1
|
Everett BG, Bergman Z, Charlton BM, Barcelona V. Sexual Orientation-Specific Policies Are Associated With Prenatal Care Use in the First Trimester Among Sexual Minority Women: Results From a Prospective Cohort Study. Ann Behav Med 2024:kaae037. [PMID: 38990643 DOI: 10.1093/abm/kaae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Previous research has shown sexual minority women (SMW) are more likely to report multiple maternal and infant health outcomes compared to heterosexual women and that these outcomes are moderated by the policy environment. Little is known, however, about prenatal care use disparities or the social determinants of prenatal care use for SMW. PURPOSE To examine the relationship between sexual orientation-specific policies that confer legal protections (e.g., hate crime protections, housing discrimination, same-sex marriage) and prenatal care use among women using a prospective, population-based data set. METHODS Using the National Longitudinal Study of Adolescent to Adult Health and logistic regression, we link measures of state policies to the use of prenatal care in the first trimester among women who had live births. The use of prospective data allows us to adjust for covariates associated with preconception care use prior to pregnancy (n = 586 singleton births to SMW; n = 4,539 singleton births to heterosexual women). RESULTS Sexual orientation-specific policies that conferred protections were associated with increased use of prenatal care among pregnancies reported by SMW (OR = 1.86, 95% CI 1.16, 2.96). In fact, in states with zero protections, we found no differences in prenatal care use by sexual minority status; however, in states with two or more protective policies, SMW were more likely to access prenatal care in the first trimester than heterosexual women. There was no relationship between sexual orientation-specific policy environments and prenatal care use among pregnancies reported by heterosexual women. CONCLUSIONS Recent research has documented that SMW are more likely to have adverse perinatal and obstetrical outcomes than their heterosexual peers. These findings suggest that Lesbian/Gay/Bisexual-specific policy protections may facilitate the use of prenatal care among SMW, a potentially important pathway to improve reproductive health among this population.
Collapse
Affiliation(s)
- Bethany G Everett
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Zoë Bergman
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Brittany M Charlton
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Cambridge, MA, USA
| | | |
Collapse
|
2
|
Moore MD, Mazzoni SE, Wingate MS, Bronstein JM. Severe Maternal Morbidity among Low-Income Patients with Hypertensive Disorders of Pregnancy. Am J Perinatol 2024; 41:e563-e572. [PMID: 35977711 DOI: 10.1055/a-1925-9972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Hypertensive disorders of pregnancy (HDP) contribute significantly to the development of severe maternal morbidities (SMM), particularly among low-income women. The purpose of the study was to explore the relationship between maternal characteristics and SMM, and to investigate if differences in SMM exist among patients with HDP diagnosis. STUDY DESIGN This study utilized 2017 Alabama Medicaid administrative claims. SMM diagnoses were captured using the Centers for Disease Control and Prevention's classification by International Classification of Diseases codes. Maternal characteristics and frequencies were compared using Chi-square and Cramer's V statistics. Logistic regression analyses were conducted to examine multivariable relationships between maternal characteristics and SMM among patients with HDP diagnosis. Odds ratios and 95% confidence intervals (CIs) were used to estimate risk. RESULTS A higher proportion of patients experiencing SMM were >34 years old, Black, Medicaid for Low-Income Families eligible, lived in a county with greater Medicaid enrollment, and entered prenatal care (PNC) in the first trimester compared with those without SMM. Almost half of patients (46.2%) with SMM had a HDP diagnosis. After controlling for maternal characteristics, HDP, maternal age, county Medicaid enrollment, and trimester PNC entry were not associated with SMM risk. However, Black patients with HDP were at increased risk for SMM compared with White patients with HDP when other factors were taken into account (adjusted odds ratio [aOR] = 1.37, 95% CI: 1.11-1.69). Patients with HDP and SMM were more likely to have a prenatal hospitalization (aOR = 1.45, 95% CI: 1.20-1.76), emergency visit (aOR = 1.30, 95% CI: 1.07-1.57), and postpartum cardiovascular prescription (aOR = 2.43, 95% CI: 1.95-3.04). CONCLUSION Rates of SMM differed by age, race, Medicaid income eligibility, and county Medicaid enrollment but were highest among patients with clinical comorbidities, especially HDP. However, among patients with HDP, Black patients had an elevated risk of severe morbidity even after controlling for other characteristics. KEY POINTS · Patients with SMM were more likely to have a HDP diagnosis.. · Among those with HDP, Black patients had elevated risk of SMM.. · Differences in care delivery did not explain SMM disparities..
Collapse
Affiliation(s)
- Matthew D Moore
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Sara E Mazzoni
- Department of Obstetrics and Gynecology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Martha S Wingate
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Janet M Bronstein
- Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
3
|
Moinester M, Stanhope KK. Extending Driver's Licenses to Undocumented Immigrants: Comparing Perinatal Outcomes Following This Policy Shift. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024:221465241230839. [PMID: 38404178 DOI: 10.1177/00221465241230839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Research shows that restrictive immigration policies and practices are associated with poor health, but far less is known about the relationship between inclusive immigration policies and health. Using data from the United States natality files, we estimate associations between state laws granting undocumented immigrants access to driver's licenses and perinatal outcomes among 4,047,067 singleton births to Mexican and Central American immigrant birthing people (2008-2021). Fitting multivariable log binomial and linear models, we find that the implementation of a license law is associated with improvements in low birthweight and mean birthweight. Replicating these analyses among U.S.-born non-Hispanic White birthing people, we find no association between the implementation of a license law and birthweight. These findings support the hypothesis that states' extension of legal rights to immigrants improves the health of the next generation.
Collapse
|
4
|
Guldi M, Hamersma S. The effects of pregnancy-related Medicaid expansions on maternal, infant, and child health. JOURNAL OF HEALTH ECONOMICS 2023; 87:102695. [PMID: 36502571 DOI: 10.1016/j.jhealeco.2022.102695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/19/2022] [Accepted: 10/22/2022] [Indexed: 06/17/2023]
Abstract
Prior research has examined how late 1980s pregnancy-related Medicaid eligibility expansions influenced outcomes around the time of birth and, more recently, adult outcomes. We offer a close examination of early childhood effects to better understand the mechanism(s) underlying the improved longer-term outcomes. The restricted-access National Maternal and Infant Health Survey allows us to explore the effects of these expansions on maternal and child outcomes near the time of birth as well as three years post-birth. Our evidence suggests earlier connection with prenatal care and possible modest improvements in birthweight and gestational age. In our follow-up data, we also identify evidence of persistent effects as measured by child developmental scores. However, the most consistent finding is our strong evidence of reduced levels of maternal depression-both during the child's infancy and three years later. We conclude that the alleviation of maternal stress is one likely mechanism for the longer-term improvements in later-life outcomes identified in studies of children exposed to Medicaid in-utero and in early infancy.
Collapse
Affiliation(s)
- Melanie Guldi
- University of Central Florida, Orlando, FL, United States
| | | |
Collapse
|
5
|
Young AMP, Catalano R, Gemmill A. The 2016 Presidential Election and Prenatal Care Utilization Among Foreign-born Hispanic Pregnant People. Med Care 2022; 60:799-805. [PMID: 36227144 DOI: 10.1097/mlr.0000000000001753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Few studies have evaluated the relationship between adequate and timely prenatal care among immigrant pregnant people and the recent political climate, including the 2016 election and associated campaigns. OBJECTIVES We examine whether the 2016 presidential election was associated with changes in prenatal care utilization among US foreign-born Hispanic pregnant people. RESEARCH DESIGN Interrupted time series. SUBJECTS All foreign-born Hispanic and US-born non-Hispanic White people delivering singleton infants from 2008 to 2017 who resided in the 23 states that fully implemented the 2003 version of the birth certificate before January 2008 (n=12,397,503). MEASURES We examine the relationship between the presidential election and changes in the odds of inadequate or late/no prenatal care among immigrant Hispanic pregnant people, as well as trends in prenatal care utilization before the election. RESULTS Our results show no unexpected changes in receipt of inadequate prenatal care, and late/no prenatal care, among the 7 monthly conception cohorts exposed to the election before the third trimester. However, we detected increases in the odds of both inadequate care and late/no prenatal care among foreign-born Hispanic pregnant people in June 2015 and January 2016, respectively. These upward level shifts persisted through the remainder of our time series ending with the cohort conceived around December 2016. CONCLUSIONS The worsening shifts in prenatal care utilization we observe may serve as a bellwether for worsening outcomes among immigrant women and their families. Research is therefore urgently needed to investigate the determinants and consequences of these concerning trends.
