1
|
Wolf ER, Richards A, Sabo RT, Woolf SH, Nelson BB, Krist AH. Neighborhood Predictors of Poor Prenatal Care and Well-Child Visit Attendance. Matern Child Health J 2024; 28:798-803. [PMID: 37991589 PMCID: PMC11001526 DOI: 10.1007/s10995-023-03844-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE Women and children continue to miss preventive visits. Which neighborhood factors predict inadequate prenatal care (PNC) and well-child visit (WCV) attendance remain unclear. DESCRIPTION In a retrospective case-control study at Virginia Commonwealth University Health System, mothers with less than 50% adherence or initiation after 5 months gestation were eligible as cases and those with ≥ 80% adherence and initiation before 5 months were eligible as controls. Children in the lowest quintile of adherence were eligible as cases and those with ≥ 80% of adherence were eligible as controls. Cases and controls were randomly selected at a 1:2 ratio and matched on birth month. Covariates were derived from the 2018 American Community Survey. A hotspot was defined as a zip code tabulation area (ZCTA) with a proportion of controls less than 0.66. ZCTAs with fewer than 5 individuals were excluded. Weighted quantile regression was used to determine which covariates were most associated with inadequate attendance. ASSESSMENT We identified 38 and 35 ZCTAs for the PNC and WCV analyses, respectively. Five of 11 hotspots for WCV were also hotspots for PNC. Education and income predicted 51% and 34% of the variation in missed PNCs, respectively; language, education and transportation difficulties explained 33%, 29%, and 17% of the variation in missed WCVs, respectively. Higher proportions of Black residents lived in hotspots of inadequate PCV and WCV attendance. CONCLUSION Neighborhood-level factors performed well in predicting inadequate PCV and WCV attendance. The disproportionate impact impact of inadequate PCV and WCV in neighborhoods where higher proportions of Black people lived highlights the potential influence of systemic racism and segregation on healthcare utilization.
Collapse
Affiliation(s)
- Elizabeth R Wolf
- Children's Hospital of Richmond at VCU, 1000 East Broad Street, Richmond, VA, 23219, USA.
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA.
| | - Alicia Richards
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Steven H Woolf
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
- Center on Society and Health, Richmond, VA, USA
| | - Bergen B Nelson
- Children's Hospital of Richmond at VCU, 1000 East Broad Street, Richmond, VA, 23219, USA
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
2
|
da Silva PHA, Aiquoc KM, da Silva Nunes AD, Medeiros WR, de Souza TA, Jerez-Roig J, Barbosa IR. Prevalence of Access to Prenatal Care in the First Trimester of Pregnancy Among Black Women Compared to Other Races/Ethnicities: A Systematic Review and Meta-Analysis. Public Health Rev 2022; 43:1604400. [PMID: 35860809 PMCID: PMC9289875 DOI: 10.3389/phrs.2022.1604400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To analyze the prevalence of access to prenatal care in the first trimester of pregnancy among black women compared to other races/ethnicities through a systematic review and meta-analysis.Methods: Searches were carried out at PUBMED, LILACS, Web of Science, Scopus, CINAHL, and in the grey literature. The quality of the studies and the risk of bias were analyzed using the Joanna Briggs Critical Appraisal Checklist for Analytical Cross-Sectional Studies instrument. The extracted data were tabulatesd and analyzed qualitatively and quantitatively through meta-analysis.Results: Black women had the lowest prevalence of access to prenatal services in the first trimester, with prevalence ranging from 8.1% to 74.81%, while among white women it varied from 44.9 to 94.0%; 60.7% of black women started prenatal care in the first trimester, while 72.9% of white women did so.Conclusion: Black women compared to other racial groups had lower prevalence of access to prenatal care, with less chance of access in the first trimester, and it can be inferred that the issue of race/skin color is an important determinant in obtaining obstetric care.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020159968_, PROSPERO CRD42020159968.
Collapse
Affiliation(s)
| | - Kezauyn Miranda Aiquoc
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Talita Araujo de Souza
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
- *Correspondence: Talita Araujo de Souza,
| | - Javier Jerez-Roig
- Faculty of Health Sciences and Welfare, University of Vic–Central University of Catalonia, Barcelona, Spain
| | | |
Collapse
|
3
|
Wolf ER, Donahue E, Sabo RT, Nelson BB, Krist AH. Barriers to Attendance of Prenatal and Well-Child Visits. Acad Pediatr 2021; 21:955-960. [PMID: 33279734 PMCID: PMC8172669 DOI: 10.1016/j.acap.2020.11.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/19/2020] [Accepted: 11/28/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Prenatal care (PNC) and well child visit (WCV) attendance are associated with improved health outcomes. We aimed to determine if the factors affecting maternal and child attendance are similar or different. METHODS We conducted a retrospective case control study at Virginia Commonwealth University Health System. We used the Adequacy of Prenatal Care Utilization Index and the American Academy of Pediatrics recommendations to assess the adequacy of PNC and WCV attendance, respectively. Mothers with less than 50% visit adherence or initiation after 5 months gestation were eligible as cases and those with 80% or more adherence and initiation before 5 months were eligible as controls. Children in the lowest quintile of adherence were eligible as cases and those with 80% or more adherence were eligible as controls. Cases and controls were randomly selected at a 1:2 ratio from the eligible subjects and frequency matched on birth month. RESULTS In adjusted analyses, mothers and children who were publicly insured or who were uninsured had higher odds of poor preventive visit attendance. Mothers who experienced intimate partner violence and had more living children were more likely to have poor attendance. Children whose mothers had younger age, greater number of pregnancies and transportation difficulties had poorer attendance. CONCLUSIONS While lack of insurance and public insurance remained significantly associated with both poor PNC and WCV attendance, other factors varied between groups. Expanding eligibility requirements and streamlining enrollment and renewal processes may improve two generations of preventive visit attendance.
Collapse
Affiliation(s)
- Elizabeth R. Wolf
- Children’s Hospital of Richmond at VCU, 1000 East Broad Street, Richmond, Virginia 23219,Virginia Commonwealth University Department of Pediatrics, 1000 East Broad Street, Richmond, Virginia
| | - Erin Donahue
- Levine Cancer Institute, Department of Cancer Biostatistics, 1021 Morehead Medical Drive, Charlotte, North Carolina 28204,Virginia Commonwealth University Department of Biostatistics, 830 East Main Street Richmond, Virginia 23219
| | - Roy T. Sabo
- Virginia Commonwealth University Department of Biostatistics, 830 East Main Street Richmond, Virginia 23219
| | - Bergen B. Nelson
- Children’s Hospital of Richmond at VCU, 1000 East Broad Street, Richmond, Virginia 23219,Virginia Commonwealth University Department of Pediatrics, 1000 East Broad Street, Richmond, Virginia
| | - Alex H. Krist
- Virginia Commonwealth University Department of Family Medicine and Population Health, 830 East Main Street, Richmond, Virginia 23219
| |
Collapse
|
4
|
Chen KL, Brozen M, Rollman JE, Ward T, Norris KC, Gregory KD, Zimmerman FJ. How is the COVID-19 pandemic shaping transportation access to health care? Transp Res Interdiscip Perspect 2021; 10:100338. [PMID: 34514368 PMCID: PMC8422279 DOI: 10.1016/j.trip.2021.100338] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 05/22/2023]
Abstract
The Coronavirus disease 19 (COVID-19) pandemic has disrupted both transportation and health systems. While about 40% of Americans have delayed seeking medical care during the pandemic, it remains unclear to what extent transportation is contributing to missed care. To understand the relationship between transportation and unmet health care needs during the pandemic, this paper synthesizes existing knowledge on transportation patterns and barriers across five types of health care needs. While the literature is limited by the absence of detailed data for trips to health care, key themes emerged across populations and settings. We find that some patients, many of whom already experience transportation disadvantage, likely need extra support during the pandemic to overcome new travel barriers related to changes in public transit or the inability to rely on others for rides. Telemedicine is working as a partial substitute for some visits but cannot fulfill all health care needs, especially for vulnerable groups. Structural inequality during the pandemic has likely compounded health care access barriers for low-income individuals and people of color, who face not only disproportionate health risks, but also greater difficulty in transportation access and heightened economic hardship due to COVID-19. Partnerships between health and transportation systems hold promise for jointly addressing disparities in health- and transportation-related challenges but are largely limited to Medicaid-enrolled patients. Our findings suggest that transportation and health care providers should look for additional strategies to ensure that transportation access is not a reason for delayed medical care during and after the COVID-19 pandemic.
