Abstract
BackgroundEarly, regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes. The purpose of this study is to better understand contributing factors to disparate prenatal care utilization outcomes among women of different racial/ethnic and social status groups before, during, and after the Great Recession (December 2007–June 2009).MethodsData from 678,235 Washington (WA) and Florida (FL) birth certificates were linked to community and state characteristic data to carry out cross-sectional pooled time series analyses with institutional review board approval for human subjects’ research. Predictors of on-time as compared to late or non-entry to prenatal care utilization (late/no prenatal care utilization) were identified and compared among pregnant women. Also explored was a simulated triadic relationship among time (within recession-related periods), social characteristics, and prenatal care utilization by clustering individual predictors into three scenarios representing low, average, and high degrees of social disadvantage.ResultsIndividual and community indicators of need (e.g., maternal Medicaid enrollment, unemployment rate) increased during the Recession. Associations between late/no prenatal care utilization and individual-level characteristics (including disparate associations among race/ethnicity groups) did not shift greatly with young maternal age and having less than a high school education remaining the largest contributors to late/no prenatal care utilization. In contrast, individual maternal enrollment in a supplemental nutrition program for women, infants, and children (WIC) exhibited a protective association against late/no prenatal care utilization. The magnitude of association between community-level partisan voting patterns and expenditures on some maternal child health programs increased in non-beneficial directions. Simulated scenarios show a high combined impact on prenatal care utilization among women who have multiple disadvantages.ConclusionsOur findings provide a compelling picture of the important roles that individual characteristics—particularly low education and young age—play in late/no prenatal care utilization among pregnant women. Targeted outreach to individuals with high disadvantage characteristics, particularly those with multiple disadvantages, may help to increase first trimester entry to utilization of prenatal care. Finally, WIC may have played a valuable role in reducing late/no prenatal care utilization, and its effectiveness during the Great Recession as a policy-based approach to reducing late/no prenatal care utilization should be further explored.
Highlights
Regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes
Community-level safety net resources, including many maternal and child health programs provided by local community health departments (LHDs), experienced cuts which may have contributed to increased difficulties among pregnant women in accessing prenatal care — during the earlier phases of the Great Recession and before federal stimulus funds became available [5,6,7]
Women who entered prenatal care late or not at all were younger, less likely to be married, slightly more likely to be foreign-born, and almost twice as likely to have less than a high school (HS) education (9.49% vs. 5.11%)
Summary
Regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes. The purpose of this study is to better understand contributing factors to disparate prenatal care utilization outcomes among women of different racial/ethnic and social status groups before, during, and after the Great Recession (December 2007–June 2009). All ethnic groups experienced increases in unemployment during the Great Recession, but Blacks continued to have the highest unemployment rates, Whites had the lowest, and Hispanics fell between the two [4]. (within the first trimester) and regular PNC is known to be an important strategy for improving health outcomes for mothers and infants [8, 9]. Improved infant health outcomes associated with early utilization of prenatal care have both quality of life and cost implications. Average medical costs for a premature or low birth weight infant during the first year of life are about $55,393, whereas annual costs for a newborn without complications averages $5085 [13]
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