Collapse
Affiliation(s)
- Anna Marie Pacheco Young
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| |
Collapse
|
6
|
Simeone RM, Reefhuis J, Jamieson DJ, Drews-Botsch CD, Lash TL, Fisher SC, Howley MM, Evans S, Howards PP. Delayed entry into prenatal care among women with pre-pregnancy health conditions, National Birth Defects Prevention Study, 1997-2011. Prev Med 2022; 164:107272. [PMID: 36152821 PMCID: PMC10392703 DOI: 10.1016/j.ypmed.2022.107272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 09/18/2022] [Indexed: 10/31/2022]
Abstract
First trimester entry into prenatal care is recommended for all women, and especially women with pre-pregnancy conditions. Our objective was to determine whether women with pre-pregnancy conditions were at lower risk of entry after the first trimester (delayed entry) into prenatal care than women without a pre-pregnancy health condition. We used data from 10,890 participants in the National Birth Defects Prevention Study who delivered liveborn infants without birth defects. Women reported pre-pregnancy conditions and timing of entry into prenatal care during a computer-assisted telephone interview. Multivariable logistic regression analyses were conducted to evaluate whether having a pre-pregnancy condition was associated with delayed entry into prenatal care compared to women without pre-pregnancy conditions. Approximately 13% of women reported delayed entry into prenatal care, and 18% of women reported a pre-pregnancy condition. Delayed entry into prenatal care was not associated with pre-pregnancy cardiometabolic or neurologic conditions. Women with thyroid conditions were less likely to report delayed entry into prenatal care (prevalence odds ratio (OR), 95% confidence interval (CI): 0.55 [0.32, 0.94]), but women with hematologic and respiratory conditions were more likely to report delayed entry into prenatal care (OR: 1.95 [1.00, 3.82] and 1.27 [0.95, 1.72], respectively), compared to those without any chronic conditions. Future research investigating the success of early prenatal care among women with thyroid conditions could identify ways to reduce delayed prenatal care among women with other pre-pregnancy conditions.
Collapse
Affiliation(s)
- Regina M Simeone
- Centers for Disease Control and Prevention, Atlanta, GA, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - Jennita Reefhuis
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Denise J Jamieson
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Carolyn D Drews-Botsch
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Sarah C Fisher
- Birth Defects Registry, New York State Department of Health, Albany, NY, United States
| | - Meredith M Howley
- Birth Defects Registry, New York State Department of Health, Albany, NY, United States
| | - Shannon Evans
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| |
Collapse
|
7
|
Noghanibehambari H, Salari M, Tavassoli N. Maternal human capital and infants' health outcomes: Evidence from minimum dropout age policies in the US. SSM Popul Health 2022; 19:101163. [PMID: 35855970 PMCID: PMC9287432 DOI: 10.1016/j.ssmph.2022.101163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
The purpose of this cross-sectional study is to examine the causal relationship of maternal education and infants' health outcomes. Using birth certificate data over the years 1970–2004 and exploiting the space-time variation in Minimum Dropout Age laws to solve the endogeneity of education, we find a sizeable effect of mothers' education on their birth outcomes. An additional year of maternal education is associated with a reduction in incidences of low birth weight and preterm birth by 15.2 and 12.7 percent, respectively. The estimates are robust across various specifications and even when allowing mothers’ cohort-of-birth to vary across regions. The results suggest that the candidate mechanisms of impact include improvements in timing, quantity, and quality of prenatal care, lower negative health behavior during pregnancy such as smoking and drinking, and higher spousal education. We provide causal evidence on the effect of mothers' education on birth outcomes. We use Minimum Dropout Age policies as the instrument. Mother education has significant impact on infants' birth outcomes. Candidate mechanisms include improvements in timing, quantity, and quality of prenatal care.
Collapse
Affiliation(s)
- Hamid Noghanibehambari
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI, 53706, USA
| | - Mahmoud Salari
- Department of Accounting, Finance, and Economics, California State University Dominguez Hills, Carson, CA, 90747, USA
| | - Nahid Tavassoli
- Department of Economics, University of Wisconsin Milwaukee, Milwaukee, WI, 53211, USA
| |
Collapse
|
8
|
Cygan-Rehm K, Karbownik K. The effects of incentivizing early prenatal care on infant health. JOURNAL OF HEALTH ECONOMICS 2022; 83:102612. [PMID: 35421668 DOI: 10.1016/j.jhealeco.2022.102612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/31/2022] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
We investigate the effects of incentivizing early prenatal care utilization on infant health by exploiting a reform that required expectant mothers to initiate prenatal care during the first ten weeks of gestation to obtain a one-time monetary transfer paid after childbirth. Applying a difference-in-differences design to individual-level data on the population of births and fetal deaths, we identify modest but statistically significant positive effects of the policy on neonatal health. We further provide suggestive evidence that improved maternal health-related knowledge and behaviors during pregnancy are plausible channels through which the reform might have affected fetal health.
Collapse
Affiliation(s)
- Kamila Cygan-Rehm
- Leibniz Institute for Educational Trajectories - LifBi, CESifo, IZA, and LASER.
| | | |
Collapse
|
9
|
Di Giacomo M, Piacenza M, Siciliani L, Turati G. The effect of co-payments on the take-up of prenatal tests. JOURNAL OF HEALTH ECONOMICS 2022; 81:102553. [PMID: 34808492 DOI: 10.1016/j.jhealeco.2021.102553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
Noninvasive prenatal screening tests help identify genetic disorders in a fetus, but their take-up remains low in several countries. Using a regression discontinuity design, we test the causal effect of a policy that eliminated co-payments for noninvasive screening tests in Italy. We identify the treatment effects by a discontinuity in women's eligibility for a free test based on their conception date. We find that the policy increases the probability of women's undergoing noninvasive screening tests by 5.5 percentage points, and the effect varies by socioeconomic status. We do not find evidence of substitution effects with more expensive and riskier invasive diagnostic tests. In addition, the increase in take-up does not affect pregnancy termination or newborn health. We find some evidence of positive effects on mothers' health behaviors during pregnancy as measured by reductions in mothers' weight gain and hospital admissions during pregnancy, but these are statistically significant only at the 10 percent level.
Collapse
Affiliation(s)
- Marina Di Giacomo
- University of Torino, Department of Economics, Social Sciences, Applied Mathematics and Statistics (ESOMAS).
| | - Massimiliano Piacenza
- University of Piemonte Orientale, Department of Economics and Business (DISEI), Novara, Italy.
| | - Luigi Siciliani
- University of York, Department of Economics and Related Studies, York, United Kingdom.
| | - Gilberto Turati
- Università Cattolica del Sacro Cuore, Department of Economics and Finance, Rome, Italy.
| |
Collapse
|
10
|
Fabi RE, Saloner B, Taylor H. State Policymaking and Stated Reasons: Prenatal Care for Undocumented Immigrants in an Era of Abortion Restriction. Milbank Q 2021; 99:693-720. [PMID: 34166528 PMCID: PMC8452360 DOI: 10.1111/1468-0009.12519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Policy Points States can create policies that provide access to publicly funded prenatal care for undocumented immigrants that garner support from diverse political coalitions. Policymakers have used a wide range of moral and practical reasons to support the expansion of care to this population, which can be tailored to frame prenatal policies for different stakeholder groups.
Collapse
Affiliation(s)
- Rachel E Fabi
- Center for Bioethics and Humanities, SUNY Upstate Medical University
| | | | | |
Collapse
|
11
|
Bertoli P, Grembi V. Territorial differences in access to prenatal care and health at birth. Health Policy 2021; 125:1092-1099. [PMID: 34127289 DOI: 10.1016/j.healthpol.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/07/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
We assess the impact of prenatal care on health at birth using birth certificates from the Czech Republic. We use a predictive machine learning algorithm to identify the observables affecting birth health outcomes. We control for those observables in our empirical analysis, which indicates that a more intense use of prenatal care is positively correlated with better health outcomes at birth. Exploiting the Czech adhesion to the EU in 2004, we construct an instrument to capture the geographical heterogeneous access to prenatal care across districts. Differently from the OLS results, the IV results do not capture any significant effect of prenatal care, leaving room for the hidden role of unobservable mothers' characteristics when it comes to health behaviors during pregnancy.
Collapse
Affiliation(s)
- Paola Bertoli
- University of Verona, via Cantarane 24, Verona 37129, Italy; Prague University of Economics and Business, Czech Republic.
| | | |
Collapse
|
12
|
Kiross GT, Chojenta C, Barker D, Loxton D. Optimum maternal healthcare service utilization and infant mortality in Ethiopia. BMC Pregnancy Childbirth 2021; 21:390. [PMID: 34011300 PMCID: PMC8136182 DOI: 10.1186/s12884-021-03860-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/06/2021] [Indexed: 01/05/2023] Open
Abstract
Background Ethiopia has one of the highest rates of infant mortality in the world. Utilization of maternal healthcare during pregnancy, at delivery, and after delivery is critical to reducing the risk of infant mortality. Studies in Ethiopia have shown how infant survival is affected by utilization of maternal healthcare services, however, no studies to date have investigated the relationship between optimum utilization of maternal healthcare services utilization and infant mortality. Therefore, this study examined the effect of optimum utilization of maternal healthcare service on infant mortality in Ethiopia based on the World Health Organization (WHO, 2010) guidelines. Methods We used nationally representative cross-sectional data from the Ethiopian Demographic and Health Survey (EDHS). Sampling weights were applied to adjust for the non-proportional allocation of the sample to the nine regions and two city administrations as well as the sample difference across urban and rural areas. A total of 7193 most recent births from mothers who had provided complete information on infant mortality, ANC visits, tetanus injections, place of delivery and skilled birth attendance during pregnancy were included. The EDHS was conducted from January to June 2016. We applied a multivariate logistic regression analysis to estimate the relationship between optimum maternal healthcare service utilization and infant mortality in Ethiopia. Results The findings from this study showed that optimum maternal healthcare service utilization had a significant association with infant mortality after adjusting for other socioeconomic characteristics. This implies that increased maternal healthcare service utilization decreases the rate of infant mortality in Ethiopia. The main finding from this study indicated that infant mortality was reduced by approximately 66% among mothers who had high utilization of maternal healthcare services compared to mothers who had not utilized maternal healthcare services (AOR = 0.34; 95%CI: 0.16–0.75; p-value = 0.007). Furthermore, infant mortality was reduced by approximately 46% among mothers who had low utilization of maternal healthcare services compared to mothers who had not utilized any maternal healthcare services (AOR = 0.54; 95%CI: 0.31–0.97; p-value = 0.040). Conclusions From this study, we concluded that optimum utilization of maternal healthcare services during pregnancy, at delivery and after delivery might reduce the rate of infant mortality in Ethiopia.