Collapse
Affiliation(s)
- Katherine L Chen
- National Clinician Scholars Program, University of California (UCLA), Los Angeles, CA, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Division of General Internal Medicine & Health Services Research, UCLA, Los Angeles, CA, USA
| | - Madeline Brozen
- Lewis Center for Regional Policy Studies at the UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Jeffrey E Rollman
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Tayler Ward
- Lewis Center for Regional Policy Studies at the UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Keith C Norris
- Division of General Internal Medicine & Health Services Research, UCLA, Los Angeles, CA, USA
| | - Kimberly D Gregory
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Cedars Sinai Medical Center & Burnes and Allen Research Institute, Los Angeles, CA, USA
| | - Frederick J Zimmerman
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| |
Collapse
|
5
|
Testa A, Jackson DB. Incarceration Exposure and Barriers to Prenatal Care in the United States: Findings from the Pregnancy Risk Assessment Monitoring System. Int J Environ Res Public Health 2020; 17:E7331. [PMID: 33049968 PMCID: PMC7578954 DOI: 10.3390/ijerph17197331] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 12/20/2022]
Abstract
Previous research demonstrates that exposure to incarceration during pregnancy - either personally or vicariously through a partner - worsens parental care. However, little is known about the specific barriers to parental care that are associated with incarceration exposure. Using data from the Pregnancy Risk Assessment Monitoring System (years 2009-2016), the current study examines the relationship between exposure to incarceration during pregnancy and barriers to prenatal care in the United States. Negative binomial and logistic regression models were used to assess the association between the recent incarceration of a woman or her partner (i.e., incarceration that occurred in the 12 months prior to the focal birth) and several barriers to prenatal care. Findings indicate that exposure to incarceration, either personally or vicariously through a partner, increases the overall number of barriers to prenatal care and this association operates through several specific barriers including a lack of transportation to doctor's appointments, having difficulty finding someone to take care of her children, being too busy, keeping pregnancy a secret, and a woman not knowing she was pregnant. Policies designed to help incarceration exposed women overcome these barriers can potentially yield benefits for enhancing access to parental care.
Collapse
Affiliation(s)
- Alexander Testa
- Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio, TX 78207, USA
| | - Dylan B. Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| |
Collapse
|
6
|
Abstract
Purpose The purpose of this article is to illustrate and discuss the impact the 2019 novel Coronavirus (COVID-19) pandemic on the delivery of obstetric care, including a discussion on the preexisting barriers, prenatal framework and need for transition to telehealth. Description The COVID-19 was first detected in China in December of 2019 and by March 2020 spread to the United States. As this virus has been associated with severe illness, it poses a threat to vulnerable populations—including pregnant women. The obstetric population already faces multiple barriers to receiving quality healthcare due to personal, environmental and economic barriers, now challenged with the additional risks of COVID-19 exposure and limited care in times much defined by social distancing. Assessment The current prenatal care framework requires patients to attend multiple in-office prenatal visits that can exponentially multiply depending on maternal and fetal comorbidities. To decrease the rate of transmission of the COVID-19 and limit exposure to patients, providers in Hillsborough County, Florida (and nationwide) are rapidly transitioning to telehealth. The use of a virtual care model allows providers to reduce in-person visits and incorporate virtual visits into the schedule of prenatal care. Conclusion Due to the COVID-19 pandemic, implementation of telehealth and telehealth have become crucial to ensure the safe and effective delivery of obstetric care. This implementation is one that will continue to require attention to planning, procedures and processes, and thoughtful evaluation to ensure the sustainability of telehealth and telehealth post COVID-19 pandemic.
Collapse
Affiliation(s)
- Kimberly Fryer
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, 6th Floor, Tampa, FL, 33606, USA.
| | - Arlin Delgado
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, 6th Floor, Tampa, FL, 33606, USA
| | - Tara Foti
- Chiles Center, College of Public Health, University of South Florida, 13201Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Chinyere N Reid
- Chiles Center, College of Public Health, University of South Florida, 13201Bruce B Downs Blvd, Tampa, FL, 33612, USA
| | - Jennifer Marshall
- Sunshine Education and Research Center, Chiles Center College of Public Health, University of South Florida, 13201 Bruce B Downs Blvd, Tampa, FL, 33612, USA
| |
Collapse
|
7
|
DiOrio D, Kroeger K, Ross A. Social Vulnerability in Congenital Syphilis Case Mothers: Qualitative Assessment of Cases in Indiana, 2014 to 2016. Sex Transm Dis 2018; 45:447-51. [PMID: 29465662 DOI: 10.1097/OLQ.0000000000000783] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital syphilis occurs when a pregnant woman with syphilis is not diagnosed or treated and the infection is passed in utero, causing severe infant morbidity and mortality. Congenital syphilis is easily prevented if women receive timely and adequate prenatal care. Cases of congenital syphilis are considered indicators of problems in the safety net. However, maternal social and behavioral factors can impede women's care, even when providers follow guidelines. METHODS We reviewed case interviews and maternal records for 23 congenital syphilis cases reported to the Centers for Disease Control and Prevention from Indiana between 2014 and 2016. We used qualitative methods to analyze narrative notes from maternal interviews to learn more about factors that potentially contributed to congenital syphilis cases. RESULTS All providers followed Centers for Disease Control and Prevention and state recommendations for screening and treatment for pregnant women with syphilis. Twenty-one of 23 women had health insurance. The number of prenatal care visits women had was suboptimal; more than one third of women had no prenatal care. Nearly one third of women's only risk factor was sex with a primary male sex partner. The majority of women suffered social vulnerabilities, including homelessness, substance abuse, and incarceration. CONCLUSIONS Despite provider adherence to guidelines and health insurance availability, some pregnant women with syphilis are unlikely to receive timely diagnosis and treatment. Pregnant women at high risk for syphilis may need additional social and material support to prevent a congenital syphilis case. Additional efforts are needed to reach the male partners of vulnerable females with syphilis.
Collapse
|
8
|
Daw JR, Sommers BD. The Affordable Care Act and Access to Care for Reproductive-Aged and Pregnant Women in the United States, 2010-2016. Am J Public Health 2019; 109:565-571. [PMID: 30789761 DOI: 10.2105/ajph.2018.304928] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To estimate the association between the Affordable Care Act (ACA), health insurance coverage, and access to care among reproductive-aged and pregnant women. METHODS We performed an observational study comparing current insurance type, cost-related barriers to medical care, and no usual source of care among reproductive-aged (n = 128 352) and pregnant (n = 2179) female respondents to the National Health Interview Survey in the United States, before (2010-2013) and after (2015-2016) the ACA coverage expansions. RESULTS Among reproductive-aged women, the ACA was associated with a 7.4 percentage-point decrease in the probability of uninsurance (95% confidence interval [CI] = -8.6, -6.2), a 3.6 percentage-point increase in Medicaid (95% CI = 2.5, 4.7), and a 3.1 percentage-point increase in nongroup private coverage (95% CI = 2.1, 4.1). The ACA was also associated with a 1.5 percentage-point decline in cost-related barriers to medical care (95% CI = -2.6, -0.5) and a 2.4 percentage-point reduction in lacking a usual source of care (95% CI = -4.5, -0.3). We did not find significant changes in insurance or cost-related barriers to care for pregnant women. CONCLUSIONS The ACA was associated with expanded insurance coverage and improvements in access to care for women of reproductive age, particularly for those with lower incomes.
Collapse
Affiliation(s)
- Jamie R Daw
- Jamie R. Daw is with the Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY. Benjamin D. Sommers is with the Harvard T. H. Chan School of Public Health and Harvard Medical School/Brigham & Women's Hospital, Boston, MA
| | - Benjamin D Sommers
- Jamie R. Daw is with the Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, NY. Benjamin D. Sommers is with the Harvard T. H. Chan School of Public Health and Harvard Medical School/Brigham & Women's Hospital, Boston, MA
| |
Collapse
|
9
|
Wally MK, Huber LRB, Issel LM, Thompson ME. The Association Between Preconception Care Receipt and the Timeliness and Adequacy of Prenatal Care: An Examination of Multistate Data from Pregnancy Risk Assessment Monitoring System (PRAMS) 2009-2011. Matern Child Health J 2018; 22:41-50. [PMID: 28752273 DOI: 10.1007/s10995-017-2352-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives Prenatal care (PNC) is a critical preventive health service for pregnant women and infants. While timely PNC has been associated with improved birth outcomes, improvements have slowed since the late 1990s. Therefore, focus has shifted to interventions prior to pregnancy. Preconception care is recommended for all women of reproductive age. This study aimed to examine preconception care and its association with timeliness and adequacy of PNC. Methods This retrospective cohort study used data from a large sample of United States first-time mothers (n = 13,509) who participated in the 2009-2011 Pregnancy Risk Assessment Monitoring System in ten states. Timeliness and adequacy of PNC data came from birth certificates, while preconception care receipt was self-reported. Logistic regression provided odds ratios (ORs) and 95% confidence intervals (CIs) to model the association between preconception care receipt and the two PNC outcomes. Results After adjustment, women who received preconception care had statistically significant increased odds of timely (OR 1.30, 95% CI 1.08, 1.57), but not adequate PNC (OR 1.08, 95% CI 0.94, 1.24) as compared to women who did not receive preconception care. Pregnancy intention modified these associations. Associations were strongest among women with intended pregnancies (timely PNC: OR 1.63 and adequate PNC: OR 1.22). Conclusions for Practice Given that untimely PNC is associated with adverse birth outcomes, the observed association warrants increased focus on implementing preconception care. Future studies should investigate how specific components of preconception care are associated with PNC timeliness/adequacy, health behaviors during pregnancy, and birth outcomes.
