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Prenatal Care in Utah: Executive Summary
Improvement in Access, but Persistent Gaps by Mothers’ Race, Ethnicity, and Nativity Status
by Kim Korinek, Ph.D. & Ken R. Smith, Ph.D.
Introduction
Developed at the turn of the 20th century,
prenatal care is seen as one of the most important advances in obstetrics in
the 20th century and its importance in reducing the incidence of
fetal death is widely established (Healy et al. 2006). Prenatal care (PNC) visits provide a setting
and context for education on pregnancy, delivery and infant care, and detection
and treatment of medical conditions that may impede healthy pregnancy and
delivery. Most medical experts
maintain, therefore, that adequate PNC allows for prevention of pregnancy and
delivery complications, and reduction of risk of low birth weight and other
post-natal health problems. In this
study, we examine the determinants of prenatal care utilization among Utah
mothers, seeking to delineate whether race, ethnicity, immigrant status, and a
range of socio-demographic characteristics influence mothers’ risks of
receiving less than adequate prenatal care.
Prenatal Care in Utah
As Utah attains the status of a new immigrant destination,
and as its demographics shift toward greater racial, ethnic, and cultural
diversity, systems of healthcare delivery will face the challenge of reaching
and serving an increasingly diverse body of patients. Ensuring the health of newborns in the state is a crucial step
toward ensuring the health of the state’s future population.
Our analyses of state birth records from 2000 to 2005
reveals that certain subgroups of mothers remain at risk of receiving
inadequate prenatal care – in particular mothers with low levels of education,
those who are unmarried or teenagers at the time of birth, and those who are
outside of the labor force at the time of their pregnancy (and hence likely to
lack insurance coverage and personal income).
These factors point to the importance of informational, social, and
socioeconomic resources for mothers as they attempt to seek care during
pregnancy. Race, ethnicity, and
immigrant status have significant effects on prenatal care utilization in the
state, independent of other maternal characteristics. We find that, controlling for education, marital status, and
other individual and neighborhood level factors, racial ethnic minority women,
in particular American Indians, African Americans, and Latinas, are more likely
than non-Hispanic white women to receive inadequate prenatal care.
Immigrant women constitute a growing proportion of mothers
giving birth in Utah in recent years.
Their utilization of prenatal care, and their subsequent perinatal
health outcomes, presents a mixed picture.
After controlling for certain individual background factors, we find
that immigrant women, both Hispanic and Non-Hispanic, fare better than
non-white minorities with respect to prenatal care utilization in the study
period. This suggests that the social
and economic barriers to healthcare are pronounced not only among newcomers,
but among long resident, socially marginalized groups, in particular American
Indians and African Americans.
While PNC adequacy standards have been widely adopted in the
field of obstetrics, recent research indicates that despite improved access to
prenatal care, racial-ethnic minority women, as compared to non-Hispanic
whites, often continue to be at greater risk of most types of pregnancy
complications and perinatal mortality (Healy et al. 2006). Healy and colleagues conclude that increased
accessibility to early prenatal care has not had the positive effect on
minority communities that was anticipated, and hence they suggest developing
novel and appropriate strategies to reach minority women so as to reduce their
levels of birth complications and perinatal mortality. Thus, for the state of Utah and its
healthcare providers to best ensure maternal and infant health across the
state’s racial, ethnic, and socioeconomic spectrum, existing gaps in prenatal
care access should be addressed, as well as the social, cultural, and economic
differences that divide these populations and influence their receipt of care.
The full report will be posted on the CPPA website www.cppa.utah.edu soon.
References
Healy, Andrew J., Fergal D. Malone, Lisa M. Sullivan, T.
Flint Porter, David A. Luthy, Christine A. Comstock, George Saade, Richard
Berkowitz, Susan Klugman, Lorraine Dugoff, Sabrina Craigo, Ilan Timor-Tritsch,
Stephen R. Carr, Honor M. Wolf, Diana W. Bianchi, and Mary E. D’Alton. 2006. “Early Access to Prenatal Care:
Implications for Racial Disparity in Perinatal Mortality,” Obstetrics and
Gynecology 107(3):625-632.
[PRINTER FRIENDLY VERSION]
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