A public health perspective of women's experiences of antenatal care: an exploration of insights from a community consultation.

OBJECTIVES: to offer a critical discussion from a public health perspective of service user's experiences of antenatal care services. DESIGN: a qualitative, descriptive study using 18 group (n = 86) and six individual semi-structured interviews (n = 6) with thematic networks analysis conducted. SETTING: ninety-two participants recruited from organisations/groups who work with vulnerable populations and/or community groups were consulted in the North West of England. FINDINGS: analysis from a public health perspective suggested four key areas: antenatal care attendance, the frequency of antenatal appointments, the location of antenatal care and the provision of risk information. The benefits of universal access to antenatal care were mainly evident to participants. The need for targeting those with identified clinical risk was valued, but participants expressed frustration at a 'one-size fits all' approach for others, which failed to adequately consider their psychosocial and educational needs. In some women, this failure prompted non-compliant behaviour. Concerns were somewhat compensated for by community-based antenatal services. CONCLUSIONS AND RECOMMENDATIONS: inequities in antenatal care persist with service users from vulnerable population groups continuing to express that these services do not meet their needs. Neither a targeted approach based on clinical needs nor a population-based approach, which service users feel limits access, meet their expectations. Proportionate universalism offers a new paradigm in public health with level of service proportionate to need. Such an approach may facilitate health-care staff to meet the expectations of vulnerable families who may require more psychosocial and educational support.

Life as a league table bottom dweller: teenage pregnancy in Lambeth.

In mid-2004, the lead for tackling teenage pregnancy in Lambeth moved from the Council to Public Health in the coterminous Primary Care Trust. Lambeth is a deprived inner-city London borough with a culturally rich and diverse population. The under-18 teenage conception rate had risen by 19% over the 5-year period (1998-2003) following the launch of the National Teenage Pregnancy Strategy. There was considerable pressure from local and national agencies to reduce this high rate (then standing at twice the English average). This article describes how we attempted to do this.