Collapse
Affiliation(s)
- Meghan K Wally
- Department of Public Health Sciences, UNC Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA.
| | - Larissa R Brunner Huber
- Department of Public Health Sciences, UNC Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - L Michele Issel
- Department of Public Health Sciences, UNC Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Michael E Thompson
- Department of Public Health Sciences, UNC Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| |
Collapse
|
10
|
Abstract
IMPORTANCE The effect of the Affordable Care Act (ACA) dependent coverage provision on pregnancy-related health care and health outcomes is unknown. OBJECTIVE To determine whether the dependent coverage provision was associated with changes in payment for birth, prenatal care, and birth outcomes. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study, using a differences-in-differences analysis of individual-level birth certificate data comparing live births among US women aged 24 to 25 years (exposure group) and women aged 27 to 28 years (control group) before (2009) and after (2011-2013) enactment of the dependent coverage provision. Results were stratified by marital status. MAIN EXPOSURES The dependent coverage provision of the ACA, which allowed young adults to stay on their parent's health insurance until age 26 years. MAIN OUTCOMES AND MEASURES Primary outcomes were payment source for birth, early prenatal care (first visit in first trimester), and adequate prenatal care (a first trimester visit and 80% of expected visits). Secondary outcomes were cesarean delivery, premature birth, low birth weight, and infant neonatal intensive care unit (NICU) admission. RESULTS The study population included 1 379 005 births among women aged 24-25 years (exposure group; 299 024 in 2009; 1 079 981 in 2011-2013), and 1 551 192 births among women aged 27-28 years (control group; 325 564 in 2009; 1 225 628 in 2011-2013). From 2011-2013, compared with 2009, private insurance payment for births increased in the exposure group (36.9% to 35.9% [difference, -1.0%]) compared with the control group (52.4% to 51.1% [difference, -1.3%]), adjusted difference-in-differences, 1.9 percentage points (95% CI, 1.6 to 2.1). Medicaid payment decreased in the exposure group (51.6% to 53.6% [difference, 2.0%]) compared with the control group (37.4% to 39.4% [difference, 1.9%]), adjusted difference-in-differences, -1.4 percentage points (95% CI, -1.7 to -1.2). Self-payment for births decreased in the exposure group (5.2% to 4.3% [difference, -0.9%]) compared with the control group (4.9% to 4.3% [difference, -0.5%]), adjusted difference-in-differences, -0.3 percentage points (95% CI, -0.4 to -0.1). Early prenatal care increased from 70% to 71.6% (difference, 1.6%) in the exposure group and from 75.7% to 76.8% (difference, 0.6%) in the control group (adjusted difference-in-differences, 0.6 percentage points [95% CI, 0.3 to 0.8]). Adequate prenatal care increased from 73.5% to 74.8% (difference, 1.3%) in the exposure group and from 77.5% to 78.8% (difference, 1.3%) in the control group (adjusted difference-in-differences, 0.4 percentage points [95% CI, 0.2 to 0.6]). Preterm birth decreased from 9.4% to 9.1% in the exposure group (difference, -0.3%) and from 9.1% to 8.9% in the control group (difference, -0.2%) (adjusted difference-in-differences, -0.2 percentage points (95% CI, -0.3 to -0.03). Overall, there were no significant changes in low birth weight, NICU admission, or cesarean delivery. In stratified analyses, changes in payment for birth, prenatal care, and preterm birth were concentrated among unmarried women. CONCLUSIONS AND RELEVANCE In this study of nearly 3 million births among women aged 24 to 25 years vs those aged 27 to 28 years, the Affordable Care Act dependent coverage provision was associated with increased private insurance payment for birth, increased use of prenatal care, and modest reduction in preterm births, but was not associated with changes in cesarean delivery rates, low birth weight, or NICU admission.
Collapse
Affiliation(s)
- Jamie R. Daw
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Benjamin D. Sommers
- Department of Health Policy and Management, Health Policy and Economics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts
| |
Collapse
|
11
|
Gonthier C, Estellat C, Deneux-Tharaux C, Blondel B, Alfaiate T, Schmitz T, Oury JF, Mandelbrot L, Luton D, Ravaud P, Azria E. Association between maternal social deprivation and prenatal care utilization: the PreCARE cohort study. BMC Pregnancy Childbirth 2017; 17:126. [PMID: 28506217 PMCID: PMC5433136 DOI: 10.1186/s12884-017-1310-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/17/2017] [Indexed: 11/25/2022] Open
Abstract
Background Maternal social deprivation is associated with an increased risk of adverse maternal and perinatal outcomes. Inadequate prenatal care utilization (PCU) is likely to be an important intermediate factor. The health care system in France provides essential health services to all pregnant women irrespective of their socioeconomic status. Our aim was to assess the association between maternal social deprivation and PCU. Methods The analysis was performed in the database of the multicenter prospective PreCARE cohort study. The population source consisted in all parturient women registered for delivery in 4 university hospital maternity units, Paris, France, from October 2010 to November 2011 (N = 10,419). This analysis selected women with singleton pregnancies that ended after 22 weeks of gestation (N = 9770). The associations between maternal deprivation (four variables first considered separately and then combined as a social deprivation index: social isolation, poor or insecure housing conditions, no work-related household income, and absence of standard health insurance) and inadequate PCU were tested through multivariate logistic regressions also adjusted for immigration characteristics and education level. Results Attendance at prenatal care was poor for 23.3% of the study population. Crude relative risks and confidence intervals for inadequate PCU were 1.6 [1.5–1.8], 2.3 [2.1–2.6], and 3.1 [2.8–3.4], for women with a deprivation index of 1, 2, and 3, respectively, compared to women with deprivation index of 0. Each of the four deprivation variables was significantly associated with an increased risk of inadequate PCU. Because of the interaction observed between inadequate PCU and mother’s country of birth, we stratified for the latter before the multivariate analysis. After adjustment for the potential confounders, this social gradient remained for women born in France and North Africa. The prevalence of inadequate PCU among women born in sub-Saharan Africa was 34.7%; the social gradient in this group was attenuated and no longer significant. Other factors independently associated with inadequate PCU were maternal age, recent immigration, and unplanned or unwanted pregnancy. Conclusion Social deprivation is independently associated with an increased risk of inadequate PCU. Recognition of risk factors is an important step in identifying barriers to PCU and developing measures to overcome them. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1310-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Clémentine Gonthier
- UMR1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University - INSERM, 53 Avenue de l'Observatoire, 75014, Paris, France.,Department of Obstetrics and Gynecology, Beaujon-Bichat Hospital, DHU Risks in Pregnancy, APHP, Paris Diderot University, 46 Rue Henri Huchard, 75018, Paris, France
| | - Candice Estellat
- Epidemiology and clinical research Department, URC Paris-Nord, APHP, 46 Rue Henri Huchard, 75018, Paris, France.,CIC 1425-EC, UMR 1123, INSERM, Paris, France
| | - Catherine Deneux-Tharaux
- UMR1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University - INSERM, 53 Avenue de l'Observatoire, 75014, Paris, France
| | - Béatrice Blondel
- UMR1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University - INSERM, 53 Avenue de l'Observatoire, 75014, Paris, France
| | - Toni Alfaiate
- Epidemiology and clinical research Department, URC Paris-Nord, APHP, 46 Rue Henri Huchard, 75018, Paris, France
| | - Thomas Schmitz
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris Diderot University, 48, boulevard Sérurier, 75019, Paris, France
| | - Jean-François Oury
- Department of Obstetrics and Gynecology, Robert Debré Hospital, AP-HP, Paris Diderot University, 48, boulevard Sérurier, 75019, Paris, France
| | - Laurent Mandelbrot
- Department of Obstetrics and Gynecology, Louis Mourier Hospital, DHU Risks in Pregnancy, AP-HP, Paris Diderot University, 178 Rue des Renouillers, 92700, Colombes, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, Beaujon-Bichat Hospital, DHU Risks in Pregnancy, APHP, Paris Diderot University, 46 Rue Henri Huchard, 75018, Paris, France.,UMR676, Paris Diderot University - INSERM, Paris, France
| | - Philippe Ravaud
- UMR1153 - Méthodes de l'évaluation thérapeutique des maladies chroniques (METHOS research team), INSERM, 1 Place du Parvis de Notre-Dame, 75004, Paris, France
| | - Elie Azria
- UMR1153 - Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé research team), DHU Risks in Pregnancy, Paris Descartes University - INSERM, 53 Avenue de l'Observatoire, 75014, Paris, France. .,Department of Obstetrics and Gynecology, Groupe Hospitalier Paris Saint Joseph, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
| |
Collapse
|
12
|
Abstract
OBJECTIVES Ectopic pregnancy is an important cause of maternal morbidity and mortality. Women who experience fragmented care may undergo unnecessary delays to diagnosis and treatment. Based on ectopic pregnancy cases observed in clinical practice that raised our concern about fragmentation of care, we designed an exploratory study to describe the number, characteristics, and outcomes of fragmented care among patients with ectopic pregnancy at one urban academic hospital. METHODS Chart review with descriptive statistics. Fragmented care was defined as a patient being evaluated at an outside facility for possible ectopic pregnancy and transferred, referred, or discharged before receiving care at the study institution. RESULTS Of 191 women seen for possible or definite ectopic pregnancy during the study period, 42 (22 %) met the study definition of fragmented care. The study was under-powered to observe statistically significant differences across groups, but we found concerning, non-significant trends: patients with fragmented care were more likely to be Medicaid recipients (65.9 vs. 58.8 %) and to experience a complication (23.8 vs. 18.1 %) compared to those with non-fragmented care. Most patients (n = 37) received no identifiable treatment prior to transfer and arrived to the study hospital with no communication to the receiving hospital from the outside provider (n = 34). Nine patients (21 %) presented with ruptured ectopic pregnancies. The fragmentation we observed in our study may contribute to previously identified socio-economic disparities in ectopic pregnancy outcomes. CONCLUSION If future research confirms these findings, health information exchanges and regional coordination of care may be important strategies for reducing maternal mortality.
