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This study surveyed females who accessed prenatal care at an urban health center to determine perceptions of barriers to early initiation of services. We hypothesized distrust of healthcare professionals would result in delayed utilization. Results indicated that both minority and non-minority patients distrust health care professionals who have strong anti-minority bias and discriminate on the basis of race. Prenatal care was initiated later for minority participants compared to White participants, but only among participants who thought doctors and nurses were biased against minorities or felt they discriminated on the basis of race. Findings suggest the need to overcome distrust in health professionals to improve access to timely prenatal care for women of all races and ethnicities.

Agency for Healthcare Research and Quality (2008). National Healthcare Disparities Report. AHRQ Publication No. 09-0002. Retrieved on June 24, 2009, from

Alexander G. R., & Kotelchuck, M. (1996). Quantifying the adequacy of prenatal care: A comparison of indices. Public Health Reports. Ill, 408-418.

American Academy of Pediatrics and American College of Obstetricians and Gynecologists. (2007). Guidelines for Perinatal Care. 6th Edition. Elk Grove Village, IX and Washington, DC: Authors.

American Psychological Association (2002). Ethical Principles of Psychologists and Code of Conduct. Retrieved June 23, 2009, from

Armstrong, K, Ravenell, K L., McMurphy, S., & Putt, M. (2007). Racial/Ethnic Differences in Physician Distrust in the United States. American Journal of Public Health, 97, 1283-1289.

Bassani, D. G., Surkan, P J., & Olinto, M. T. (2009). Inadequate use of prenatal services among Brazilian women: the role of maternal characteristics. International Perspectives on Sexual and Reproductive Health, 35, 15-20.

Boulware, L. E., Cooper, L. A., Ratner, L. E., LaVeist, T. A, & Powe, N. R. (2003). Race and trust in the health care system. Public Health Reports, 118, 358-365.

Broekhuizen, F. E, Utrie, J., Van Mullem, C. V (1992). Drug use or inadequate prenatal care? Adverse pregnancy outcome in an urban setting. American Journal of Obstetrics & Gynecology, 166, 1747-1756.

Casagrande, S. S., Gary, T. L., LaVeist, T. L., Gaskin, D. J, & Cooper, L. A. (2007). Perceived discrimination and adherence to medical care in a racially integrated community. Journal of General Internal Medicine, 22, 389-95.

Delaware Health Statistics Center (2007). Delaware birth and death data 2000 to 2006. Dover, DE: Delaware Health and Social Services, Division of Public Health. Retrieved on June 10, 2009, from bthsdths_pubdata.html.

Delaware Health Statistics Center (2008). Delaware Vital Statistics Annual Report 2006. Dover, DE: Delaware Health and Social Services, Division of Public Health. Retrieved on June 11, 2009, from

Delaware Healthy Mother and Infant Consortium. (2006). Delaware Healthy Mother and Infant Consortium 2006 Annual Report: Reducing Infant Mortality in Delaware. Dover, DE: Delaware Health and Social Services, Division of Public Health. Retrieved on June 1, 2009, from imdhmichome.html .

Department of Health and Human Services (2007). National Health Expenditures. Office of the Actuary, Centers for Medicare and Medicaid Services. National Health Statistics Group. Retrieved on June 29, 2009, from httpV/wwwcmsiihs^ov/NationaHealtnExpendData/

El-Mohandes, A., Herman, A. A., Nabil El-Khorazaty, M., Katta, P S., White, D., & Grylack, L. (2003). Prenatal care reduces the impact of illicit drug use on perinatal outcomes. Journal of Perinatology, 23, 354-360.

Hadley, J., & Cunningham, P (2004). Availability of safety net providers and access to care of uninsured persons. Health Services Research, 39(5), 1527-1546.

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Kawachi, L, Daniels, N., & Robinson, D. (2005). Health disparities by race and class: Why both matter. Health Affairs, 24(2), 343-352.

Kotelchuck M. (1994). An evaluation of the Kessner Adequacy of Prenatal-Care Index and a proposed Adequacy of Prenatal-Care Utilization Index. American Journal of Public Health, 84, 1414-1420.

LaVeist, T. A., Nickerson, K J., & Bowie J. V (2000). Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Medical Care Research and Review. 57 (Suppl 1), 146-161.

Lillie-Blanton, M., & Hoffman, C. (2005). The role of health insurance coverage in reducing racial/ethnic disparities in health care. Health Affairs, 24(2), 398-408.

Lillie-Blanton, M., Rushing, O., & Ruiz, S. (2003). Key facts: Race, ethnicity and medical care [Electronic version]. Retrieved December 5, 2006, from wwwldïorg/minorityhealthAipload/Key-I^ct^

MacDorman, M. F, & Mathews, M. F (2008). Recent trends in infant mortality in the United States. NCHS data brief, no 9. Hyattsville, MD: National Center for Health Statistics.

Mead, H., Cartwright-Smith, L., Jones, K., Ramos, C." Siegel, B., Woods, K (2008). Racial and Ethnic Disparities in U.S. Healthcare: A Chartbook. The Commonwealth Fund. Retrieved on June 24, 2009, from ht^://^ and-Ethnic-Disparities-in-U-S-HealthGare- A-Chartbook.aspx

Mikhail, B. L, & Curry, M. A. (1999). Perceived impediments to prenatal care among lowincome women. Western Journal of Nursing Research, 21, 335-355.

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Peterson, J.W, Sterling, Y.M., & Weekes, D. (1997). Access to health care: Perspectives of African American families with chronically ill children. Family and Community Health, 19, 64-77.

Schneider, E. C, Zaslavsky, A. M., & Espstein, A. M. (2002). Racial disparities in the quality of care for enrollees in Medicare managed care. JAMA, 287, 1288-1294.

Sparks, P. J. (2009). Do biological, sociodemographic, and behavioral characteristics explain racial/ethnic disparities in preterm births? Social Science & Medicine, 68, 1667-1675.

van Ryn, M., & Fu, S. S. (2003). Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? American Journal of Public Health, 93, 248-255.

JOURNAL OF PRENATAL AND PERINATAL PSYCHOLOGY AND HEALTH publishes research and clinical articles from the cutting edge of the science of prenatal and perinatal psychology and health. The journal, published quarterly since 1986, is dedicated to the in-depth exploration human reproduction and pregnancy and the mental and emotional development of the unborn and newborn child.

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