Collapse
Affiliation(s)
- Girmay Tsegay Kiross
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia. .,Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Daniel Barker
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| |
Collapse
|
13
|
Lin CL. Postpartum medical utilization: The role of prenatal economic activity and living costs. ECONOMICS AND HUMAN BIOLOGY 2021; 41:100989. [PMID: 33784611 DOI: 10.1016/j.ehb.2021.100989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
This study is the first to explore the extent to which prenatal economic fluctuations affect postpartum outpatient care utilization during three-month, six-month, and one-year postpartum periods in Taiwan and to document their counter-cyclical patterns for economic activity and pro-cyclical patterns for the CPI change rate. We present evidence that medical care utilization occurring during the postpartum period is sensitive to economic activity within the first trimester of pregnancy and the CPI change rate within the second trimester. The findings herein reveal that negative prenatal economic shocks lead to a higher probability of cesarean section, more outpatient visits for depressive disorders, hypertension, gestational diabetes, and anemia in the pregnancy period, and a lower number of prenatal care visits that could deteriorate postpartum maternal health. Moreover, our results are consistent with low-salary and private-sector-employed mothers who face credit constraints and experience the risk of losing their job, respectively, during a decline in economic activity and who subsequently suffer from nutritional deficits and maternal stress that lead to postpartum health deterioration. Conversely, high-salary mothers do not face credit constraints and have greater coping ability to deal with stress and nutritional problems, while public-sector-employed mothers are affected only by nutrition.
Collapse
|
14
|
Zhou Q, Yu Q, Wang X, Shi P, Shen Q, Zhang Z, Chen Z, Pu C, Xu L, Hu Z, Ma A, Gong Z, Xu T, Wang P, Wang H, Hao C, Li L, Gao X, Li C, Hao M. Are Essential Women's Healthcare Services Fully Covered? A Comparative Analysis of Policy Documents in Shanghai and New York City from 1978-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4261. [PMID: 33920527 PMCID: PMC8072775 DOI: 10.3390/ijerph18084261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to analyze the changes in the 10 major categories of women's healthcare services (WHSs) in Shanghai (SH) and New York City (NYC) from 1978 to 2017, and examine the relationship between these changes and maternal mortality ratio (MMR). Content analysis of available public policy documents concerning women's health was conducted. Two indicators were designed to represent the delivery of WHSs: The essential women's healthcare service coverage rate (ESCR) and the assessable essential healthcare service coverage rate (AESCR). Spearman correlation was used to analyze the relationship between the two indicators and MMR. In SH, the ESCR increased from 10% to 90%, AESCR increased from 0% to 90%, and MMR decreased from 24.0/100,000 to 1.01/100,000. In NYC, the ESCR increased from 0% to 80%, the AESCR increased from 0% to 60%, and the MMR decreased from 24.7/100,000 to 21.4/100,000. The MMR significantly decreased as both indicators increased (p < 0.01). Major advances have been made in women's healthcare in both cities, with SH having a better improvement effect. A common shortcoming for both was the lack of menopausal health service provision. The promotion of women's health still needs to receive continuous attention from governments of SH and NYC. The experiences of the two cities showed that placing WHSs among policy priorities is effective in improving service status.
Collapse
Affiliation(s)
- Qingyu Zhou
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (Q.Z.); (Q.Y.); (X.W.); (L.L.); (X.G.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai 200032, China
| | - Qinwen Yu
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (Q.Z.); (Q.Y.); (X.W.); (L.L.); (X.G.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xin Wang
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (Q.Z.); (Q.Y.); (X.W.); (L.L.); (X.G.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai 200032, China
| | - Peiwu Shi
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Zhejiang Academy of Medical Sciences, Hangzhou 310012, China
| | - Qunhong Shen
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Public Policy and Management, Tsinghua University, Beijing 100084, China
| | - Zhaoyang Zhang
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Project Supervision Center of National Health Commission of the People’s Republic of China, Beijing 100044, China
| | - Zheng Chen
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Grassroots Public Health Management Group, Public Health Management Branch of Chinese Preventive Medicine Association, Shanghai 201800, China
| | - Chuan Pu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China
| | - Lingzhong Xu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Public Health, Shandong University, Jinan 250012, China
| | - Zhi Hu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Health Service Management, Anhui Medical University, Hefei 230032, China
| | - Anning Ma
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- School of Management, Weifang Medical University, Weifang 261053, China
| | - Zhaohui Gong
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Committee on Medicine and Health of Central Committee of China Zhi Gong Party, Beijing 100011, China
| | - Tianqiang Xu
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Institute of Inspection and Supervision, Shanghai Municipal Health Commission, Shanghai 200031, China
| | - Panshi Wang
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Shanghai Municipal Health Commission, Shanghai 200031, China
| | - Hua Wang
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Jiangsu Preventive Medicine Association, Nanjing 210009, China
| | - Chao Hao
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Changzhou Center for Disease Control and Prevention, Changzhou 213003, China
| | - Li Li
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (Q.Z.); (Q.Y.); (X.W.); (L.L.); (X.G.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xiang Gao
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (Q.Z.); (Q.Y.); (X.W.); (L.L.); (X.G.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai 200032, China
| | - Chengyue Li
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (Q.Z.); (Q.Y.); (X.W.); (L.L.); (X.G.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai 200032, China
| | - Mo Hao
- Research Institute of Health Development Strategies, Fudan University, Shanghai 200032, China; (Q.Z.); (Q.Y.); (X.W.); (L.L.); (X.G.)
- Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China; (P.S.); (Q.S.); (Z.Z.); (Z.C.); (C.P.); (L.X.); (Z.H.); (A.M.); (Z.G.); (T.X.); (P.W.); (H.W.); (C.H.)
- Department of Health Policy and Management, School of Public Health, Fudan University, Shanghai 200032, China
| |
Collapse
|
15
|
Testa A, Jackson DB. Barriers to Prenatal Care Among Food-Insufficient Women: Findings from the Pregnancy Risk Assessment Monitoring System. J Womens Health (Larchmt) 2021; 30:1268-1277. [PMID: 33416423 DOI: 10.1089/jwh.2020.8712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This study examines the relationship among food insufficiency, adequacy of prenatal care, and barriers to prenatal care. Materials and Methods: Using data from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2009-2016, negative binomial and logistic regression models were used to assess the association among food insufficiency during pregnancy, late onset of prenatal care, the number of prental care visits, as well as barriers to prenatal care. Results: Findings indicate that food insufficiency is associated with not initiating prenatal care during the first trimester and having fewer overall visits. In addition, food insufficiency is associated with more overall barriers to prenatal care, and this association operates through several specific barriers, including not having enough money, lacking transportation to get to the clinic or doctor's office, not being able to get time off work, not having a Medicaid card, having too many other things going on, and having no one to take care of children. Conclusion: Considering the adverse consequences of both food insufficiency and a lack of sufficient prenatal care for maternal and child health, study findings suggest a need to develop targeted interventions that expand access and remove barriers to prenatal care among food-insufficient women.
Collapse
Affiliation(s)
- Alexander Testa
- Department of Criminology and Criminal Justice, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
16
|
Patton EW, Saia K, Stein MD. Integrated substance use and prenatal care delivery in the era of COVID-19. J Subst Abuse Treat 2021; 124:108273. [PMID: 33771277 PMCID: PMC7979279 DOI: 10.1016/j.jsat.2020.108273] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/24/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic has directly impacted integrated substance use and prenatal care delivery in the United States and has driven a rapid transformation from in-person prenatal care to a hybrid telemedicine care model. Additionally, changes in regulations for take home dosing for methadone treatment for opioid use disorder due to COVID-19 have impacted pregnant and postpartum women. We review the literature on prenatal care models and discuss our experience with integrated substance use and prenatal care delivery during COVID-19 at New England's largest safety net hospital and national leader in substance use care. In our patient-centered medical home for pregnant and postpartum patients with substance use disorder, patients' early responses to these changes have been overwhelmingly positive. Should clinicians continue to use these models, thoughtful planning and further research will be necessary to ensure equitable access to the benefits of telemedicine and take home dosing for all pregnant and postpartum patients with substance use disorder.
Collapse
Affiliation(s)
- Elizabeth W Patton
- Boston University School of Medicine, Department of Obstetrics and Gynecology, 85 East Concord St, 6th Floor, Boston, MA 02118, United States of America; Boston Medical Center, 850 Harrison Ave, Boston, MA 02118, United States of America.
| | - Kelley Saia
- Boston University School of Medicine, Department of Obstetrics and Gynecology, 85 East Concord St, 6th Floor, Boston, MA 02118, United States of America; Boston Medical Center, 850 Harrison Ave, Boston, MA 02118, United States of America.
| | - Michael D Stein
- Boston University School of Public Health, Department of Health Law, Policy and Management, 715 Albany St, Talbot Building, Boston, MA 02118, United States of America.
| |
Collapse
|
17
|
Factors Associated With a Trusting Relationship Between Pregnant and Postpartum Women With Substance Use Disorders and Maternity Nurses. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-20-00018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trusting relationships between pregnant and postpartum women with substance use disorders (SUDs) and maternity nurses can improve health outcomes for women and their infants. This study was conducted to identify factors associated with the formation of trust in these nurse–patient relationships. Using a qualitative description approach, semi-structured interviews were conducted with 10 women who used substances during pregnancy and 15 maternity nurses. The narratives were analyzed with standard content analytic techniques. Findings revealed that six characteristics of nurses and five characteristics of women fostered or hindered the formation of trusting relationships. The characteristics of the maternity nurses were (a) interpersonal connections, (b) demeanor toward women, (c) ways of providing care, (d) approaches to providing information, (e) attitudes toward substance use, and (f) addiction expertise. The characteristics of the women were (a) engagement with nurses, (b) demeanor toward nurses, (c) attitudes toward care, (d) investment in recovery, and (e) ways of interacting with infant. The characteristics provide a framework by which maternity nurses can examine their attitudes and behaviors toward women with SUDs and inform the development of strategies to enhance their practice with this population.
