Social determinants of health and disparities in prenatal care utilization during the Great Recession period 2005-2010
| Autor: | Betty Bekemeier, Erin L. Blakeney, Jerald R. Herting, Brenda K. Zierler |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
medicine.medical_specialty Social Determinants of Health media_common.quotation_subject Reproductive medicine Ethnic group Disparities Prenatal care Great recession lcsh:Gynecology and obstetrics Recession Health Services Accessibility 03 medical and health sciences 0302 clinical medicine Pregnancy medicine Humans 030212 general & internal medicine Social determinants of health Social behavior Reproductive History lcsh:RG1-991 Disadvantage media_common 030219 obstetrics & reproductive medicine business.industry Medicaid 1. No poverty Pregnancy Outcome Obstetrics and Gynecology Prenatal Care Patient Acceptance of Health Care WIC United States Partisan voting patterns Economic Recession Prenatal care utilization Socioeconomic Factors Birth Certificates 8. Economic growth Female Pregnant Women business Demography Social status Research Article |
| Zdroj: | BMC Pregnancy and Childbirth BMC Pregnancy and Childbirth, Vol 19, Iss 1, Pp 1-20 (2019) |
| ISSN: | 1471-2393 |
| Popis: | Background Early, regular prenatal care utilization is an important strategy for improving maternal and infant health outcomes. The purpose of this study is to better understand contributing factors to disparate prenatal care utilization 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 Washington (WA) and Florida (FL) birth certificates were linked to community and state characteristic data to carry out cross-sectional pooled time series analyses with institutional review board approval for human subjects’ research. Predictors of on-time as compared to late or non-entry to prenatal care utilization (late/no prenatal care utilization) were identified and compared among pregnant women. Also explored was a simulated triadic relationship among time (within recession-related periods), social characteristics, and prenatal care utilization by clustering individual predictors into three scenarios representing low, average, and high degrees of social disadvantage. Results Individual and community indicators of need (e.g., maternal Medicaid enrollment, unemployment rate) increased during the Recession. Associations between late/no prenatal care utilization and individual-level characteristics (including disparate associations among race/ethnicity groups) did not shift greatly with young maternal age and having less than a high school education remaining the largest contributors to late/no prenatal care utilization. In contrast, individual maternal enrollment in a supplemental nutrition program for women, infants, and children (WIC) exhibited a protective association against late/no prenatal care utilization. The magnitude of association between community-level partisan voting patterns and expenditures on some maternal child health programs increased in non-beneficial directions. Simulated scenarios show a high combined impact on prenatal care utilization among women who have multiple disadvantages. Conclusions Our findings provide a compelling picture of the important roles that individual characteristics—particularly low education and young age—play in late/no prenatal care utilization among pregnant women. Targeted outreach to individuals with high disadvantage characteristics, particularly those with multiple disadvantages, may help to increase first trimester entry to utilization of prenatal care. Finally, WIC may have played a valuable role in reducing late/no prenatal care utilization, and its effectiveness during the Great Recession as a policy-based approach to reducing late/no prenatal care utilization should be further explored. |
| Databáze: | OpenAIRE |
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