Disparities in Prenatal Care: How Much is the Difference? Does Insurance Matter?

Purpose: This systematic review and meta-analysis examines racial/ethnic and insurance status disparities in prenatal care inadequacy in California compared to other states, in the context of the 1990 Medicaid expansion and provides bench marks for the California, San Joaquin Valley Region.

Methods: Thirty (30) epidemiologic studies provided 65 racial ethnic comparisons and 15 studies provided 19 insurance status comparisons. Inclusion criteria was: being published in the United States between January 1990 and December 2005, having race or insurance as independent variable and adequacy or inadequacy of prenatal care as dependent variable, and having descriptive data. We compared several states to California for the period before 1992 and after (1992-1998).

Findings: Women of color compared to white women had 2 times higher odds of inadequate prenatal care. Women who had Medicaid or were uninsured had about 4 and one half times higher odds of inadequate pre-natal care before the period of major Medicaid expansion. During the period of Major Medicaid expansion (1992-1998) the relative racial disparity widened for California and narrowed for other states; but California achieved the largest absolute reduction in prenatal inadequacy for all racial ethnic groups.

Conclusion: Expanding Medicaid to all women of childbearing age groups can reduce inadequate prenatal care rate; but race/ethnicity and insurance status disparities might persist unless specific measures are taken to identify and eliminate other causes of disparities.