Online Program

Social determinants of health and disparities in prenatal care during the Great Recession in Washington and Florida

Sunday, November 1, 2015

Erin Abu-Rish Blakeney, PhD, RN, Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA
Brenda Zierler, PhD, RN, School of Nursing-Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA
Betty Bekemeier, RN, PhD, FAAN, School of Nursing, Department of Psychosocial & Community Health, University of Washington, Seattle, WA
Objectives:  Early, regular prenatal care (PNC) is an important strategy for improving maternal and infant health outcomes.  The purpose of this study was to better understand contributing factors to disparate PNC outcomes among women of different racial/ethnic and social status groups before, during, and after the Great Recession (December 2007-June 2009). 

Methods:  Data from 678,235 birth certificates were linked to local community (county/local health jurisdiction) and state characteristic data to carry out cross-sectional pooled time series analyses.  Predictors of late or no entry to PNC (late/no PNC) among pregnant women in the states of Washington and Florida were identified and compared.  A simulated triadic relationship among time (within recession-related periods), social characteristics, and PNC by clustering individual predictors into three scenarios representing low, average, and high degrees of social disadvantage was also explored. 

Results:  Individual and community indicators of need (e.g., maternal Medicaid enrollment, unemployment rate) increased during the Recession.  Associations between late/no PNC and individual-level characteristics (including disparate associations among race/ethnicity groups) did not shift greatly.  In contrast, maternal WIC enrollment exhibited a protective association against late/no PNC. 

Conclusions:  Our findings provide a compelling picture of the important roles that individual characteristics—particularly low education and young age—play in late/no PNC among pregnant women.  Simulated scenarios show a high combined impact on PNC among women who have multiple disadvantages. Finally, WIC may have played a valuable role in reducing late/no PNC, and its effectiveness during the Great Recession should be further explored.  

Learning Areas:

Provision of health care to the public
Public health or related nursing
Public health or related research

Learning Objectives:
Compare roles that individual characteristics played in late or non-initiation of prenatal care (PNC) among pregnant women during the Great Recession. Describe combined impacts on initiation of prenatal care among women with multiple disadvantages.

Keyword(s): Maternal and Child Health, Prenatal Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I recently completed my PhD and carried out this research for my dissertation. During my PhD I completed extensive coursework in research methods and statistics as well as study of maternal child health epidemiology and approaches to data visualization. My dissertation research was funded by NIH-funded Multidisciplinary Predoctoral Clinical Research Training Program (TL1) Trainee and I was mentored by active practice-based public health services and systems researchers.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.