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Quality matters: redefining prenatal care adequacy
Dissertation

Quality matters: redefining prenatal care adequacy

Amanda Marie Boyle Doty
Doctor of Public Health (Dr.P.H.), Drexel University
Mar 2026
DOI:
https://doi.org/10.17918/00011322
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Doty_Amanda_2026947.97 kB
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Abstract

Prenatal care adequacy Prenatal care utilization
There is an urgent, ongoing maternal health crisis in the United States, which demands immediate action to ensure adequate prenatal care. Prenatal care is associated with healthy maternal and child health outcomes; however, traditional indices of prenatal care adequacy primarily measure only utilization. Prenatal care initiation and frequency of visits may not fully capture patient priorities for prenatal care adequacy. There are literature gaps in identifying patient perspectives, priorities, and definitions of prenatal care adequacy. This dissertation uses mixed methods to explore the dimensions and concept of prenatal care adequacy. This dissertation consists of three distinct, yet interconnected papers focused on prenatal care adequacy. These three works (1) evaluate one dimension of prenatal care adequacy (utilization) in a local context, along with barriers to and documentation practices for prenatal care use, (2) compare patient prenatal care adequacy ratings with satisfaction, perceived quality, and utilization categories, and (3) explore patient definitions of adequate prenatal care. Collectively, findings from these works suggest that utilization-based indices provide an incomplete assessment of prenatal care adequacy. This dissertation advances a patient-centered framework for measuring prenatal care adequacy.

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