Collapse
Affiliation(s)
- Debra B Stulberg
- Department of Family Medicine, The University of Chicago, 5841 South Maryland Avenue MC 7110, Suite M - 156, Chicago, IL, 60637, USA. .,Departments of Obstetrics and Gynecology, The University of Chicago, 5841 S. Maryland Ave., MC2050, Chicago, IL, 60637, USA. .,Maclean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA.
| | - Irma Dahlquist
- Department of Family Medicine, The University of Chicago, 5841 South Maryland Avenue MC 7110, Suite M - 156, Chicago, IL, 60637, USA
| | - Christina Jarosch
- Psychiatry Residency Program, University of Minnesota, F282/2A West, 2450 Riverside Avenue South, Minneapolis, MN, 55454, USA
| | - Stacy T Lindau
- Departments of Obstetrics and Gynecology, The University of Chicago, 5841 S. Maryland Ave., MC2050, Chicago, IL, 60637, USA.,Maclean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA.,Department of Medicine - Geriatrics, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
13
|
Beckham AJ, Urrutia RP, Sahadeo L, Corbie-Smith G, Nicholson W. “We Know but We Don’t Really Know”: Diet, Physical Activity and Cardiovascular Disease Prevention Knowledge and Beliefs Among Underserved Pregnant Women. Matern Child Health J 2015; 19:1791-801. [DOI: 10.1007/s10995-015-1693-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
14
|
Heaman MI, Sword W, Elliott L, Moffatt M, Helewa ME, Morris H, Gregory P, Tjaden L, Cook C. Barriers and facilitators related to use of prenatal care by inner-city women: perceptions of health care providers. BMC Pregnancy Childbirth 2015; 15:2. [PMID: 25591945 PMCID: PMC4302607 DOI: 10.1186/s12884-015-0431-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 01/05/2015] [Indexed: 11/28/2022] Open
Abstract
Background Socioeconomic disparities in the use of prenatal care (PNC) exist even where care is universally available and publicly funded. Few studies have sought the perspectives of health care providers to understand and address this problem. The purpose of this study was to elicit the experiential knowledge of PNC providers in inner-city Winnipeg, Canada regarding their perceptions of the barriers and facilitators to PNC for the clients they serve and their suggestions on how PNC services might be improved to reduce disparities in utilization. Methods A descriptive exploratory qualitative design was used. Semi-structured interviews were conducted with 24 health care providers serving women in inner-city neighborhoods with high rates of inadequate PNC. Content analysis was used to code the interviews based on broad categories (barriers, facilitators, suggestions). Emerging themes and subthemes were then developed and revised through the use of comparative analysis. Results Many of the barriers identified related to personal challenges faced by inner-city women (e.g., child care, transportation, addictions, lack of support). Other barriers related to aspects of service provision: caregiver qualities (lack of time, negative behaviors), health system barriers (shortage of providers), and program/service characteristics (distance, long waits, short visits). Suggestions to improve care mirrored the facilitators identified and included ideas to make PNC more accessible and convenient, and more responsive to the complex needs of this population. Conclusions The broad scope of our findings reflects a socio-ecological approach to understanding the many determinants that influence whether or not inner-city women use PNC services. A shift to community-based PNC supported by a multidisciplinary team and expanded midwifery services has potential to address many of the barriers identified in our study. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0431-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Maureen I Heaman
- College of Nursing Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada. .,Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada. .,Department of Obstetrics, Gynecology & Reproductive Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0L8, Canada.
| | - Wendy Sword
- School of Nursing and Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, L8N 3Z5, Canada.
| | - Lawrence Elliott
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada. .,Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0J9, Canada.
| | - Michael Moffatt
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0W3, Canada. .,Department of Pediatrics and Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3A 1S1, Canada.
| | - Michael E Helewa
- Department of Obstetrics, Gynecology & Reproductive Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 0L8, Canada.
| | - Heather Morris
- Faculty of Nursing, University of Alberta, Edmonton, AB, T5G 1C9, Canada.
| | - Patricia Gregory
- Department of Nursing, Red River College, Winnipeg, MB, R3H 0J9, Canada.
| | - Lynda Tjaden
- Public Health, Winnipeg Regional Health Authority, Winnipeg, MB, R3A 0X7, Canada.
| | - Catherine Cook
- Population and Aboriginal Health, Winnipeg Regional Health Authority, Winnipeg, MB, R3B 1E2, Canada.
| |
Collapse
|
15
|
Heaman MI, Moffatt M, Elliott L, Sword W, Helewa ME, Morris H, Gregory P, Tjaden L, Cook C. Barriers, motivators and facilitators related to prenatal care utilization among inner-city women in Winnipeg, Canada: a case-control study. BMC Pregnancy Childbirth 2014; 14:227. [PMID: 25023478 PMCID: PMC4223395 DOI: 10.1186/1471-2393-14-227] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/09/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The reasons why women do not obtain prenatal care even when it is available and accessible are complex. Despite Canada's universally funded health care system, use of prenatal care varies widely across neighborhoods in Winnipeg, Manitoba, with the highest rates of inadequate prenatal care found in eight inner-city neighborhoods. The purpose of this study was to identify barriers, motivators and facilitators related to use of prenatal care among women living in these inner-city neighborhoods. METHODS We conducted a case-control study with 202 cases (inadequate prenatal care) and 406 controls (adequate prenatal care), frequency matched 1:2 by neighborhood. Women were recruited during their postpartum hospital stay, and were interviewed using a structured questionnaire. Stratified analyses of barriers and motivators associated with inadequate prenatal care were conducted, and the Mantel-Haenszel common odds ratio (OR) was reported when the results were homogeneous across neighborhoods. Chi square analysis was used to test for differences in proportions of cases and controls reporting facilitators that would have helped them get more prenatal care. RESULTS Of the 39 barriers assessed, 35 significantly increased the odds of inadequate prenatal care for inner-city women. Psychosocial issues that increased the likelihood of inadequate prenatal care included being under stress, having family problems, feeling depressed, "not thinking straight", and being worried that the baby would be apprehended by the child welfare agency. Structural barriers included not knowing where to get prenatal care, having a long wait to get an appointment, and having problems with child care or transportation. Attitudinal barriers included not planning or knowing about the pregnancy, thinking of having an abortion, and believing they did not need prenatal care. Of the 10 motivators assessed, four had a protective effect, such as the desire to learn how to protect one's health. Receiving incentives and getting help with transportation and child care would have facilitated women's attendance at prenatal care visits. CONCLUSIONS Several psychosocial, attitudinal, economic and structural barriers increased the likelihood of inadequate prenatal care for women living in socioeconomically disadvantaged neighborhoods. Removing barriers to prenatal care and capitalizing on factors that motivate and facilitate women to seek prenatal care despite the challenges of their personal circumstances may help improve use of prenatal care by inner-city women.
