Inequities in Adequacy of Prenatal Care and Shifts in Rural/Urban Differences Early in the COVID-19 Pandemic

Abstract

BackgroundAdequate prenatal care is vital for positive maternal, fetal, and child health outcomes; however, differences in prenatal care utilization exist, particularly among rural populations. The COVID-19 pandemic accelerated the adoption of telehealth in prenatal care, but its impact on the adequacy of care remains unclear. MethodsUsing Pregnancy Risk Assessment Monitoring System (PRAMS) data, this study examined prenatal care adequacy during the early-pandemic year (2020) and pre-pandemic years (2016–2019) and investigated rural-urban inequities. Logistic regression models assessed the association between the pandemic year and prenatal care adequacy, and considered barriers to virtual care as a covariate. ResultsThe sample consisted of 163,758 respondents in 2016–2019 and 42,314 respondents in 2020. Overall, the study participants were 12% less likely to receive adequate prenatal visits during the early-pandemic year (2020) compared with 2016–2019 (adjusted odds ratio [aOR] = 0.88; 95% confidence interval [CI] [0.86, 0.91]). Respondents in rural areas had lower odds of receiving adequate prenatal care compared with those in urban areas during both pre-pandemic years (aOR = 0.90; 95% CI [0.88, 0.93]) and the early-pandemic year (aOR = 0.94; 95% CI [0.88, 0.99]). However, after adjusting for barriers to virtual care, the difference between rural and urban areas in the early-pandemic year became nonsignificant (aOR = 0.93; 95% CI [0.78, 1.11]). Barriers to virtual care, including lack of phones, data, computers, internet access, and private space, were significantly associated with inadequate prenatal care. ConclusionDuring the early-pandemic year, PRAMS respondents experienced reduced adequacy of prenatal care. Although rural-urban inequities persisted, our results suggest that existing barriers to virtual care explained these inequities. Telehealth interventions that minimize these barriers could potentially enhance health care utilization among pregnant people.