Utilization of Maternal Health Care Among Immigrant Mothers in New York City, 2016–2018

Abstract

Immigrant women represent half of New York City (NYC) births, and some immigrant groups have elevated risk for poor maternal health outcomes. Disparities in health care utilization across the maternity care spectrum may contribute to differential maternal health outcomes. Data on immigrant maternal health utilization are under-explored in the literature. We conducted a cross-sectional analysis of the population-based NYC Pregnancy Risk Assessment Monitoring System survey, using 2016–2018 data linked to birth certificate variables, to explore self-reported utilization of preconception, prenatal, and postpartum health care and potential explanatory pathways. We stratified results by maternal nativity and, for immigrants, by years living in the US; geographic region of origin; and country of origin income grouping. Among immigrant women, 43% did not visit a health care provider in the year before pregnancy, compared to 27% of US-born women (risk difference [RD] = 0.16, 95% CI [0.13, 0.20]), 64% had no dental cleaning during pregnancy compared to 49% of US-born women (RD = 0.15, 95% CI [0.11, 0.18]), and 11% lost health insurance postpartum compared to 1% of US-born women (RD = 0.10, 95% CI [0.08, 0.11]). The largest disparities were among recent arrivals to the US and immigrants from countries in Central America, South America, South Asia, and sub-Saharan Africa. Utilization differences were partially explained by insurance type, paternal nativity, maternal education, and race and ethnicity. Disparities may be reduced by collaborating with community-based organizations in immigrant communities on strategies to improve utilization and by expanding health care access and eligibility for public health insurance coverage before and after pregnancy.

State Public Insurance Coverage Policies and Postpartum Care Among Immigrants

“…19 Another recent study found that receipt of postpartum care was similar among immigrants and nonimmigrants in New York City, which covers all low-income immigrants. 20 The current study makes a substantial contribution to the existing literature by documenting a significant negative association between state public insurance policies that restrict eligibility by immigration status and receipt of postpartum care in a large sample of states with large immigrant populations.…”

Risk and protective factors for pregnancy‐related urinary incontinence until 1 year postpartum: A cohort study using patient‐reported outcome measures in Italy

“…The present study also assessed some maternity pathway‐related attributes that have been considered in a few previous studies 10–12 . High‐risk pregnancy, discomfort during pregnancy, delaying pregnancy examinations due to waiting, difficulty in accessing health services, and not having pregnancy examinations booked by health workers were risk factors.…”

“…In a previous paper, we explored the main sociodemographic and delivery‐related features associated with a higher risk of pregnancy‐related UI using patient‐reported data collected longitudinally up to 6 months postpartum 9 . However, our previous work did not consider variables related to utilization patterns of maternity care pathways, which are crucial risk factors for maternal‐fetal comorbidities according to the literature 10–12 …”

Analysis of State Medicaid Expansion and Access to Timely Prenatal Care Among Women Who Were Immigrant vs US Born

“…Our finding that Medicaid exclusions appear to be detrimental to prenatal care use by women who are immigrants is a key link to emerging evidence on maternal health disadvantage faced by women who are immigrants. 29 The healthy immigrant effect is often found in research on reproductive health, such that immigrant women fared better than their US-born counterparts. 30 A 2018 report noted that, in fact, this health advantage erodes over time 31 and is not apparent in all immigrant groups.…”