Collapse
Affiliation(s)
- Maureen I Heaman
- College of Nursing, Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3T 2N2, Canada
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
- Department of Obstetrics, Gynecology & Reproductive Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0L8, Canada
| | - Michael Moffatt
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
- Department of Pediatrics and Child Health, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
| | - Lawrence Elliott
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3, Canada
- Department of Medical Microbiology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Wendy Sword
- School of Nursing and Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON L8N 3Z5, Canada
| | - Michael E Helewa
- Department of Obstetrics, Gynecology & Reproductive Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0L8, Canada
| | - Heather Morris
- Faculty of Nursing, University of Alberta, Edmonton, AB T5G1C9, Canada
| | - Patricia Gregory
- Women’s Health Program, Winnipeg Regional Health Authority, Winnipeg, MB R3E 0L8, Canada
| | - Lynda Tjaden
- Public Health, Winnipeg Regional Health Authority, Winnipeg, MB R3A 0X7, Canada
| | - Catherine Cook
- Population and Aboriginal Health, Winnipeg Regional Health Authority, Winnipeg, MB R3B 1E2, Canada
| |
Collapse
|
16
|
Haddrill R, Jones GL, Mitchell CA, Anumba DOC. Understanding delayed access to antenatal care: a qualitative interview study. BMC Pregnancy Childbirth 2014; 14:207. [PMID: 24935100 PMCID: PMC4072485 DOI: 10.1186/1471-2393-14-207] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 06/05/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Delayed access to antenatal care ('late booking') has been linked to increased maternal and fetal mortality and morbidity. The aim of this qualitative study was to understand why some women are late to access antenatal care. METHODS 27 women presenting after 19 completed weeks gestation for their first hospital booking appointment were interviewed, using a semi-structured format, in community and maternity hospital settings in South Yorkshire, United Kingdom. Interviews were transcribed verbatim and entered onto NVivo 8 software. An interdisciplinary, iterative, thematic analysis was undertaken. RESULTS The late booking women were diverse in terms of: age (15-37 years); parity (0-4); socioeconomic status; educational attainment and ethnicity. Three key themes relating to late booking were identified from our data: 1) 'not knowing': realisation (absence of classic symptoms, misinterpretation); belief (age, subfertility, using contraception, lay hindrance); 2) 'knowing': avoidance (ambivalence, fear, self-care); postponement (fear, location, not valuing care, self-care); and 3) 'delayed' (professional and system failures, knowledge/empowerment issues). CONCLUSIONS Whilst vulnerable groups are strongly represented in this study, women do not always fit a socio-cultural stereotype of a 'late booker'. We report a new taxonomy of more complex reasons for late antenatal booking than the prevalent concepts of denial, concealment and disadvantage. Explanatory sub-themes are also discussed, which relate to psychological, empowerment and socio-cultural factors. These include poor reproductive health knowledge and delayed recognition of pregnancy, the influence of a pregnancy 'mindset' and previous pregnancy experience, and the perceived value of antenatal care. The study also highlights deficiencies in early pregnancy diagnosis and service organisation. These issues should be considered by practitioners and service commissioners in order to promote timely antenatal care for all women.
Collapse
Affiliation(s)
- Rosalind Haddrill
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Georgina L Jones
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Caroline A Mitchell
- Academic Unit of Primary Medical Care, Samuel Fox House, Northern General Hospital, University of Sheffield, Herries Road, Sheffield S5 7AU, UK
| | - Dilly OC Anumba
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, The Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK
| |
Collapse
|
17
|
Abstract
The federal Healthy Start program began 20 years ago, yet outcome evaluations lack sufficient rigor to draw conclusions on program impact. We evaluated the impact of the Healthy Start program on birth outcomes, prenatal care, and public services utilization. Birth record data for the St. Louis Healthy Start Program (SLHS) and non-SLHS controls (matched using a propensity score technique) were assessed for differences. Propensity score matching techniques matched SLHS to non-SLHS clients on potentially confounding variables for births from years 2006 to 2008. Traditional multivariable logistic regression on the full, unmatched sample was also conducted for comparison. Matching eliminated any prior statistical differences between groups on covariates. 168 controls and 84 SLHS participants remained in the final matched analysis group. Both analysis techniques were similar on all outcomes, revealing significant group differences for low birth weight (matched OR = 0.28, p = 0.023) and prematurity (matched OR = 0.25, p = 0.012) but not for prenatal care (matched OR = 0.76, p = 0.414), or public services utilization (matched OR = 3.31, p = 0.121). Early results for this Healthy Start project are positive in key areas directly impacting infant mortality. However, continued analysis of this program for sustained impact in these areas and ultimately, a reduction in infant mortality is needed. Additionally, more rigorous experimental and quasi-experimental evaluation designs are needed to assess the impact of other Healthy Start programs around the country.
Collapse
Affiliation(s)
- Benjamin P Cooper
- Brown School, Washington University in St. Louis, Campus Box 1009, One Brookings Drive, St. Louis, MO 63130, USA.
| | | | | | | |
Collapse
|
18
|
Wu M, Lagasse LL, Wouldes TA, Arria AM, Wilcox T, Derauf C, Newman E, Shah R, Smith LM, Neal CR, Huestis MA, Dellagrotta S, Lester BM. Predictors of inadequate prenatal care in methamphetamine-using mothers in New Zealand and the United States. Matern Child Health J 2013; 17:566-75. [PMID: 22588827 PMCID: PMC3717345 DOI: 10.1007/s10995-012-1033-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study compared patterns of prenatal care among mothers who used methamphetamine (MA) during pregnancy and non-using mothers in the US and New Zealand (NZ), and evaluated associations among maternal drug use, child protective services (CPS) referral, and inadequate prenatal care in both countries. The sample consisted of 182 mothers in the MA-Exposed and 196 in the Comparison groups in the US, and 107 mothers in the MA-Exposed and 112 in the Comparison groups in NZ. Positive toxicology results and/or maternal report of MA use during pregnancy were used to identify MA use. Information about sociodemographics, prenatal care and prenatal substance use was collected by maternal interview. MA-use during pregnancy is associated with lower socioeconomic status, single marital status, and CPS referral in both NZ and the US. Compared to their non-using counterparts, MA-using mothers in the US had significantly higher rates of inadequate prenatal care. No association was found between inadequate care and MA-use in NZ. In the US, inadequate prenatal care was associated with CPS referral, but not in NZ. Referral to CPS for drug use only composed 40 % of all referrals in the US, but only 15 % of referrals in NZ. In our study population, prenatal MA-use and CPS referral eclipse maternal sociodemographics in explanatory power for inadequate prenatal care. The predominant effect of CPS referral in the US is especially interesting, and should encourage further research on whether the US policy of mandatory reporting discourages drug-using mothers from seeking antenatal care.
Collapse
Affiliation(s)
- Min Wu
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women and Infants Hospital, Providence, RI, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Doran KM, Colucci AC, Hessler RA, Ngai CK, Williams ND, Wallach AB, Tanner M, Allen MH, Goldfrank LR, Wall SP. An Intervention Connecting Low-Acuity Emergency Department Patients With Primary Care: Effect on Future Primary Care Linkage. Ann Emerg Med 2013; 61:312-321.e7. [DOI: 10.1016/j.annemergmed.2012.10.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 08/22/2012] [Accepted: 10/15/2012] [Indexed: 11/21/2022]
|
20
|
Bryant AS, Nakagawa S, Gregorich SE, Kuppermann M. Race/Ethnicity and pregnancy decision making: the role of fatalism and subjective social standing. J Womens Health (Larchmt) 2012; 19:1195-200. [PMID: 20469962 DOI: 10.1089/jwh.2009.1623] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Rates of unintended pregnancy in the United States differ by race and ethnicity. We examined whether these differences might be explained by maternal fatalism and subjective social standing. METHODS We used data from 1070 pregnant women of sociodemographically diverse backgrounds enrolled in prenatal care in the San Francisco Bay area. Logistic regression was used to explore the relationship between attitude variables and a measure of pregnancy decision making ("not trying to get pregnant"). RESULTS African American women were more likely than others to report not trying to get pregnant with the current pregnancy (adjusted odds ratio [AOR] 2.04, 95% confidence interval [95% CI] 1.22-3.43, p = 0.007). Higher subjective social standing was associated with a lower likelihood of not trying among white and U.S.-born women only (AOR 0.67, p = 0.001 and AOR 0.75, p < 0.001, respectively. Fatalism was associated with not trying in bivariate but not multivariable analyses. CONCLUSIONS In this population, the likelihood of reporting not trying to get pregnant was higher among racial/ethnic minorities regardless of subjective social standing. Programs aimed at reduction in unintended pregnancy rates need to be targeted to a broader population of women.
