Inequities in utilization of prenatal care: a population-based study in the Canadian province of Manitoba.

Autor: Heaman MI; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada. Maureen.Heaman@umanitoba.ca., Martens PJ; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113 - 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada.; Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada., Brownell MD; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113 - 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada.; Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada., Chartier MJ; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113 - 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada.; Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada., Thiessen KR; College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada., Derksen SA; Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada., Helewa ME; Department of Obstetrics, Gynecology and Reproductive Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, WR120-735 Notre Dame Avenue, Winnipeg, MB, R3E 0L8, Canada.
Jazyk: angličtina
Zdroj: BMC pregnancy and childbirth [BMC Pregnancy Childbirth] 2018 Nov 01; Vol. 18 (1), pp. 430. Date of Electronic Publication: 2018 Nov 01.
DOI: 10.1186/s12884-018-2061-1
Abstrakt: Background: Ensuring high quality and equitable maternity services is important to promote positive pregnancy outcomes. Despite a universal health care system, previous research shows neighborhood-level inequities in utilization of prenatal care in Manitoba, Canada. The purpose of this population-based retrospective cohort study was to describe prenatal care utilization among women giving birth in Manitoba, and to determine individual-level factors associated with inadequate prenatal care.
Methods: We studied women giving birth in Manitoba from 2004/05-2008/09 using data from a repository of de-identified administrative databases at the Manitoba Centre for Health Policy. The proportion of women receiving inadequate prenatal care was calculated using a utilization index. Multivariable logistic regressions were used to identify factors associated with inadequate prenatal care for the population, and for a subset with more detailed risk information.
Results: Overall, 11.5% of women in Manitoba received inadequate, 51.0% intermediate, 33.3% adequate, and 4.1% intensive prenatal care (N = 68,132). Factors associated with inadequate prenatal care in the population-based model (N = 64,166) included northern or rural residence, young maternal age (at current and first birth), lone parent, parity 4 or more, short inter-pregnancy interval, receiving income assistance, and living in a low-income neighborhood. Medical conditions such as multiple birth, hypertensive disorders, antepartum hemorrhage, diabetes, and prenatal psychological distress were associated with lower odds of inadequate prenatal care. In the subset model (N = 55,048), the previous factors remained significant, with additional factors being maternal education less than high school, social isolation, and prenatal smoking, alcohol, and/or illicit drug use.
Conclusion: The rate of inadequate prenatal care in Manitoba ranged from 10.5-12.5%, and increased significantly over the study period. Factors associated with inadequate prenatal care included geographic, demographic, socioeconomic, and pregnancy-related factors. Rates of inadequate prenatal care varied across geographic regions, indicating persistent inequities in use of prenatal care. Inadequate prenatal care was associated with several individual indicators of social disadvantage, such as low income, education less than high school, and social isolation. These findings can inform policy makers and program planners about regions and populations most at-risk for inadequate prenatal care and assist with development of initiatives to reduce inequities in utilization of prenatal care.
Databáze: MEDLINE
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