Does increasing access to prenatal care reduce racial disparities in birth outcomes?

Abstract

Purpose: To examine the effectiveness of early and adequate prenatal care (PNC) in reducing racial disparities in pre-term birth (PTB) among low-income women. Design and methods: This retrospective study examined birth records for 14,950 low-income Black and White women. The primary outcome of interest was racial disparities in PTB. Exposures of interest were first trimester entry into, and adequacy of, PNC. Maternal residential proximity to nearest PNC provider was calculated. Bivariate analyses were performed for PTB by race. Binary logistic regression was performed, controlling for maternal age, smoking status and racial segregation. Attributable risk of PTB for no or late entry into PNC, and percent difference by race was calculated. Results: We find that early and adequate PNC significantly decreases the risk of preterm birth, however, we find no evidence that this reduces racial disparities. Low income black females in a large metropolitan county have greater geographic access to and utilization of PNC than low-income white females, yet racial disparities in preterm birth remain. Attributable risk of PTB for no or late entry into PNC was lower for Black women (32.2%) than White women (39.4%). Conclusions: Our findings suggest that adequate PNC alone does not reduce the marked racial disparities in preterm birth. Practice implications: Public health agencies and health care providers need to look beyond access to care, to achieve racial equity in birth outcomes. Expansion of evidence-based, comprehensive nursing interventions shown to reduce preterm birth, such as the Nurse Family Partnership home visiting program, could contribute to these efforts.