A qualitative assessment of structural barriers to prenatal care and congenital syphilis prevention in Kern County, California

• DOI: 10.1371/journal.pone.0249419
• Publication Date: 2021-04-01T18:07:20Z
• Authors: Elaine Y. L. Chan; Carolyn Smullin; Stephanie Clavijo; Melissa Papp-Green; Eunhee Park; Marlene Nelson; Gloria Giarratano; Jennifer A. Wagman
• Keywords: Adult; General Science & Technology; Substance-Related Disorders; Science; Mothers; Reproductive health and childbirth; California; Interviews as Topic; Congenital; 03 medical and health sciences; Rare Diseases; 0302 clinical medicine; Clinical Research; Pregnancy; Infant Mortality; Behavioral and Social Science; Humans; Syphilis; Healthcare Disparities; Poverty; Pediatric; Prevention; Syphilis, Congenital; Q; Postpartum Period; R; Prenatal Care; Perinatal Period - Conditions Originating in Perinatal Period; Health Services; Health Literacy; 3. Good health; Good Health and Well Being; Sexually Transmitted Infections; Medicine; Female; Research Article

Congenital syphilis is the result of placental transmission from mother to fetus of Treponema pallidum. Although congenital syphilis is preventable through timely treatment, the rate of new infections in the United States (US) has increased each year since 2013, and is increasing at a noticeably greater pace in California (CA). Most research into congenital syphilis has focused on individual psychosocial and behavioral factors that contribute to maternal vulnerability for syphilis. The aim of this study was to evaluate structural barriers to prenatal care access and utilization and congenital syphilis prevention in Kern County, CA. Transcripts from 8 in-depth interviews with prenatal care providers and 5 focus group discussions with 42 pregnant and postpartum persons were examined using thematic analysis. Structural barriers experienced by pregnant and postpartum persons to prenatal care access and utilization included (1) burdens of poverty; (2) stigma around substance use in pregnancy; (3) citizenship status; (4) lack of healthcare coverage; (5) low sexual health literacy; and (6) gender inequality Structural barriers experienced by prenatal care providers in congenital syphilis prevention included (1) limited guidance on clinical management of syphilis in pregnancy; (2) decay in public health infrastructure; and (3) inadequate support for managing patients’ social comorbidities. The response to congenital syphilis prevention will require an examination of the complex context of social determinants of health in which persons diagnosed with syphilis live in.