Collapse
|
18
|
Melnyk BM, Gennaro S, Szalacha LA, Hoying J, O'Connor C, Cooper A, Gibeau A. Randomized controlled trial of the COPE-P intervention to improve mental health, healthy lifestyle behaviors, birth and post-natal outcomes of minority pregnant women: Study protocol with implications. Contemp Clin Trials 2020; 98:106090. [PMID: 32745703 PMCID: PMC7686149 DOI: 10.1016/j.cct.2020.106090] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emotionally distressed pregnant minority women experience multiple adverse outcomes, including pre-eclampsia, preterm birth, operative deliveries and low birth weight. Although the United States Preventive Services Task Force recommends screening in pregnant women, many practices do not screen because efficacious interventions and systems are not in place to treat them. AIM Purpose of this randomized controlled trial (RCT) is to test a group delivered manualized cognitive-behavioral skills building intervention entitled COPE-P versus an attention control program on the mental health, birth and postpartum outcomes of minority pregnant women experiencing depressive, anxiety and stress symptoms. METHODS Design is a longitudinal randomized block RCT with repeated measures (beginning with screening prior to 18 weeks, group prenatal care in both groups from 16 + 1 to 31 + 1 weeks and ending at 6 months postpartum) at two study sites (New York city and Columbus, Ohio). Race/ethnicity is being blocked to ensure equal numbers of Hispanic and Black women. 384 women are being recruited from antenatal clinics if they are: between 18 and 40 years; in an uncomplicated singleton pregnancy <18 weeks; and self-identify as Black or Hispanic. Valid and reliable measures are being used to assess healthy lifestyle behaviors and mental health outcomes immediately following the interventions, six - eight weeks postpartum and at the children's six-month well baby visit. Birth and delivery outcomes also are being assessed. CONCLUSION If found to be efficacious, the COPE-P intervention could be a key solution to managing those with emotional distress and improving their outcomes.
Collapse
Affiliation(s)
- Bernadette Mazurek Melnyk
- Health Promotion and Wellness, The Ohio State University, the Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, College of Nursing, Pediatrics & Psychiatry, College of Medicine, The Ohio State University, 1585 Neil Ave, Columbus, OH 43210, United States of America.
| | - Susan Gennaro
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United States of America
| | - Laura A Szalacha
- Research Methodology and Biostatistics Core, USF Health Morsani College of Medicine, College of Nursing, University of South Florida, United States of America
| | - Jacqueline Hoying
- Consumer Core, the Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, The Ohio State University College of Nursing, Columbus, OH, United States of America
| | - Caitlin O'Connor
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, United States of America
| | - Andrea Cooper
- The Ohio State University College of Nursing, Columbus, OH, United States of America
| | - Anne Gibeau
- Midwifery, Jacobi Medical Center, Bronx, NY, United States of America
| |
Collapse
|
19
|
New evidence on the impact of the quality of prenatal care on neonatal and infant mortality in India. J Biosoc Sci 2019; 52:439-451. [DOI: 10.1017/s0021932019000543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractEvidence on the impact of the quality of prenatal care on childhood mortality is limited in developing countries, including India. Therefore, using nationally representative data from the latest round of the National Family Health Survey (2015–16), this study examined the impact of the quality of prenatal care on neonatal and infant mortality in India using a multivariable binary logistic regression model. The effect of the essential components of prenatal care services on neonatal and infant mortality were also investigated. The results indicate that improvement in the quality of prenatal care is associated with a decrease in neonatal (OR: 0.93, 95% CI: 0.91–0.97) and infant (OR: 0.94, 95% CI: 0.92–0.96) mortality in India. Tetanus toxoid vaccination, consumption of iron–folic acid tablets during pregnancy and having been weighed during pregnancy were statistically associated with a lower risk of neonatal and infant mortality. Educating women on pregnancy complications was also associated with a lower risk of neonatal mortality. No effect of blood pressure examination, blood test and examination of the abdomen during pregnancy were found on either of the two indicators of childhood mortality. Although the coverage of prenatal care has increased dramatically in India, the quality of prenatal care is still an area of concern. There is therefore a need to ensure high-quality prenatal care in India.
Collapse
|
20
|
Measuring perinatal and postpartum quality of life of women and associated factors in semi-urban Bangladesh. Qual Life Res 2019; 28:2989-3004. [PMID: 31312976 DOI: 10.1007/s11136-019-02247-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE The objective of this study was to measure the health-related quality of life (HRQoL) among pregnant women in the perinatal and postpartum periods and determine influencing factors that predict their HRQoL. METHODS The study was conducted among pregnant women who live in a semi-urban area of Chandpur, Bangladesh. A total of 465 women were recruited. The EuroQoL 5-Dimension 3-Level (EQ-5D-3L) and EuroQoL visual analog scale (EQ-VAS) instruments were used to measure the HRQoL of participants. Two-sample mean test (t test) was performed to examine the changes in HRQoL between the perinatal and postnatal periods of the same individuals. Multivariate linear regression was employed to identify the factors influencing HRQoL during the two periods. RESULTS Overall, the HRQoL scores improved significantly from the perinatal (0.49) to postpartum (0.86) period. Approximately 58% of women experienced moderate or extreme levels of health problems during the perinatal period regardless of their health status. However, most women had significantly improved health status in the postpartum period. Gestational weight gain and recommended postnatal care were significantly associated with improved HRQoL. Factors that negatively influenced changes in HRQoL included adolescent motherhood, caesarean delivery, inadequate antenatal care consultations and living in a poor household, during both the perinatal and postpartum periods. CONCLUSIONS Overall health status is found to be poor among women during the perinatal period compared with the postpartum period. The study indicates that interventions to address the influencing factors are needed to ensure better quality of life for women both pre- and post-birth. Community-based initiatives, such as awareness building, might address negative factors and subsequently improve health status and reduce adverse health outcomes related to pregnancy and postnatal care.
Collapse
|
21
|
Smith A, Burger R, Black V. Demand-Side Causes and Covariates of Late Antenatal Care Access in Cape Town, South Africa. Matern Child Health J 2019; 23:512-521. [PMID: 30600513 DOI: 10.1007/s10995-018-2663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives The objective of this study was to investigate the causes and covariates of late antenatal care access in South Africa. Methods A cross-sectional study was conducted, interviewing 221 women at four public-sector labour wards in Cape Town, South Africa in 2014. A definition of late attendance as attending ≥ 5 months was used. Data were analysed using univariate, bivariate and multivariate methods. Results Of the women who attended antenatal care at a public-sector clinic (n = 213, 96.4%), more than half (51.2%) attended ≥ 3 months and < 5 months, and a quarter (26.3%) attended ≥ 5 months. For those attending ≥ 5 months, 51.8% cited late recognition of pregnancy as the major reason for delayed attendance. Supply-side barriers were not identified as large contributing factors to delayed attendance. Late antenatal care access was predominantly associated with demand-side factors. Women who accessed antenatal care ≥ 5 months were more likely to be in the poorest 40% of the wealth-index distribution (p = 0.034) and to not have completed high school (p = 0.006). They were also more likely to report alcohol consumption during pregnancy (p = 0.020) and be multiparous (p = 0.035). Having completed high school was protective of late antenatal care access in stepwise logistic regression analysis (OR 0.403, CI 0.210-0.773, p < 0.01). For women who attended ≥ 3 months, late access was associated with unwanted pregnancy (p = 0.030). Conclusions for Practice Improved access to pregnancy tests could assist in earlier pregnancy identification. Interventions to increase awareness of the importance of early antenatal care attendance among vulnerable women may help.
