Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010
Abstract Background Early, 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 s...
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| Format: | Article |
| Language: | English |
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BMC
2019-10-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | http://link.springer.com/article/10.1186/s12884-019-2486-1 |
| _version_ | 1818998231673077760 |
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| author | Erin L. Blakeney Jerald R. Herting Betty Bekemeier Brenda K. Zierler |
| author_facet | Erin L. Blakeney Jerald R. Herting Betty Bekemeier Brenda K. Zierler |
| author_sort | Erin L. Blakeney |
| collection | DOAJ |
| description | Abstract Background Early, 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). Methods Data 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. Results Individual 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. Conclusions Our 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. |
| first_indexed | 2024-12-20T21:58:15Z |
| format | Article |
| id | doaj.art-60c6fcf7e1f441c182eaa908c6d0511c |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-20T21:58:15Z |
| publishDate | 2019-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-60c6fcf7e1f441c182eaa908c6d0511c2022-12-21T19:25:24ZengBMCBMC Pregnancy and Childbirth1471-23932019-10-0119112010.1186/s12884-019-2486-1Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010Erin L. Blakeney0Jerald R. Herting1Betty Bekemeier2Brenda K. Zierler3Department of Biobehavioral Nursing and Health Informatics, Center for Health Sciences Interprofessional Education, Research, and Practice (CHSIE)Department of Sociology, University of WashingtonSchool of Nursing, University of WashingtonDepartment of Biobehavioral Nursing and Health Informatics, Center for Health Sciences Interprofessional Education, Research, and Practice (CHSIE)Abstract Background Early, 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). Methods Data 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. Results Individual 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. Conclusions Our 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.http://link.springer.com/article/10.1186/s12884-019-2486-1WICPrenatal care utilizationGreat recessionDisparitiesPartisan voting patternsSocial behavior |
| spellingShingle | Erin L. Blakeney Jerald R. Herting Betty Bekemeier Brenda K. Zierler Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010 BMC Pregnancy and Childbirth WIC Prenatal care utilization Great recession Disparities Partisan voting patterns Social behavior |
| title | Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010 |
| title_full | Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010 |
| title_fullStr | Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010 |
| title_full_unstemmed | Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010 |
| title_short | Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010 |
| title_sort | social determinants of health and disparities in prenatal care utilization during the great recession period 2005 2010 |
| topic | WIC Prenatal care utilization Great recession Disparities Partisan voting patterns Social behavior |
| url | http://link.springer.com/article/10.1186/s12884-019-2486-1 |
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