Why Do Women Decline Preconception Health Care? Findings from the 2007 Los Angeles Mommy and Baby (LAMB) Project

BACKGROUND While the benefits of preconception counseling (PCC) are well documented, little is known about who doesn't receive PCC in Los Angeles County (LAC) and , and why not. METHODS We analyzed data from the 2007 LAMB Survey (n=6,264), which asked women in the 6 months pre pregnancy “ Did you talk to a health professional about how to prepare for a healthy pregnancy?” If no, we asked why she didn't go. LAMB is a population-based mail survey of LAC women who recently gave birth to a live-born infant. All calculations were performed using data weighted to 2007 LAC population data. RESULTS Our analyses show that 70% of women didn't receive PCC in the 6 months pre-pregnancy. Compared to women who received PCC, these women were: younger (28 vs. 30 years, p<0.05), having <12 years of education (33.4% vs. 23.2%, p<0.005), being unmarried (38.6% vs. 21.5%, p<0.005), and having no pre-pregnancy health insurance (37.6% vs.16.9%, p<0.005). Latina and African American women were less likely to receive PCC (25%, 27%, respectively ), compared to Asian/Pacific Islander and white women (36%, 58%, respectively). The most common reasons for not receiving PCC were: unexpected pregnancy and knowing how to prepare for pregnancy (59% and 37%, respectively).

DISCUSSION Unexpected pregnancy was the major reason for not receiving PCC. Efforts to promote PCC should target women of reproductive age who are capable of becoming pregnant, especially Latinas, African American women, and indigent women. Social policy changes impacting funding and access to PCC are also needed.