Adequate Prenatal Care and Birth Outcome- A three-year birth file analysis and a Provider Perspective

Purpose: This study examines impact of demographics, place of residence, birth-year and systems of care on adequate prenatal care and birth outcomes for the uninsured/underinsured in the San Joaquin Valley.

Methods: Quantitative data were drawn from the 2002-2004 California Birth Master Files for eight counties (N=182,478). Independent variables were mothers' race/ethnicity; age; education; nativity; insurance; place of residence (county, clusters) and year of birth. Community Clusters (61) were aggregates of zip codes that approximate health service planning areas. The dependent variables were adequate prenatal care, low birth weight and pre-term births. Bivariate and multivariate analyses explored associations between variables. Qualitative data were drawn from semi-structured interviews with provider staff (n=41) in 3 counties to identify system barriers.

Findings: Mothers' race/ethnicity; nativity; education; age and place of residence were associated with inadequate prenatal care. Mother's race/ethnicity, nativity, age, payment source and adequate care were associated with pre-term births and low birth weight. Qualitative analysis illustrates a two-tiered system: providers who serve low-income, uninsured women perceive many access barriers and offer various services to reduce disparity, while providers who serve higher income, well-insured patients perceive fewer barriers and offer fewer support services.

Conclusion: Income and insurance status segregation in addition to inequalities in adequate prenatal care and birth outcomes were apparent between white women and women in underserved racial/ethnic groups.