Collapse
Affiliation(s)
- Anja Smith
- Research on Socio-Economic Policy (ReSEP), Department of Economics, Stellenbosch University, Stellenbosch, South Africa.
| | - Ronelle Burger
- Research on Socio-Economic Policy (ReSEP), Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | - Vivian Black
- Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
22
|
Cameron L, Contreras Suarez D, Cornwell K. Understanding the determinants of maternal mortality: An observational study using the Indonesian Population Census. PLoS One 2019; 14:e0217386. [PMID: 31158243 PMCID: PMC6546237 DOI: 10.1371/journal.pone.0217386] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 05/11/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND For countries to contribute to Sustainable Development Goal 3.1 of reducing the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030, identifying the drivers of maternal mortality is critically important. The ability of countries to identify the key drivers is however hampered by the lack of data sources with sufficient observations of maternal death to allow a rigorous analysis of its determinants. This paper overcomes this problem by utilising census data. In the context of Indonesia, we merge individual-level data on pregnancy-related deaths and households' socio-economic status from the 2010 Indonesian population census with detailed data on the availability and quality of local health services from the Village Census. We use these data to test the hypothesis that health service access and quality are important determinants of maternal death and explain the differences between high maternal mortality and low maternal mortality provinces. METHODS The 2010 Indonesian Population Census identifies 8075 pregnancy-related deaths and 5,866,791 live births. Multilevel logistic regression is used to analyse the impacts of demographic characteristics and the existence of, distance to and quality of health services on the likelihood of maternal death. Decomposition analysis quantifies the extent to which the difference in maternal mortality ratios between high and low performing provinces can be explained by demographic and health service characteristics. FINDINGS Health service access and characteristics account for 23% (CI: 17.2% to 28.5%) of the difference in maternal mortality ratios between high and low-performing provinces. The most important contributors are the number of doctors working at the community health centre (8.6%), the number of doctors in the village (6.9%) and distance to the nearest hospital (5.9%). Distance to health clinics and the number of midwives at community health centres and village health posts are not significant contributors, nor is socio-economic status. If the same level of access to doctors and hospitals in lower maternal mortality Java-Bali was provided to the higher maternal mortality Outer Islands of Indonesia, our model predicts 44 deaths would be averted per 100,000 pregnancies. CONCLUSION Indonesia has employed a strategy over the past several decades of increasing the supply of midwives as a way of decreasing maternal mortality. While there is evidence of reductions in maternal mortality continuing to accrue from the provision of midwife services at village health posts, our findings suggest that further reductions in maternal mortality in Indonesia may require a change of focus to increasing the supply of doctors and access to hospitals. If data on maternal death is collected in a subsequent census, future research using two waves of census data would prove a useful validation of the results found here. Similar research using census data from other countries is also likely to be fruitful.
Collapse
Affiliation(s)
- Lisa Cameron
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Diana Contreras Suarez
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Katy Cornwell
- Centre for Development Economics and Sustainability, Monash University, Clayton, Victoria, Australia
- World Vision Australia, Burwood East, Victoria, Australia
| |
Collapse
|
23
|
Green TL. Unpacking Racial/Ethnic Disparities in Prenatal Care Use: The Role of Individual-, Household-, and Area-Level Characteristics. J Womens Health (Larchmt) 2018; 27:1124-1134. [DOI: 10.1089/jwh.2017.6807] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tiffany L. Green
- Department of Health Behavior and Policy, VCU School of Medicine, Richmond, Virginia
| |
Collapse
|
24
|
Atkins DN, Held ML, Lindley LC. The impact of expanded health insurance coverage for unauthorized pregnant women on prenatal care utilization. Public Health Nurs 2018; 35:459-465. [PMID: 29888487 DOI: 10.1111/phn.12524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the effect of expanding Medicaid health insurance coverage for unauthorized women on prenatal care utilization. DESIGN AND SAMPLE A natural experiment design was used. We examined the prenatal care utilization of 20,876 unauthorized women from Nebraska, which expanded Medicaid coverage for unauthorized women, and South Carolina, which has never expanded coverage. MEASURES Measurements of prenatal care utilization included adequate prenatal care using the Kotelchuck Index and the number of prenatal care visits. The policy independent variable of interest was an interaction between the policy years (2007-2009) and Nebraska residence. Demographic characteristics were included as covariates. Analysis entailed a difference-in-difference approach to compare prenatal care utilization by state, both before and after legislation was passed to fund care among unauthorized women in Nebraska. RESULTS Women with insurance coverage were more likely to utilize prenatal services. Unauthorized women living in Nebraska during Medicaid expansion were 28% more likely to receive adequate prenatal care (OR = 1.28, p < 0.01) and had about one more prenatal care visit (IRR = 1.05, p < 0.01) than women who did not have expanded Medicaid coverage. CONCLUSIONS Findings have important public health policy implications to support improved birth outcomes among native-born infants of unauthorized women.
Collapse
Affiliation(s)
- Danielle N Atkins
- Department of Health Management and Informatics, University of Central Florida, Orlando, Florida
| | - Mary L Held
- College of Social Work, University of Tennessee, Knoxville, Nashville, Tennessee
| | - Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, Knoxville, Tennessee
| |
Collapse
|
25
|
Hitimana R, Lindholm L, Krantz G, Nzayirambaho M, Condo J, Sengoma JPS, Pulkki-Brännström AM. Health-related quality of life determinants among Rwandan women after delivery: does antenatal care utilization matter? A cross-sectional study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:12. [PMID: 29703248 PMCID: PMC5921437 DOI: 10.1186/s41043-018-0142-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/17/2018] [Indexed: 06/02/2023]
Abstract
BACKGROUND Despite the widespread use of antenatal care (ANC), its effectiveness in low-resource settings remains unclear. In this study, self-reported health-related quality of life (HRQoL) was used as an alternative to other maternal health measures previously used to measure the effectiveness of antenatal care. The main objective of this study was to determine whether adequate antenatal care utilization is positively associated with women's HRQoL. Furthermore, the associations between the HRQoL during the first year (1-13 months) after delivery and socio-economic and demographic factors were explored in Rwanda. METHODS In 2014, we performed a cross-sectional population-based survey involving 922 women who gave birth 1-13 months prior to the data collection. The study population was randomly selected from two provinces in Rwanda, and a structured questionnaire was used. HRQoL was measured using the EQ-5D-3L and a visual analogue scale (VAS). The average HRQoL scores were computed by demographic and socio-economic characteristics. The effect of adequate antenatal care utilization on HRQoL was tested by performing two multivariable linear regression models with the EQ-5D and EQ-VAS scores as the outcomes and ANC utilization and socio-economic and demographic variables as the predictors. RESULTS Adequate ANC utilization affected women's HRQoL when the outcome was measured using the EQ-VAS. Social support and living in a wealthy household were associated with a better HRQoL using both the EQ-VAS and EQ-5D. Cohabitating, and single/unmarried women exhibited significantly lower HRQoL scores than did married women in the EQ-VAS model, and women living in urban areas exhibited lower HRQoL scores than women living in rural areas in the ED-5D model. The effect of education on HRQoL was statistically significant using the EQ-VAS but was inconsistent across the educational categories. The women's age and the age of their last child were not associated with their HRQoL. CONCLUSIONS ANC attendance of at least four visits should be further promoted and used in low-income settings. Strategies to improve families' socio-economic conditions and promote social networks among women, particularly women at the reproductive age, are needed.
Collapse
Affiliation(s)
- Regis Hitimana
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Lindholm
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Gunilla Krantz
- Section of Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Manasse Nzayirambaho
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Jean Paul Semasaka Sengoma
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Anni-Maria Pulkki-Brännström
- Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| |
Collapse
|
26
|
Green TL, Bodas MV, Jones HA, Masho SW, Hagiwara N. Disparities in Self-Reported Prenatal Counseling: Does Immigrant Status Matter? J Community Health 2018. [PMID: 29516385 DOI: 10.1007/s10900-018-0495-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Immigrant women face unique barriers to prenatal care access and patient-provider communication. Yet, few prior studies have examined U.S.-born/immigrant differences in the content of care. The purpose of this study was to investigate the roles of immigrant status, English proficiency and race/ethnicity on the receipt of self-reported prenatal counseling using nationally representative data. We used data from the Early Childhood Longitudinal Study-Birth Cohort (N ≈ 8100). We investigated differences in self-reported prenatal counseling by immigrant status, English proficiency, and race/ethnicity using logistic regression. Counseling topics included diet, smoking, drinking, medication use, breastfeeding, baby development and early labor. In additional analyses, we separately examined these relationships among Hispanic, Mexican and Non-Hispanic (NH) Asian women. Neither immigrant status nor self-reported English proficiency was associated with prenatal counseling. However, we found that being interviewed in a language other than English language by ECLS-B surveyors was positively associated with counseling on smoking (OR, 2.599; 95% CI, 1.229-5.495) and fetal development (OR, 2.408; 95% CI, 1.052-5.507) among Asian women. Race/ethnicity was positively associated with counseling, particularly among NH black and Hispanic women. There is little evidence of systematic overall differences in self-reported prenatal counseling between U.S.-born and immigrant mothers. Future research should investigate disparities in pregnancy-related knowledge among racial/ethnic subgroups.
Collapse
Affiliation(s)
- Tiffany L Green
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, Richmond, VA, 23219, USA.
| | - Mandar V Bodas
- Department of Health Behavior and Policy, VCU School of Medicine, Virginia Commonwealth University, Richmond, USA
| | - Heather A Jones
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Saba W Masho
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Nao Hagiwara
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| |
Collapse
|
27
|
Makate M, Makate C. The impact of prenatal care quality on neonatal, infant and child mortality in Zimbabwe: evidence from the demographic and health surveys. Health Policy Plan 2017; 32:395-404. [PMID: 27993962 DOI: 10.1093/heapol/czw154] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 11/13/2022] Open
Abstract
The impact of the quality of prenatal care on child mortality outcomes has received less attention in sub-Saharan Africa. This study endeavoured to explore the effect of the quality of prenatal care and its individual components on neonatal, infant and under-five mortality. The empirical analysis uses data from the three most recent waves of the nationally representative Demographic and Health Survey for Zimbabwe conducted in 1999, 2005/06 and 2010/11. The results indicate that a one-unit increase in the quality of prenatal care lowers the prospect of neonatal, infant and under-five mortality by approximately 42.33, 30.86 and 28.65%, respectively. These findings remained roughly the same even after adjusting for potential mediating factors. Examining the effect of individual prenatal care components on child mortality revealed that women who receive information on possible complications arising during pregnancy are less liable to experience a neonatal death. Similarly, women who had blood pressure checks and tetanus immunizations were less likely to experience an infant or under-five death. We did not find any statistically meaningful impact on child mortality outcomes of blood and urine sample checks, iron tablet consumption, and the receipt of malarial tablets. Overall, our results suggest the need for public health policymakers to focus on ensuring high-quality prenatal care to enhance the survival prospects of Zimbabwe's infants.
