Birth Outcomes of Immigrant and Native-born Hispanic Women: Role of Prenatal Care Utilization and Participation in the Women, Infants and Children (WIC) Program

Abstract

In recent years, immigration to the U.S. from Central America and Mexico has increased substantially. This trend is evident in Prince George’s County, Maryland, which has growing numbers of both Hispanic immigrants and native-born Hispanic Americans. From 2011 to 2012, the infant mortality rate among Hispanics in Prince George’s County rose from 3.0 to 5.5 per 1,000 live births. The County lacked information about how birth outcomes were related to immigrant/native-born status and utilization of maternal health services, including receipt of adequate prenatal care and participation in the Women, Infants and Children (WIC) program. Previous studies have found that immigrant Hispanic women have better birth outcomes than native-born women (the “Hispanic Paradox”), but it is not known whether this pattern occurs in Prince George’s County. This study examined the association between immigrant status and two birth outcomes: preterm birth and infant low birth weight (LBW). It focused on how Hispanic women’s immigrant status (immigrant/native-born) was related to their use of prenatal care and WIC participation, as well as the association between these maternal health services and two infant birth outcomes. A major goal of the study was to assess whether or not adequate prenatal care and WIC participation mediated the relationship between women’s immigrant status and birth outcomes. Data from the 2011-2012 birth certificates of 4,971 Hispanic women in Prince George’s County were used to test study hypotheses. Findings revealed that native-born Hispanic women were significantly more likely to obtain adequate prenatal care than their immigrant peers, while immigrants were significantly more likely to enroll in WIC. Adequate prenatal care failed to predict either preterm birth or infant LBW, but WIC enrollment was significantly associated with lower likelihood of infant LBW. Consistent with the Hispanic Paradox, immigrant Hispanic women had significantly better birth outcomes than their native-born peers. WIC participation partially mediated the relationship between immigration status and infant LBW. Approximately 7% of the association between being an immigrant and reduced infant LBW was explained by WIC participation. Findings may assist policymakers and practitioners in designing interventions to reduce negative birth outcomes in Prince George’s County, Maryland, and the nation.