Individual-, County-, And Structural-Level Factors In Prenatal Care Utilization And Birth Outcomes

Abstract

This research explores Black/White differences in prenatal care utilization, the contribution of these differences to racial disparities in birth outcomes, and the effect of community context on these outcomes. Black women initiate and continue prenatal care at rates that are lower than those for White women, which may contribute to their high relative risk of adverse birth outcomes, including infant mortality. The decision to use prenatal care might seem like an easy one for most pregnant women. However, pregnant Black women face significant financial, geographic, and psychosocial barriers to initiating and continuing care. Although there is a wide body of literature examining a variety of barriers to prenatal care utilization and the racial differences in utilization between Black and White women, this has not systematically examined the variation in utilization that exists between Black women of different socioeconomic statuses (SES). This research employs an intersectional framework to examine the effect of individual- and community-level socioeconomic factors on Black women’s prenatal care utilization patterns. This is done using the most recently released version of the Center for Disease Control’s (CDC) Linked Birth/Death dataset linked with the 5-year file of the American Community Survey (ACS) dataset. Black women are not a monolith, which is why it is important to examine within group variation to better understand the factors that push and pull Black women into and out of prenatal care, and the associated birth outcomes.