Collapse
Affiliation(s)
- Marshall Makate
- Department of Economics, State University of New York at Albany, Albany, NY, USA and
| | - Clifton Makate
- UNEP Tongji Institute of Environment for Sustainable Development, Tongji University, Shanghai, People's Republic of China
| |
Collapse
|
28
|
Habibov N, Zainiddinov H. Do family planning messages improve antenatal care utilization? Evidence from Tajikistan. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 13:29-34. [DOI: 10.1016/j.srhc.2017.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 05/26/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
|
29
|
Yan J. The Effects of Prenatal Care Utilization on Maternal Health and Health Behaviors. HEALTH ECONOMICS 2017; 26:1001-1018. [PMID: 27374163 DOI: 10.1002/hec.3380] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 05/25/2016] [Accepted: 06/02/2016] [Indexed: 05/06/2023]
Abstract
While many economic studies have explored the role of prenatal care in infant health production, the literature is sporadic on the effects of prenatal care on the mother. This research contributes to this understudied but important area using a unique large dataset of sibling newborns delivered by 0.17 million mothers. We apply within-mother estimators to find robust evidence that poor prenatal care utilization due to late onset of care, low frequency of care visits, or combinations of the two significantly increases the risks of maternal insufficient gestational weight gain, prenatal smoking, premature rupture of membranes, precipitous labor, no breastfeeding, postnatal underweight, and postpartum smoking. The magnitude of the estimates relative to the respective sample means of the outcome variables ranges from 3% to 33%. The results highlight the importance of receiving timely and sufficient prenatal care in improving maternal health and health behaviors during pregnancy as well as after childbirth. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Ji Yan
- Department of Economics, Appalachian State University, Boone, NC, USA
| |
Collapse
|
30
|
Abstract
Background Infant mortality rate in Nigeria is among the highest world-wide. Utilization of modern health care facilities during pregnancy and at delivery reduces infant mortality rate. We examined the relationship between Infant Mortality (IM) and Maternal Health Care Services Access Index (MHCI) in Nigeria. Methods This cross-sectional study utilized 2013 NDHS data and included women aged 15–49 years (n=12511). MHCI was obtained from information on antenatal visit, antenatal attendance, tetanus toxoid injection during pregnancy, place of delivery and birth attendance. Cox-proportional hazard and Brass models were used for the analysis (α=0.05). Results Mean MHCI was higher among women with lower prevalence of IM. About 5.1% and 3.4% of the women with none and complete MHCI had experienced infant deaths respectively. The hazard of experienced infant deaths was 1.497(1.068–2.098) and 1.466(1.170–1.836) significantly higher among women with no and low MHCI respectively than those with complete MHCI. This pattern was observed when other factors were used as control. The refined IM probability (range=0.0482–0.1102) and IM rates (range=50–119) increased with reduction in the level of MHCI. The IM rate reduces from 119 per 1,000 live births among women whose MHCI score was zero to 50 per 1,000 live births among those with complete MHCI score. Conclusion Infant death was least experienced among women who had complete MHCI. If women optimize utilization of health facility during pregnancy and delivery, infant deaths will reduce in Nigeria.
Collapse
Affiliation(s)
- Adebowale Sa
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Udjo E
- 2Bureau of Marketing Research, University of South Africa, South Africa
| |
Collapse
|
31
|
Loftus CT, Stewart OT, Hensley MD, Enquobahrie DA, Hawes SE. A Longitudinal Study of Changes in Prenatal Care Utilization Between First and Second Births and Low Birth Weight. Matern Child Health J 2016; 19:2627-35. [PMID: 26138322 DOI: 10.1007/s10995-015-1783-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Because previous analyses of prenatal care (PNC) utilization and risk of low birth weight (LBW) may have been influenced by selection bias, we conducted a study using longitudinal data of women with repeat pregnancies. METHODS We analyzed Washington State birth certificates of first and second live births (2003-2012). We estimated relative risk (RR) of LBW at second birth associated with Kotelchuck Index PNC level among women stratified by level of PNC in their first birth (n = 67,571). RESULTS Among women with inadequate PNC prior to their first birth (n = 10,355), women with intermediate or adequate PNC before their second birth (n = 7464) had a reduced risk of LBW (adjusted RR 0.61, 95% CI: 0.48, 0.78) compared to those whose PNC level remained inadequate. Likewise, among women with intermediate or adequate PNC prior to their first birth (n = 57,216), those with inadequate PNC before the second birth (n = 7095) had higher risk of LBW (adjusted RR 1.59, 95% CI: 1.36, 1.85) compared to those who remained at intermediate or adequate PNC. CONCLUSIONS Our findings support the hypothesis that PNC decreases LBW risk at second birth, independent of factors related to the utilization of PNC at first birth.
Collapse
Affiliation(s)
- Christine T Loftus
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA
| | - Orion T Stewart
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA.
| | - Mark D Hensley
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA
| | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA
| | - Stephen E Hawes
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA, 98195, USA
| |
Collapse
|
32
|
Anatomy of Good Prenatal Care: Perspectives of Low Income African-American Women on Barriers and Facilitators to Prenatal Care. J Racial Ethn Health Disparities 2016; 4:79-86. [PMID: 26823064 DOI: 10.1007/s40615-015-0204-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/27/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although early, consistent prenatal care (PNC) can be helpful in improving poor birth outcomes, rates of PNC use tend to be lower among African-American women compared to Whites. This study examines low-income African-American women's perspectives on barriers and facilitators to receiving PNC in an urban setting. METHODS We conducted six focus groups with 29 women and individual structured interviews with two women. Transcripts were coded to identify barriers and facilitators to obtaining PNC; codes were reviewed to identify emergent themes. RESULTS Barriers to obtaining PNC included structural barriers such as transportation and insurance, negative attitudes towards PNC, perceived poor quality of care, unintended pregnancy, and psychosocial stressors such as overall life stress and chaos. Facilitators of PNC included positive experiences such as trusting relationships with providers, respectful staff and providers, and social support. CONCLUSIONS Findings suggest important components in an ideal PNC model to engage low-income African-American women.
Collapse
|
33
|
The Influence of Social Welfare Policies on Health Disparities Across the Life Course. HANDBOOKS OF SOCIOLOGY AND SOCIAL RESEARCH 2016. [DOI: 10.1007/978-3-319-20880-0_29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
34
|
Habibov N, Zainiddinov H. Effect of TV and radio family planning messages on the probability of modern contraception utilization in post-Soviet Central Asia. Int J Health Plann Manage 2015; 32:e17-e38. [PMID: 26490393 DOI: 10.1002/hpm.2318] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 11/06/2022] Open
Abstract
This study evaluates the effects of family planning message broadcast on radio and TV on the probability of modern contraception utilization in post-Soviet Central Asia. Viewing family planning messages on TV improves the chances of using modern contraception for a woman who actually saw the messages by about 11 and 8 per cent in Kyrgyzstan and Tajikistan, respectively. If every woman in Kyrgyzstan and Tajikistan had an opportunity to watch a family planning message on TV, then the likelihood of using modern contraception would have improved by 10 and 7 per cent in Kyrgyzstan and Tajikistan, respectively. By contrast, the effect of hearing family planning messages on radio is not significant in both countries. © 2015 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd. KEY MESSAGES Viewing family planning messages on TV improves the chances of using modern contraception for a woman who actually saw the messages by about 11 and 8 per cent in Kyrgyzstan and Tajikistan, respectively. If every woman in Kyrgyzstan and Tajikistan had an opportunity to watch a family planning message on TV, then the probability of using modern contraception would have improved by 10 and 7 per cent in Kyrgyzstan and Tajikistan, respectively. Consequently, using TV family planning messages in both countries should be encouraged. In comparison, the effect of hearing family planning messages on radio is not significant in both countries.
Collapse
Affiliation(s)
- Nazim Habibov
- School of Social Work, University of Windsor, Windsor, Ontario, Canada
| | - Hakim Zainiddinov
- Department of Sociology, Rutgers University, New Brunswick, New Jersey, USA
| |
Collapse
|
35
|
Does prenatal care benefit maternal health? A study of post-partum maternal care use. Health Policy 2015; 119:1382-9. [DOI: 10.1016/j.healthpol.2015.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 11/21/2022]
|
36
|
Awiti JO. A multilevel analysis of prenatal care and birth weight in Kenya. HEALTH ECONOMICS REVIEW 2014; 4:33. [PMID: 26208933 PMCID: PMC4502077 DOI: 10.1186/s13561-014-0033-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 11/07/2014] [Indexed: 06/08/2023]
Abstract
The paper investigates the effect of adequate use of prenatal care on birth weight in Kenya using data from the Kenya Demographic and Health Survey of 2008-2009 together with additional administrative data. Both a single-level model and a multi-level model are estimated. The estimation strategy controls for potential sample selection bias, potential endogeneity of prenatal care, and potential unobserved heterogeneity. The results indicate that adequate use of prenatal care increases birth weight, holding other factors constant. We further observe that the single-level model overstates the effect of prenatal care on birth weight. The results imply that infant health can be improved by using prenatal care adequately. The study calls for the pursuit of policies that encourage adequate use of prenatal care by expectant mothers such as ensuring availability of skilled health care providers such as doctors and nurses at prenatal care clinics, reducing the average distances mothers have to cover when seeking prenatal care services, intensifying education of females as a way of empowering them to be able to make the right choices regarding when to seek prenatal care and from whom, and increasing income opportunities for households.
