Timeliness and Adequacy of Prenatal Care Among Department of Veterans Affairs–Enrolled Veterans: The First Step May Be the Biggest Hurdle

Abstract

Little is known about access to and use of prenatal care by veterans using U.S. Department of Veterans Affairs (VA) maternity benefits. We compared the timeliness and adequacy of prenatal care by veteran status and payor. We used VA clinical and admistrative data linked with California vital statistics patient discharge data to identify all births to VA-enrolled veterans and non-veterans between 2000 and 2012. Births were categorized based on veteran status and payor (non-veterans with Medicaid, non-veterans with private insurance, VA-enrolled veterans using VA maternity care benefits, and VA-enrolled veterans with other payor). Outcomes were timeliness of prenatal care (initiation before the end of the first trimester) and adequacy of prenatal care as measured by the Kotelchuck Index (inadequate, intermediate, adequate). Covariates included demographic, health, and pregnancy characteristics. We used generalized linear models and multinomial logistic regression to analyze the association of veteran status and payor with timeliness of prenatal care and adequacy of prenatal care, respectively. We identified 6,196,432 births among VA-enrolled veterans (n=17,495) and non-veterans (n=6,178,937). Non-veterans using Medicaid had the lowest percentage of timely prenatal care (78.1%; n=2,240,326), followed by VA-enrolled veterans using VA maternity care benefits (82.8%; n=1,248). VA-enrolled veterans using VA maternity care benefits were the most likely to receive adequate prenatal care (92.0%; n=1,365). Results remained consistent after adjustment. This study provides key baseline data regarding access to and use of prenatal care by veterans using VA maternity benefits. Longitudinal studies including more recent data are needed to understand the impact of changing VA policy.