Improving access to prenatal care through community outreach workers

Background: In the United States, infants born to women of low socioeconomic status have worse birth outcomes than infants of women of higher socioeconomic status. A known risk factor which contributes to this disparity is access to prenatal care. Early and adequate prenatal care can reduce rates of infant mortality. Methods: Healthy Start (HS) of Chester County is part of a national initiative to reduce rates of poor birth outcomes. The program uses community outreach workers to target women at high risk of delivering premature or low birth weight infants. Culturally-competent outreach workers build trusting relationships with participants to help them navigate the healthcare system and access resources such as prenatal care. Results: HS commissioned an independent evaluation by the Family Planning Council of Southeastern Pennsylvania which compared data of program participants with data of demographically similar women from the same communities. From 2003-2009, HS participants consistently initiated prenatal care in the first trimester at a lower rate than the community cohort. For instance, among the participants, the average for 2008-2009 was 43%- compared to 56% for the community cohort. Despite such disparity, the rates of adequacy of prenatal care as measured by the Adequacy of Prenatal Care Utilization Index were comparable. Among the participants, the average for 2008-2009 was 49%- compared to 53% for the community cohort. Conclusions: With guidance and support of community outreach workers, HS participants gained access to prenatal care and utilized services at similar rates to the community comparison group, despite starting prenatal care later.