Does Increasing Access to Prenatal Care Reduce Racial Disparities in Birth Outcomes?

Abstract

To examine the effectiveness of early and adequate prenatal care (PNC) in reducing racial disparities in pre-term birth (PTB) among low-income women. Design and methods: This retrospective study examined birth records for 14,950 low-income Black and White women. The primary outcome of interest was racial disparities in PTB. Exposures of interest were first trimester entry into, and adequacy of, PNC. Maternal residential proximity to nearest PNC provider was calculated. Bivariate analyses were performed for PTB by race. Binary logistic regression was performed, controlling for maternal age, smoking status and racial segregation. Attributable risk of PTB for no or late entry into PNC, and percent difference by race was calculated. Results: We find that early and adequate PNC significantly decreases the risk of preterm birth, however, we find no evidence that this reduces racial disparities. Low income black females in a large metropolitan county have greater geographic access to and utilization of PNC than low-income white females, yet racial disparities in preterm birth remain. Attributable risk of PTB for no or late entry into PNC was lower for Black women (32.2%) than White women (39.4%). Conclusions: Our findings suggest that adequate PNC alone does not reduce the marked racial disparities in preterm birth. Practice implications: Public health agencies and health care providers need to look beyond access to care, to achieve racial equity in birth outcomes. Expansion of evidence-based, comprehensive nursing interventions shown to reduce preterm birth, such as the Nurse Family Partnership home visiting program, could contribute to these efforts.

California’s Comprehensive Perinatal Services Program and birth outcomes

“…Despite the substantial differences in PTB and LBW risk across racial/ethnic groups, we found the association between CPSP and birth outcome did not vary across racial/ethnic subgroups, a finding consistent with previous evidence that increasing access to prenatal service led to better outcomes but not smaller racial disparity ( 39 ). It remained unclear how well CPSP was understood by and how accessible it was for Medi-Cal beneficiaries of minority background.…”

State Approaches to Simplify Medicaid Eligibility and Implications for Inequality of Infant Health

“…These results complicate earlier evidence of the weak relationship between prenatal care and infant health for Black women (Sonchak 2015;Thurston, Fields, and White 2021). Substantial administrative barriers to prenatal care could limit benefits for Black women.…”

Racial and ethnic disparities in preterm birth: a mediation analysis incorporating mixtures of polybrominated diphenyl ethers

“…Given this is the first study that evaluated the potential mediation role of PBDEs for this disparity, future studies of larger sample sizes or conducted among a higher-risk population might be needed to validate our findings. Past studies have revealed other mediators (such as socioeconomic and health factors, and access to healthcare) for the racial and ethnic disparity in PTB, but a large proportion of the disparity remained ( 9 – 11 , 71 – 73 ). If PBDEs truly mediate part of the racial and ethnic disparity in length of gestation or PTB, then this class of chemicals might be an additional modifiable factor to help further alleviate this disparity.…”