Collapse
Affiliation(s)
- Allison S Bryant
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California 94143-0132, USA.
| | | | | | | |
Collapse
|
21
|
Liang YW, Chang HP, Lin YH, Lin LY, Chen WY. Factors affecting adequate prenatal care and the prenatal care visits of immigrant women to Taiwan. J Immigr Minor Health 2014; 16:44-52. [PMID: 23065308 DOI: 10.1007/s10903-012-9734-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This paper investigates prenatal care utilization, identifies factors affecting the adequacy of prenatal care, and explores the effect of adequate initial timing of prenatal care on total prenatal care visits among Taiwan new immigrant females. Data was obtained from the 2008 Prenatal Care Utilization among Taiwan New Immigrant Females Survey on women who either had at least one preschool-aged child or had delivered their infants but were still hospitalized (N = 476). The Adequacy of Prenatal Care Utilization Index was applied to rate the prenatal care adequacy. The logistic regression model was used to investigate factors associated with the adequacy of prenatal care utilization, and the linear regression model was estimated to identify the impact of influential factors on the prenatal care usage. Females' nationality, employment, and transportation convenience increased the likelihood of receiving adequate prenatal care. Having adequate initial timing of prenatal care was found to be positively related to the frequency of prenatal care visits. Prenatal care utilization can be affected by factors within the health care system and by characteristics of the population; therefore, a measure of prenatal care utilization cannot distinguish these factors but reflects the result of all of them in varying combinations.
Collapse
|
22
|
Shoff C, Yang TC, Matthews SA. What has geography got to do with it? Using GWR to explore place-specific associations with prenatal care utilization. GeoJournal 2012; 77:331-341. [PMID: 23408146 PMCID: PMC3569028 DOI: 10.1007/s10708-010-9405-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We use a geographically weighted regression (GWR) approach to examine how the relationships between a set of predictors and prenatal care vary across the continental US. At its most fundamental, GWR is an exploratory technique that can facilitate the identification of areas with low prenatal care utilization and help better understand which predictors are associated with prenatal care at specific locations. Our work complements existing prenatal care research in providing an ecological, place-sensitive analysis. We found that the percent of the population who was uninsured was positively associated with the percent of women receiving late or no prenatal care in the global model. The GWR map not only confirmed, but also demonstrated the spatial varying association. Additionally, we found that the number of Ob-Gyn doctors per 100,000 females of childbearing age in a county was associated with the percentage of women receiving late or no prenatal care, and that a higher value of female disadvantage is associated with higher percentages of late or no prenatal care. GWR offers a more nuanced examination of prenatal care and provides empirical evidence in support of locally tailored health policy formation and program implementation, which may improve program effectiveness.
Collapse
Affiliation(s)
- Carla Shoff
- Department of Agricultural Economics and Rural Sociology, and The Population Research Institute, The Pennsylvania State University, 13 Armsby Building, University Park, PA 16802 U.S.A.,
| | - Tse-Chuan Yang
- Social Science Research Institute, The Pennsylvania State University, 803 Oswald Tower, University Park, PA 16802 U.S.A.,
| | - Stephen A. Matthews
- Associate Professor of Sociology, Anthropology and Demography, Population Research Institute, Social Science Research Institute, The Pennsylvania State University, 507 Oswald Tower, University Park, PA 16802 U.S.A.,
| |
Collapse
|
23
|
|
24
|
Baker E, Rajasingam D. Using Trust databases to identify predictors of late booking for antenatal care within the UK. Public Health 2012; 126:112-6. [DOI: 10.1016/j.puhe.2011.10.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Revised: 02/24/2011] [Accepted: 10/25/2011] [Indexed: 11/30/2022]
|
25
|
|
26
|
Choté AA, Koopmans GT, Redekop WK, de Groot CJM, Hoefman RJ, Jaddoe VWV, Hofman A, Steegers EAP, Mackenbach JP, Trappenburg M, Foets M. Explaining ethnic differences in late antenatal care entry by predisposing, enabling and need factors in The Netherlands. The Generation R Study. Matern Child Health J 2011; 15:689-99. [PMID: 20533083 PMCID: PMC3131512 DOI: 10.1007/s10995-010-0619-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Despite compulsory health insurance in Europe, ethnic differences in access to health care exist. The objective of this study is to investigate how ethnic differences between Dutch and non-Dutch women with respect to late entry into antenatal care provided by community midwifes can be explained by need, predisposing and enabling factors. Data were obtained from the Generation R Study. The Generation R Study is a multi-ethnic population-based prospective cohort study conducted in the city of Rotterdam. In total, 2,093 pregnant women with a Dutch, Moroccan, Turkish, Cape Verdean, Antillean, Surinamese Creole and Surinamese Hindustani background were included in this study. We examined whether ethnic differences in late antenatal care entry could be explained by need, predisposing and enabling factors. Subsequently, logistic regression analysis was used to assess the independent role of explanatory variables in the timing of antenatal care entry. The main outcome measure was late entry into antenatal care (gestational age at first visit after 14 weeks). With the exception of Surinamese-Hindustani women, the percentage of mothers entering antenatal care late was higher in all non-Dutch compared to Dutch mothers. We could explain differences between Turkish (OR = 0.95, CI: 0.57–1.58), Cape Verdean (OR = 1.65. CI: 0.96–2.82) and Dutch women. Other differences diminished but remained significant (Moroccan: OR = 1,74, CI: 1.07–2.85; Dutch Antillean OR 1.80, CI: 1.04–3.13). We found that non-Dutch mothers were more likely to enter antenatal care later than Dutch mothers. Because we are unable to explain fully the differences regarding Moroccan, Surinamese-Creole and Antillean women, future research should focus on differences between 1st and 2nd generation migrants, as well as on language barriers that may hinder access to adequate information about the Dutch obstetric system.
Collapse
Affiliation(s)
- A A Choté
- Department of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
The provision of preconception and prenatal care is a critical and time-honored role for family physicians. It could even be termed the first preventive care a human being receives. It has been suggested by some studies that, because of the continuity of care that is considered a cornerstone of family practice, family physicians provide prenatal care that may improve birth outcome. Although prenatal care is acknowledged as important for a healthy pregnancy and delivery, there is debate regarding the true efficacy of prenatal care.
Collapse
Affiliation(s)
- Erin Kate Dooley
- Médicos Para La Familia, Department of Surgical Family Medicine, 3030 Covington Pike, Memphis, TN 38128, USA.
| | | |
Collapse
|
28
|
Weir S, Posner HE, Zhang J, Willis G, Baxter JD, Clark RE. Predictors of prenatal and postpartum care adequacy in a medicaid managed care population. Womens Health Issues 2011; 21:277-85. [PMID: 21565526 DOI: 10.1016/j.whi.2011.03.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 03/09/2011] [Accepted: 03/09/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To examine factors affecting prenatal and postpartum care for an insured, but vulnerable, population. METHODS Individual-level data on three measures of care adequacy were obtained for Massachusetts Medicaid Managed Care women who met the National Committee on Quality Assurance's Healthcare Effectiveness Data and Information Set denominator criteria for the prenatal and postpartum care measures in 2007 (n = 1,882). We modeled individual compliance with each measure separately as a binomial logistic function with individual and neighborhood characteristics, provider type, and health plan as explanatory variables. FINDINGS In our sample, 85% of women initiated care in the first trimester, but only 62% met the goal of receiving more than 80% of the recommended number of prenatal visits. Just 60% had a timely postpartum care visit. Having a diagnosis of substance abuse or dependence reduced the odds of meeting all measures. Women with disabilities were less likely to attain two of the three measures of adequate care, as were women with other children in the household. Women who enrolled in Medicaid in the first trimester were more likely to receive the recommended number of prenatal visits than those who were enrolled before pregnancy. CONCLUSION Given the importance of prenatal and postpartum care for maternal and child health and the recent national declining trend in timely care, initiatives to improve rates of timely and adequate care are crucial and must include components tailored toward particularly vulnerable subpopulations.
Collapse
Affiliation(s)
- Sharada Weir
- Center for Health Policy and Research, Commonwealth Medicine, University of Massachusetts Medical School, Shrewsbury, Massachusetts, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Schillaci MA, Waitzkin H, Carson EA, Romain SJ. Prenatal care utilization for mothers from low-income areas of New Mexico, 1989-1999. PLoS One 2010; 5:e12809. [PMID: 20862298 PMCID: PMC2941446 DOI: 10.1371/journal.pone.0012809] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 08/20/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prenatal care is considered to be an important component of primary health care. Our study compared prenatal care utilization and rates of adverse birth outcomes for mothers from low- and higher-income areas of New Mexico between 1989 and 1999. METHODOLOGY/PRINCIPAL FINDINGS Prenatal care indicators included the number of prenatal care visits and the first month of prenatal care. Birth outcome indicators included low birth weight, premature birth, and births linked with death certificates. The results of our study indicated that mothers from low-income areas started their prenatal care significantly later in their pregnancies between 1989 and 1999, and had significantly fewer prenatal visits between 1989 and 1997. For the most part, there were not significant differences in birth outcome indicators between income groupings. CONCLUSIONS/SIGNIFICANCE These findings suggest that while mothers from low-income areas received lower levels of prenatal care, they did not experience a higher level of adverse birth outcomes.
