Abstract
INTRODUCTION: Timely and adequate prenatal care is critical for improving pregnancy outcomes. Rural and underserved women in the U.S. have a higher burden of chronic disease, higher risk of adverse pregnancy outcomes, and lower access to maternity care services. This study explored perceived barriers and challenges to prenatal care in rural and underserved counties in the Texas Panhandle. METHODS: Semi-structured qualitative interviews were conducted with 34 key informants (maternal health partners, healthcare professionals, and organizational leaders) in six Texas Panhandle counties. Recruitment included purposive and chain-referral sampling for maximum variation. Thematic analysis was conducted using ATLAS.ti (Version 25.0.1); coding was emergent and iterative. Findings were structured around major themes identified within the Social Ecological Model. RESULTS: Delayed entry into prenatal care emerged as a significant overarching problem driven by four main barriers: 1) lack of insurance at the start of pregnancy resulted in delays in coverage and thus limited early access to care; 2) healthcare setting barriers included policies and practices that delayed care for uninsured women and too few providers for rural and low-income women; 3) long distances and limited transportation options, whether in rural or underserved urban areas, impacted the ability to attend prenatal care visits; 4) gaps in knowledge about insurance, appropriate timing of prenatal care, and available community resources also delayed healthcare engagement. These barriers were exacerbated by community-based beliefs and challenges related to low-income, resulting in transportation difficulties, constraints in accessing online insurance applications, and the inability to afford out-of-pocket healthcare. CONCLUSION: Community-driven strategies to improve early entry into prenatal care in these rural and semi-urban areas include addressing insurance enrollment, education, healthcare setting barriers, and distance to resources and care. Understanding and addressing these barriers among rural and underserved communities may improve the timeliness and adequacy of prenatal care which is crucial for identifying and managing maternal health conditions and preventing complications.