Effects of Neighborhood Characteristics on Timing and Use of Prenatal Care: The Case of Milwaukee City, Wisconsin

Background: Although neighborhood characteristics (NCs) and prenatal care (PNC) have been associated with birth outcomes, the association of NCs with PNC timing and use is unclear.

Objective: To examine whether NCs are associated with late (3rd trimester) or no prenatal care among black women and white women.

Methods: Analysis of 66045 City of Milwaukee Health Department geocoded resident¢s birth records from 1999-2004, merged with US 2000 census tract (CT) data. Race-stratified random effects multilevel regression models were estimated for black women (n=29928) and white women (n=20680) to examine the association of 4 NC measures of concentration of lower education, residential instability, poverty, and deprivation with late or no PNC, controlling for 4 individual-level characteristics (maternal education, age, marital status, and prenatal smoking).

Results: Black women (7%) were significantly more likely than white women (2%) to have late or no PNC, and to live in CTs with higher concentrations of lower education, residential instability, poverty, and deprivation. The odds of late or no PNC were significantly greater for white women in the lowest educational attainment CT quartile (OR=2.4 [95% CI;1.7-3.5]) and for black women in lowest (OR=1.9 [1.3-2.6]) and moderately-low (OR=1.5 [1.03-2.1]) educational attainment CTs. White women residing in low and moderately-low residentially stable CTs were twice as likely as those in the highest residentially stable CTs to have late or no PNC (OR=2.1 [1.5-2.9]). Compared with their counterparts in least deprived CTs, black women in the most deprived CTs (OR=1.7 [1.1-2.4]) and white women in moderately-high (OR=1.7 [1.2-2.5]) and most deprived CTs (OR=2.0 [1.4-3.1]) had twice the odds of late or no PNC. Compared to their counterparts residing in the least deprived CTs, black women in moderately-high (OR=1.5 [1.2-2.0]) and highest (OR=1.7 [1.3-2.3]) deprived CTs, and white women in moderately-low (OR=1.6 [1.2-2.1]), moderately-high (OR=2.4 [1.7-3.2]), and highest (OR=2.5 [1.7-3.6]) deprived CTs had significantly greater odds of late or no PNC. A gradient was observed, with black and white women in the more impoverished CTs at greater risk of late or no PNC than those in less impoverished CTs.

Conclusions: Adverse neighborhood conditions are associated with racial disparities in PNC, and increased risk of late or no PNC for both black women and white women.