Collapse
Affiliation(s)
- Michael A Schillaci
- Department of Social Sciences, University of Toronto Scarborough, Scarborough, Ontario, Canada.
| | | | | | | |
Collapse
|
30
|
Abstract
The primary objective for prenatal care has not changed in the past 100 years: to have the pregnancy end with a healthy baby and mother. By identifying risk factors for pregnancy complications or other maternal health concerns that need to be addressed, the provider hopes to optimize pregnancy outcome. By using a series of screening and diagnostic tests, as well as serially trending certain components of the physical examination, the provider monitors the ongoing "health" of the pregnancy. As the ability to screen and intervene has improved over the last century, the issues to be assessed have expanded to include not only medical aspects of care but also barriers to access, psychologic considerations, and patient education about general health, pregnancy, and childbirth.
Collapse
Affiliation(s)
- Sharon T Phelan
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA.
| |
Collapse
|
31
|
Sunil TS, Spears WD, Hook L, Castillo J, Torres C. Initiation of and barriers to prenatal care use among low-income women in San Antonio, Texas. Matern Child Health J 2008; 14:133-40. [PMID: 18843529 DOI: 10.1007/s10995-008-0419-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 09/24/2008] [Indexed: 10/21/2022]
Abstract
Healthy People 2010 goals set a target of 90% of mothers starting prenatal care in the first trimester of pregnancy. While there are questions about the value of prenatal care (PNC), there is much observational evidence of the benefits of PNC including reduction in maternal, fetal, perinatal, and infant deaths. The objective of this study was to understand barriers to PNC as well as factors that impact early initiation of care among low-income women in San Antonio, Texas. A survey study was conducted among low-income women seeking care at selected public health clinics in San Antonio. Interviews were conducted with 444 women. Study results show that women with social barriers, those who were less educated, who were living alone (i.e. without an adult partner or spouse), or who had not planned their pregnancies were more likely to initiate PNC late in their pregnancies. It was also observed that women who enrolled in the WIC program were more likely to initiate PNC early in their pregnancies. Women who initiated PNC late in pregnancy had the highest odds of reporting service-related barriers to receiving care. However, financial and personal barriers created no significant obstacles to women initiating PNC. The majority of women in this study reported that they were aware of the importance of PNC, knew where to go for care during pregnancy, and were able to pay for care through financial assistance, yet some did not initiate early prenatal care. This clearly establishes that the decision making process regarding PNC is complex. It is important that programs consider the complexity of the decision-making process and the priorities women set during pregnancy in planning interventions, particularly those that target low-income women. This could increase the likelihood that these women will seek PNC early in their pregnancies.
Collapse
Affiliation(s)
- T S Sunil
- Department of Sociology, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA.
| | | | | | | | | |
Collapse
|
32
|
Foster DG, Biggs MA, Ralph LJ, Arons A, Brindis CD. Family planning and life planning reproductive intentions among individuals seeking reproductive health care. Womens Health Issues 2008; 18:351-9. [PMID: 18485738 DOI: 10.1016/j.whi.2008.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 02/08/2008] [Accepted: 02/27/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Little research has focused on men and women's reproductive intentions before pregnancy and their perceived personal and social motivations to prevent an unintended pregnancy. METHODS To assess the reproductive intentions of low-income men and women in California, we asked individuals seeking reproductive health services about their plans for childbearing, including an ideal timeframe and perceived advantages of delay. We also asked about their health care visit to examine how contraceptive use and services relate to reproductive intentions. RESULTS The majority (77%) of the 1,409 reproductive health clients surveyed wanted to have a/another child, but hoped to delay childbearing by an average of 5.4 years. The most common reasons for wanting to delay pregnancy were related to finances (24%) or education (19%), with differences by race/ethnicity and gender. We did not observe a clear relationship between the length of time the client wanted to delay pregnancy and the type of contraceptive method dispensed during the clinic visit. CONCLUSIONS Individuals seeking reproductive health care perceive many personal benefits to planning and timing their pregnancies, and most will need many years of contraceptive protection to achieve their reproductive goals. Providers should work with their patients to ensure that they receive a contraceptive method that is consistent with the length of pregnancy prevention they desire.
Collapse
|
33
|
Lin ML, Wang HH. Prenatal examination behavior of Southeast Asian pregnant women in Taiwan: A questionnaire survey. Int J Nurs Stud 2008; 45:697-705. [PMID: 17339036 DOI: 10.1016/j.ijnurstu.2006.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2006] [Revised: 11/30/2006] [Accepted: 12/10/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is growing concern about the factors affecting the prenatal examinations of immigrant women. OBJECTIVES The purpose of this study was to examine the relationships between the knowledge of pregnancy, attitude toward pregnancy and experience of medical services, and prenatal examination behavior of pregnant Southeast Asian women in Taiwan. DESIGN This was a cross-sectional study with a structured questionnaire administered to participants. SETTING Participants were recruited from the community health centers in Kaohsiung County, Taiwan. PARTICIPANTS The sampling criteria were as follows: each subject was to (a) have come from a Southeast Asian country, (b) be over 28 weeks pregnant to less than one year postpartum, (c) be able to communicate either in Mandarin or Taiwanese, and (d) be willing to participate in the research after hearing an explanation of it. As a result, 140 participants were recruited. A total of 132 participants completed the questionnaire and were used for data analysis. METHODS The participants completed structured questionnaires, which included the Demographic Inventory Scale, Knowledge of Pregnancy Scale, Attitudes toward Pregnancy Scale, Experience of Medical Services Scale and the Prenatal Examination Behavior Scale. RESULTS Findings show that 80.3% of the subjects attended their first-time prenatal examination during the first trimester and 59.1% of the subjects evaluated their prenatal examinations as being adequate. Their attitude toward childbearing was significantly correlated with their prenatal examination behavior, including the initial time of prenatal examination and frequencies of prenatal examinations during pregnancy. Positive attitudes toward childbearing and prenatal examination, and the number of years spent in Taiwan were all significant predictive factors of frequencies of prenatal examinations during pregnancy. The findings of this study can not only help healthcare professionals understand the prenatal examination behavior and related factors of the participants, but also provide guidance to healthcare professionals as they assist these pregnant Southeast Asian women in Taiwan in developing childbearing and family plans. CONCLUSION The attitude toward childbearing of the participants was significantly correlated with their prenatal examination behavior. They require professional help in seeking out appropriate medical services that will improve their healthcare quality during pregnancy.
Collapse
Affiliation(s)
- Miao-Ling Lin
- Health Bureau of Kaohsiung County, Health Promotion Section, No, 830-1, Chengging Rd., Niaosong Shiang, Kaohsiung County 830, Taiwan, ROC
| | | |
Collapse
|
34
|
Bennett I, Switzer J, Aguirre A, Evans K, Barg F. 'Breaking it down': patient-clinician communication and prenatal care among African American women of low and higher literacy. Ann Fam Med 2006; 4:334-40. [PMID: 16868237 PMCID: PMC1522153 DOI: 10.1370/afm.548] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 11/22/2005] [Accepted: 01/30/2006] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Low literacy has been associated with poor medical adherence, but its role in maternal care utilization has not been explored. METHODS We undertook a concurrent mixed methods study among 202 African American women of low (< or = 6th grade) and higher literacy receiving Medicaid. Poor use of prenatal care was defined by (1) starting care after the first trimester and (2) inadequate care utilization according to the Adequacy of Prenatal Care Utilization Index (APNCU). Participant-derived themes regarding prenatal care and care utilization were identified and explored through individual interviews (free listing and cultural consensus analysis; n = 40), and 4 confirmatory focus groups stratified by literacy. RESULTS Thirty-three women (16%) had low-literacy levels, 120 (61%) women started prenatal care after the first trimester, and 101 (50%) had inadequate utilization of prenatal care. Neither measure varied by literacy (P >.05). Cultural consensus analysis identified a single prenatal care factor that was comprised of 9 items, shared by women of low and higher literacy (eigenvalue 0.881, SD 0.058). Focus groups confirmed these items among participants from both literacy groups. Communication with clinicians was a central theme linking all of the factor items. Effective communication, exemplified by "breaking it down," was described as encouraging, whereas ineffective communication discouraged use of care. CONCLUSION Women who had both low- and higher-literacy skills had high rates of poor prenatal care utilization and reported that communication with clinicians influenced their use of prenatal care. Improving the clarity of communication by breaking down information into simple parts should be a priority for prenatal clinicians.
