviews with 20 maternal health care providers residing in northwest Arkansas was chosen.

Findings: Several perceived barriers were noted, including transportation, lack of health insurance, communication and language, and socio-cultural barriers that described an incongruence between traditional and Western medical models of care. There was an overall discord between the collectivist cultural identity of Marshallese families and the individualistic maternal health care system that merits further research.

Discussion: Solutions to these barriers, such as increased cultural competency training for maternal health care providers and the incorporation of community health workers are discussed.

Keywords: Community-based participatory research; Marshallese; Maternal health; Pacific Islanders; Prenatal.

MeSH terms

  • Adult
  • Communication Barriers
  • Communication*
  • Community-Based Participatory Research
  • Cultural Competency*
  • Female
  • Focus Groups
  • Health Services Accessibility*
  • Humans
  • Insurance, Health
  • Interviews as Topic
  • Language
  • Maternal Health
  • Maternal Health Services / organization & administration*
  • Native Hawaiian or Other Pacific Islander*
  • Pacific Islands
  • Pregnancy
  • Qualitative Research