Prenatal Care in the United States: Perceptions of Resettled Bhutanese-Nepali Refugees

Abstract

The Bhutanese-Nepali community in the United States, estimated to be greater than 100,000, has been fleeing religious and ethnic persecution since the 1980s. Ohio ranks fifth in the United States in the number of resettled Bhutanese-Nepali refugees. Studies have shown refugee women have worse pregnancy outcomes than non-refugee women. However, early and optimal prenatal care can improve pregnancy outcomes. This project aimed to (a) evaluate the perceived quality of prenatal care among resettled Bhutanese-Nepali refugees and (b) explore relationships between multiple demographic variables and perceived quality of prenatal care. This descriptive, cross-sectional, mixed-methods survey design project measured prenatal care perceptions among resettled Bhutanese-Nepali refugees who received their prenatal care in a large Central Ohio teaching hospital. Study participants were at least 18 years old and had delivered a full-term newborn within the past six weeks. Participants completed the Quality of Prenatal Care Questionnaire (QPCQ), a 46-item tool utilizing Likert-type questions, along with a demographic form and additional qualitative questions. The tool developer provided the Nepali-language version of the QPCQ. A total of 49 Bhutanese-Nepali women completed the study. The average participant was 29 years old, had two living children, was married, and had been in the United States for six years. Nearly half (49%) had given birth at least once in Nepal. Participants highly rated the quality of their prenatal care with a mean QPCQ score of 4.17/5. The Information-Sharing Subscale received the highest mean score (M = 4.3), indicating high-quality prenatal care. The lowest scored subscale was the Approachability Subscale (M = 4.09), which asked participants if providers were abrupt, rushed, and made them feel like they were wasting their time. No significant relationships were found between QPCQ total or subscale scores and: age, number of years in the U.S., number of children born in the U.S., or total number of living children. The findings indicate patients feel they are being adequately educated by their providers and are included in the decision-making process. Providers can improve care by taking more time with patients and making an active effort not to seem rushed during prenatal appointments.