Collapse
Affiliation(s)
- Ian Bennett
- Department of Family Practice and Community Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | | | | | | | | |
Collapse
|
35
|
Abstract
OBJECTIVE We explored methods and potential applications of a systematic approach to studying and monitoring social disparities in health and health care. METHODS Using delayed or no prenatal care as an example indicator, we (1) categorized women into groups with different levels of underlying social advantage; (2) described and graphically displayed rates of the indicator and relative group size for each social group; (3) identified and measured disparities, calculating relative risks and rate differences to compare each group with its a priori most-advantaged counterpart; (4) examined changes in rates and disparities over time; and (5) conducted multivariate analyses for the overall sample and "at-risk" groups to identify particular factors warranting attention. RESULTS We identified at-risk groups and relevant factors and suggest ways to direct efforts for reducing prenatal care disparities. CONCLUSIONS This systematic approach should be useful for studying and monitoring disparities in other indicators of health and health care.
Collapse
Affiliation(s)
- Paula A Braveman
- Center on Social Disparities in Health, Department of Family and Community Medicine, University of California, San Francisco, CA 94143-0900, USA.
| | | | | | | |
Collapse
|
36
|
Abstract
Many studies have found evidence for the importance of antenatal care on pregnancy outcomes. This paper focuses on the determinants of antenatal care use in Taiwan and provides a comparison of access to care before and after National Health Insurance (NHI) was implemented in 1995. A negative binomial model is applied to data from the 1989 and 1996 Taiwan Maternal and Infant Health Surveys to analyze antenatal care use. The results show that women in some situations had more antenatal care visits than average regardless of NHI implementation. These situations include: having a highly educated husband; gaining more weight than average during pregnancy; experiencing a first pregnancy; carrying twins or triplets; having care provided by a doctor rather than other caregivers; and switching to another health care facility during pregnancy. Regarding societal change, the trend toward delaying pregnancy is causing a change in care use. Additionally, three changes in care patterns after NHI are noteworthy. First, antenatal care visits at maternity clinics increased more than visits at hospitals. Second, before NHI's implementation, women who did blue-collar work or farm work sought care more frequently than housewives, but after NHI began government employees and businesswomen sought care more frequently. Third, antenatal care visits of mothers living in Taiwan's central area increased more than visits of those in the northern area. The expansion of medical care in aboriginal areas and outlying islands may prove to be one of NHI's best achievements.
Collapse
Affiliation(s)
- Chin-Shyan Chen
- Department of Economics, National Taipei University, Taipei, Taiwan.
| | | | | |
Collapse
|
37
|
Adams EK, Gavin NI, Handler A, Manning W, Raskind-Hood C. Transitions in insurance coverage from before pregnancy through delivery in nine states, 1996-1999. Health Aff (Millwood) 2003; 22:219-29. [PMID: 12528854 DOI: 10.1377/hlthaff.22.1.219] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Efforts to extend coverage to pregnant women, along with an expanding economy, did not prevent increases in the uninsured in the latter 1990s. Welfare reform may have led to declining Medicaid enrollments and caseloads. Data representative of live births in nine states show that in some states more than one-third of all pregnant women and almost two-thirds of low-income pregnant women lacked insurance before their pregnancy in 1996 and 1999. More than one-third of all pregnant women made some change in coverage by the time they delivered their baby. Among low-income women, the largest change was from uninsured status before pregnancy to Medicaid at delivery.
Collapse
Affiliation(s)
- E Kathleen Adams
- Department of Health Policy and Management, Emory University, Atlanta, USA
| | | | | | | | | |
Collapse
|
38
|
Abstract
PURPOSE This exploratory study described the prenatal care experience in the public and private arena from the perceptions of childbearing women using interpretive interactionism. DATA SOURCES A face-to-face interview comprised of eight open-ended questions was used to obtain pregnant women's perceptions of their prenatal care experience and prenatal care needs. The purposive sample consisted of six women who received private prenatal care and 14 women who received public prenatal care. CONCLUSIONS Five essential elements of the prenatal care experience were identified. Prenatal care was viewed as a cooperative effort between informal self-care and formal care by health professionals. Issues related to individuality and normality were important considerations in the delivery of prenatal care. IMPLICATIONS FOR PRACTICE Controversy exists over the effectiveness of prenatal care in preventing poor outcomes, as the definition of what constitutes adequate prenatal care remains unclear. Advanced practice nurses (APNs) continue to play a pivotal role in the provision of prenatal care services. The expanded knowledge and skills possessed by APNs place them in a pivotal position to develop and implement individualized, developmentally appropriate prenatal care that the women in this study so desperately wanted. In addition, they can assist women in continuing the health promoting behaviors initiated prenatally through out their lifespan.
Collapse
|
39
|
Abstract
OBJECTIVES This study examined the relationship between timing of insurance coverage and prenatal care among low-income women. METHODS Timeliness of prenatal care initiation and adequacy of number of visits were studied among 5455 low-income participants in a larger cross-sectional statewide survey of postpartum women in California during 1994-1995. RESULTS Although only 2% of women remained uninsured throughout pregnancy, one fifth lacked coverage during the first trimester. Rates of untimely care were highest (> or =64%) among women who were uninsured throughout their pregnancy or whose coverage began after the first trimester; rates were lowest (about 10%) among women who obtained coverage during the first trimester. Women who first obtained Medi-Cal coverage during pregnancy were at low risk of having too few visits. CONCLUSIONS Timing of prenatal coverage should be considered in research on the relationship between coverage and care use among low-income women. Earlier studies that relied solely on principal payer information, without data on when coverage began, may have led to inaccurate inferences about lack of coverage as a barrier to prenatal care.
Collapse
Affiliation(s)
- Susan Egerter
- Department of Family and Community Medicine, School of Medicine, University of California, Box 0900, San Francisco, CA 94143, USA.
| | | | | |
Collapse
|
40
|
Braveman P, Cubbin C, Marchi K, Egerter S, Chavez G. Measuring socioeconomic status/position in studies of racial/ethnic disparities: Maternal and infant health. Public Health Rep 2001. [DOI: 10.1016/s0033-3549(04)50073-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
41
|
Braveman P, Cubbin C, Marchi K, Egerter S, Chavez G. Measuring socioeconomic status/position in studies of racial/ethnic disparities: maternal and infant health. Public Health Rep 2001; 116:449-63. [PMID: 12042609 PMCID: PMC1497365 DOI: 10.1093/phr/116.5.449] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Theoretical and empiric considerations raise concerns about how socioeconomic status/position (abbreviated here as SES) is often measured in health research. The authors aimed to guide the use of two common socioeconomic indicators, education and income, in studies of racial/ethnic disparities in low birthweight, delayed prenatal care, unintended pregnancy, and breastfeeding intention. METHODS Data from a statewide postpartum survey in California (N = 10,055) were linked to birth certificates. Overall and by race/ethnicity, the authors examined: (a) correlations among several measures of education and income; (b) associations between each SES measure and health indicator; and (c) racial/ethnic disparities in the health indicators "adjusting" for different SES measures. RESULTS Education-income correlations were moderate and varied by race/ethnicity. Racial/ethnic associations with the health indicators varied by SES measure, how SES was specified, and by health indicator. CONCLUSIONS Conclusions about the role of race/ethnicity could vary with how SES is measured. Education is not an acceptable proxy for income in studies of ethnically diverse populations of childbearing women. SES measures generally should be outcome- and population-specific, and chosen on explicit conceptual grounds; researchers should test multiple theoretically appropriate measures and consider how conclusions might vary with how SES is measured. Researchers should recognize the difficulty of measuring SES and interpret findings accordingly.
Collapse
Affiliation(s)
- P Braveman
- Department of Family and Community Medicine, University of California, San Francisco, 94143, USA.
| | | | | | | | | |
Collapse
|
42
|
Abstract
OBJECTIVES To describe the characteristics and risk factors of women with only third-trimester (late) or no prenatal care. METHODS A statewide postpartum survey was conducted that included 6364 low-income women delivering in California hospitals in 1994 and 1995. RESULTS The following factors appeared most important, considering both prevalence and association with late or no care: poverty, being uninsured, multiparity, being unmarried, and unplanned pregnancy. Forty-two percent of women with no care were uninsured, and uninsured women were at dramatically increased risk of no care. Over 40% of uninsured women with no care had applied for Medi-Cal prenatally but did not receive it. Risks did not vary by ethnicity except that African American women were at lower risk of late care than women of European background. Child care problems were not significantly associated with either late or no care, and transportation problems (not asked of women with no care) were not significantly related to late care. CONCLUSIONS Lack of insurance appeared to be a significant barrier for the 40% of women with no care who unsuccessfully applied for Medi-Cal prenatally, indicating a need to address barriers to Medi-Cal enrollment. However, lack of financial access is unlikely to completely explain the dramatic risks associated with being uninsured. In addition to eliminating barriers to prenatal coverage, policies to reduce late/no care should focus on pre-pregnancy factors (e.g., planned pregnancy and poverty reduction) rather than on logistical barriers during pregnancy.
Collapse
Affiliation(s)
- M Nothnagle
- Department of Family Medicine, Brown University, Providence, Rhode Island, USA
| | | | | | | |
Collapse
|