Collapse
|
37
|
Habibov N, Fan L. The effect of maternal healthcare on the probability of child survival in Azerbaijan. BIOMED RESEARCH INTERNATIONAL 2014; 2014:317052. [PMID: 25110673 PMCID: PMC4119731 DOI: 10.1155/2014/317052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 06/23/2014] [Accepted: 06/23/2014] [Indexed: 11/25/2022]
Abstract
This study assesses the effects of maternal healthcare on child survival by using nonrandomized data from a cross-sectional survey in Azerbaijan. Using 2SLS and simultaneous equation bivariate probit models, we estimate the effects of delivering in healthcare facility on probability of child survival taking into account self-selection into the treatment. For women who delivered at healthcare facilities, the probability of child survival increases by approximately 18%. Furthermore, if every woman had the opportunity to deliver in healthcare facility, then the probability of child survival in Azerbaijan as a whole would have increased by approximately 16%.
Collapse
Affiliation(s)
- Nazim Habibov
- School of Social Work, University of Windsor, Windsor, ON, Canada N9B 3P4
| | - Lida Fan
- School of Social Work, Lakehead University, Thunder Bay, ON, Canada P7B 5E1
| |
Collapse
|
38
|
Patton-López MM, López-Cevallos DF, Cancel-Tirado DI, Vazquez L. Prevalence and correlates of food insecurity among students attending a midsize rural university in Oregon. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:209-214. [PMID: 24406268 DOI: 10.1016/j.jneb.2013.10.007] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 09/19/2013] [Accepted: 10/29/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To examine the prevalence and identify correlates of food insecurity among students attending a rural university in Oregon. METHODS Cross-sectional nonprobability survey of 354 students attending a midsize rural university in Oregon during May, 2011. The main outcome was food insecurity measured using the US Department of Agriculture Household Food Security Survey Module: 6-Item Short Form. Socioeconomic and demographic variables were included in multivariate logistic regression models. RESULTS Over half of students (59%) were food insecure at some point during the previous year. Having fair/poor health (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.07-4.63), being employed (OR, 1.73; 95% CI, 1.04-2.88), and having an income < $15,000/y (OR, 2.23; 95% CI, 1.07-4.63) were associated with food insecurity. In turn, good academic performance (grade point average of ≥ 3.1) was inversely associated with food insecurity. CONCLUSIONS Food insecurity seems to be a significant issue for college students. It is necessary to expand research on different campus settings and further strengthen support systems to increase access to nutritious foods for this population.
Collapse
Affiliation(s)
| | | | | | - Leticia Vazquez
- Department of Community Health, Western Oregon University, Monmouth, OR
| |
Collapse
|
39
|
Hooge SL, Benzies KM, Mannion CA. Effects of a Brief, Prevention-Focused Parenting Education Program for New Mothers. West J Nurs Res 2014; 36:957-74. [DOI: 10.1177/0193945913519871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We evaluated the effects of a parenting program, Baby and You, on parenting knowledge, parenting morale, and social support using a single-group, pre-test, and post-test design with 159 Canadian mothers of infants aged 2 to 9 months old. Baby and You is a prevention-focused parenting program (PFPP) to improve maternal and infant health through education and social support. The 4-week curriculum focuses on infant development and safety, parent–child relationships, maternal self-care, and community resources. We computed repeated-measures ANOVAs separately for scores on Parenting Knowledge Scale, Parenting Moral Index, and Family Support Scale. We found a significant increase between pre-test and post-test on parenting knowledge, but not parenting morale or social support. Parenting morale may be a stable construct that shows little change over time. It may take more than 4 weeks of programming for mothers to identify and integrate new sources of social support.
Collapse
|
40
|
Slaughter-Acey JC, Caldwell CH, Misra DP. The influence of personal and group racism on entry into prenatal care among African American women. Womens Health Issues 2013; 23:e381-7. [PMID: 24041828 PMCID: PMC3845454 DOI: 10.1016/j.whi.2013.08.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 08/05/2013] [Accepted: 08/07/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Racism has been hypothesized as a barrier to accessing health care. No quantitative study has directly assessed its influence on women's initiation of prenatal care (PNC). We examined the relationship between PNC entry and experiences of personal and group racism among low-income, African-American (AA) women. We also examined whether the use of denial of racism as a coping mechanism was associated with a delay in accessing PNC. METHODS Using a prospective/retrospective cohort design we collected data from 872 AA women (prenatally, n = 484; postpartum, n = 388). Multinomial logistic regression was used to assess the relationship between the overall denial of racism index and PNC initiation. FINDINGS PNC entry was not associated with personal experiences of racism (p = .33); it was significantly associated with group experiences (p < .01). CONCLUSION Denial of racism experienced by other AAs was a barrier to early PNC among low-income, AA women. Delayed access to PNC may be rooted in the avoidance of racialized experiences among less empowered women when faced with discrimination. Our findings have important implication for the engagement of AA women into the PNC delivery system and the health care system postpartum.
Collapse
Affiliation(s)
- Jaime C Slaughter-Acey
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Michigan.
| | | | | |
Collapse
|
41
|
Noonan K, Corman H, Schwartz-Soicher O, Reichman NE. Effects of prenatal care on child health at age 5. Matern Child Health J 2013; 17:189-99. [PMID: 22374319 PMCID: PMC3391357 DOI: 10.1007/s10995-012-0966-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The broad goal of contemporary prenatal care is to promote the health of the mother, child, and family through the pregnancy, delivery, and the child's development. Although the vast majority of mothers giving birth in developed countries receive prenatal care, past research has not found compelling evidence that early or adequate prenatal care has favorable effects on birth outcomes. It is possible that prenatal care confers health benefits to the child that do not become apparent until after the perinatal period. Using data from a national urban birth cohort study in the US, we estimate the effects of prenatal care on four markers of child health at age 5-maternal-reported health status, asthma diagnosis, overweight, and height. Prenatal care, defined a number of different ways, does not appear to have any effect on the outcomes examined. The findings are robust and suggest that routine health care encounters during the prenatal period could potentially be used more effectively to enhance children's health trajectories. However, future research is needed to explore the effects of prenatal care on additional child health and developmental outcomes as well as the effects of preconceptional and maternal lifetime healthcare on child health.
Collapse
Affiliation(s)
- Kelly Noonan
- Department of Economics, Rider University and National Bureau of Economic Research, 2083 Lawrenceville Rd., Lawrenceville, NJ 08648, Phone: 609-895-5539, Fax: 609-609-896-5387
| | - Hope Corman
- Department of Economics, Rider University and National Bureau of Economic Research, 2083 Lawrenceville Rd., Lawrenceville, NJ 08648, Phone: 609-895-5559, Fax: 609-609-896-5387
| | | | - Nancy E. Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, 97 Paterson St., Room 435, New Brunswick, NJ 08903, Phone: 732-235-7977, Fax: 732-235-7088
| |
Collapse
|
42
|
Winkelmann R. Copula bivariate probit models: with an application to medical expenditures. HEALTH ECONOMICS 2012; 21:1444-1455. [PMID: 22025413 DOI: 10.1002/hec.1801] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 07/14/2011] [Accepted: 09/16/2011] [Indexed: 05/31/2023]
Abstract
The bivariate probit model is frequently used for estimating the effect of an endogenous binary regressor (the 'treatment') on a binary health outcome variable. This paper discusses simple modifications that maintain the probit assumption for the marginal distributions while introducing non-normal dependence using copulas. In an application of the copula bivariate probit model to the effect of insurance status on the absence of ambulatory health care expenditure, a model based on the Frank copula outperforms the standard bivariate probit model.
Collapse
Affiliation(s)
- Rainer Winkelmann
- University of Zurich, Department of Economics, CH-8032 Zurich, Switzerland.
| |
Collapse
|
43
|
Kitsantas P, Gaffney KF, Cheema J. Life stressors and barriers to timely prenatal care for women with high-risk pregnancies residing in rural and nonrural areas. Womens Health Issues 2012; 22:e455-60. [PMID: 22841802 DOI: 10.1016/j.whi.2012.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 06/20/2012] [Accepted: 06/20/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify the contribution of life stressors and barriers to the untimely initiation of prenatal care for women with high-risk pregnancies living in rural and nonrural areas. METHODS Data collected in 10 U.S. states by the 2006-2008 Pregnancy Risk Assessment Monitoring System (PRAMS) were used (n = 34,161). Data were weighted to reflect the PRAMS complex survey design. Separate logistic regression models derived adjusted odds ratios for untimely prenatal care initiation based on several life stressors and barriers. RESULTS Women with high-risk pregnancies living in rural areas were more likely to report late initiation of prenatal care (17.5% vs. 14.6%). The most frequently reported life stressors were the same for both cohorts: Moving, having a very sick family member, arguing more than usual with their partners, and having bills they could not pay. The most frequently cited barriers were also the same for both groups: Not having enough money or insurance for health care visits and not being able to get an appointment when they wanted one. Having two or more barriers increased the risk of late prenatal care initiation by 2.85-fold for rural women and 2.01-fold for nonrural women. CONCLUSION To increase timely prenatal care initiation, preconception interventions are needed that address common life stressors and barriers shared by women living in rural and nonrural areas.
Collapse
Affiliation(s)
- Panagiota Kitsantas
- Department of Health Administration and Policy, The College of Health and Human Services, George Mason University, Fairfax, VA 22030, USA.
| | | | | |
Collapse
|
44
|
Measuring the Impact and Outcomes of Maternal Child Health Federal Programs. Matern Child Health J 2012; 17:886-96. [DOI: 10.1007/s10995-012-1067-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
45
|
Comas M, Català L, Sala M, Payà A, Sala A, Del Amo E, Castells X, Cots F. Descriptive analysis of childbirth healthcare costs in an area with high levels of immigration in Spain. BMC Health Serv Res 2011; 11:77. [PMID: 21492486 PMCID: PMC3100245 DOI: 10.1186/1472-6963-11-77] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 04/15/2011] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to estimate the cost of childbirth in a teaching hospital in Barcelona, Spain, including the costs of prenatal care, delivery and postnatal care (3 months). Costs were assessed by taking into account maternal origin and delivery type. Methods We performed a cross-sectional study of all deliveries in a teaching hospital to mothers living in its catchment area between October 2006 and September 2007. A process cost analysis based on a full cost accounting system was performed. The main information sources were the primary care program for sexual and reproductive health, and hospital care and costs records. Partial and total costs were compared according to maternal origin and delivery type. A regression model was fit to explain the total cost of the childbirth process as a function of maternal age and origin, prenatal care, delivery type, maternal and neonatal severity, and multiple delivery. Results The average cost of childbirth was 4,328€, with an average of 18.28 contacts between the mother or the newborn and the healthcare facilities. The delivery itself accounted for more than 75% of the overall cost: maternal admission accounted for 57% and neonatal admission for 20%. Prenatal care represented 18% of the overall cost and 75% of overall acts. The average overall cost was 5,815€ for cesarean sections, 4,064€ for vaginal instrumented deliveries and 3,682€ for vaginal non-instrumented deliveries (p < 0.001). The regression model explained 45.5% of the cost variability. The incremental cost of a delivery through cesarean section was 955€ (an increase of 31.9%) compared with an increase of 193€ (6.4%) for an instrumented vaginal delivery. The incremental cost of admitting the newborn to hospital ranged from 420€ (14.0%) to 1,951€ (65.2%) depending on the newborn's severity. Age, origin and prenatal care were not statistically significant or economically relevant. Conclusions Neither immigration nor prenatal care were associated with a substantial difference in costs. The most important predictors of cost were delivery type and neonatal severity. Given the impact of cesarean sections on the overall cost of childbirth, attempts should be made to take into account its higher cost in the decision of performing a cesarean section.
Collapse
Affiliation(s)
- Mercè Comas
- Epidemiology and Evaluation Department, IMIM-Hospital del Mar, Barcelona, Spain
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
A broad set of academic literatures shows that childbearing is associated with a variety of negative health outcomes for teenage mothers. Many researchers question whether teenage childbearing is the causal explanation for the negative outcomes (i.e., whether there is a biological effect of teenage childbearing or whether the relationship is due to other factors correlated with health and teenage childbearing). This study investigates the relationship between teenage childbearing and labor and delivery complications using a panel of confidential birth certificate data over the period from 1994 to 2003 from the state of Texas. Findings show that compared to mothers aged 25 to 29 having their first child, teenager mothers appear to have superior health in most--but not all--labor and delivery outcomes.
Collapse
Affiliation(s)
- Leonard M Lopoo
- The Maxwell School, Syracuse University, Syracuse, New York, USA.
| |
Collapse
|
47
|
Schillaci MA, Waitzkin H, Carson EA, Romain SJ. Prenatal care utilization for mothers from low-income areas of New Mexico, 1989-1999. PLoS One 2010; 5:e12809. [PMID: 20862298 PMCID: PMC2941446 DOI: 10.1371/journal.pone.0012809] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Accepted: 08/20/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prenatal care is considered to be an important component of primary health care. Our study compared prenatal care utilization and rates of adverse birth outcomes for mothers from low- and higher-income areas of New Mexico between 1989 and 1999. METHODOLOGY/PRINCIPAL FINDINGS Prenatal care indicators included the number of prenatal care visits and the first month of prenatal care. Birth outcome indicators included low birth weight, premature birth, and births linked with death certificates. The results of our study indicated that mothers from low-income areas started their prenatal care significantly later in their pregnancies between 1989 and 1999, and had significantly fewer prenatal visits between 1989 and 1997. For the most part, there were not significant differences in birth outcome indicators between income groupings. CONCLUSIONS/SIGNIFICANCE These findings suggest that while mothers from low-income areas received lower levels of prenatal care, they did not experience a higher level of adverse birth outcomes.
Collapse
Affiliation(s)
- Michael A Schillaci
- Department of Social Sciences, University of Toronto Scarborough, Scarborough, Ontario, Canada.
| | | | | | | |
Collapse
|
48
|
Nizalova OY, Vyshnya M. Evaluation of the impact of the Mother and Infant Health Project in Ukraine. HEALTH ECONOMICS 2010; 19 Suppl:107-125. [PMID: 20593450 DOI: 10.1002/hec.1609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This paper exploits a unique opportunity to evaluate the impact of the quality change in the labor and delivery services brought about by the Mother and Infant Health Project in Ukraine. Employing program evaluation methods, we find that the administrative units participating in the Project have exhibited greater improvements in both maternal and infant health compared to the control ones. Among the infant health characteristics, the MIHP impact is most pronounced for infant mortality resulting from deviations in perinatal period. As for the maternal health, the MIHP is the most effective at combating anemia, blood circulation and urinary-genital system complications, and late toxicosis. The analysis suggests that the effects are due to early attendance of antenatal clinics, lower share of C-sections, and greater share of normal deliveries. Preliminary cost-effectiveness analysis shows enormous benefit per dollar spent on the project: the cost to benefit ratio is one to 97 taking into account both maternal and infant lives saved as well as cost savings due to the changes in labor and delivery practices.
Collapse
Affiliation(s)
- Olena Y Nizalova
- Kyiv School of Economics, Kyiv Economics Institute, Kyiv, Ukraine.
| | | |
Collapse
|
49
|
Reichman NE, Corman H, Noonan K, Schwartz-Soicher O. Effects of prenatal care on maternal postpartum behaviors. REVIEW OF ECONOMICS OF THE HOUSEHOLD 2010; 8:171-197. [PMID: 20582158 PMCID: PMC2889707 DOI: 10.1007/s11150-009-9074-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Most research on the effectiveness of prenatal care has focused on birth outcomes and has found small or no effects. It is possible, however, that prenatal care is "too little too late" to improve pregnancy outcomes in the aggregate, but that it increases the use of pediatric health care or improves maternal health-related parenting practices and, ultimately, child health. We use data from the Fragile Families and Child Wellbeing birth cohort study that have been augmented with hospital medical record data to estimate effects of prenatal care timing on pediatric health care utilization and health-related parenting behaviors during the first year of the child's life. We focus on maternal postpartum smoking, preventive health care visits for the child, and breastfeeding. We use a multi-pronged approach to address the potential endogeneity of the timing of prenatal care. We find that first trimester prenatal care appears to decrease maternal postpartum smoking by about 5 percentage points and increase the likelihood of 4 or more well-baby visits by about 1 percentage point, and that it may also have a positive effect on breastfeeding. These findings suggest that there are benefits to standard prenatal care that are generally not considered in evaluations of prenatal care programs and interventions.
Collapse
Affiliation(s)
- Nancy E. Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, 97 Paterson St., Room 435, New Brunswick, NJ 08903, USA,
| | - Hope Corman
- Department of Economics, Rider University and National Bureau of Economic Research, 2083 Lawrenceville Rd., Lawrenceville, NJ 08648, USA,
| | - Kelly Noonan
- Department of Economics, Rider University and National Bureau of Economic Research, 2083 Lawrenceville Rd., Lawrenceville, NJ 08648, USA,
| | - Ofira Schwartz-Soicher
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA,
| |
Collapse
|
50
|
Bloch JR, Dawley K, Suplee PD. Application of the Kessner and Kotelchuck prenatal care adequacy indices in a preterm birth population. Public Health Nurs 2009; 26:449-59. [PMID: 19706128 DOI: 10.1111/j.1525-1446.2009.00803.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Healthy People 2010 goals to eliminate racial and ethnic health disparities that persist in the utilization of prenatal care (PNC) highlight the importance of measuring PNC as a variable in maternal and infant health outcomes research. These disparities are significantly correlated to adverse infant outcomes in preterm birth (PTB), a leading cause of infant mortality and life-long morbidity. Currently the most extensively used PNC adequacy indices (Kessner and Kotelchuck) were developed to measure outcomes in populations consisting mostly of full-term births. It is unclear whether these PNC adequacy indices are reliable when pregnancy is truncated due to PTB (<37 weeks). This paper compares and demonstrates how they can be applied in a specific PTB cohort. DESIGN AND SAMPLE This secondary analysis of a nested case-control study compares Kessner and Kotelchuck adequacy scores of 367 mothers of PTB infants. RESULTS There were significant differences in the rating of PNC inadequacy ( p<.001) depending on the PNC adequacy index used. CONCLUSION Critical evaluation is warranted before using these PNC adequacy indices in future public health nursing and PTB research.
Collapse
Affiliation(s)
- Joan Rosen Bloch
- College of Nursing & Health Professions, Drexel University, 245 N.15th Street, MS 1030, Philadelphia, PA 19102, USA.
| | | | | |
Collapse
|