Study finds persistent disparities in access to prenatal care among pregnant women

According to an analysis published in Open JAMA Network October 28.

The study, conducted by researchers from the Icahn School of Medicine at Mount Sinai and the University at Albany, SUNY, covered the period between 2011 and 2019, a time when access to prenatal care (defined by study as health care provided to pregnant women in the first trimester) was increased in states that expanded Medicaid under the Affordable Care Act.

While access to timely prenatal care has increased overall after the expansion of Medicaid, disparities between immigrant and US-born pregnant women have increased among those of Hispanic descent. In states that expanded Medicaid, 76.3% of immigrant Hispanic pregnant women received timely prenatal care after the expansion, compared to about 81.1% of American-born Hispanic pregnant women.

According to the Centers for Disease Control and Prevention, approximately one in four births in the United States is to an immigrant or non-US citizen. Some immigrants are excluded from safety net programs, including Medicaid, which provides health care to low-income US citizens.

“Our study shows that exclusions of immigrants from Medicaid eligibility can exacerbate disparities,” said co-corresponding author Teresa Janevic, PhD, MPH, associate professor of obstetrics, gynecology, and life sciences. reproduction, population health science and policy, and health systems design and global health. at Icahn Mount Sinai. “Timely and appropriate access to antenatal care is important because it benefits mothers and infants beyond pregnancy and birth. We know that pre-pregnancy insurance coverage leads to earlier initiation of antenatal care; therefore, Medicaid coverage before pregnancy is an important lever for improving prenatal care.”

The cross-sectional analysis used data from the National Center for Health Statistics and examined the prenatal care of more than 6 million pregnant people before and after Medicaid expansion in 16 states, including 400,000 immigrant pregnant women. The researchers also took into account characteristics such as age, number of children, level of education, race and ethnicity.

Dr. Janevic said the findings could inform current policy discussions about maternal health equity, demonstrating that some Medicaid coverage restrictions based on immigration status contribute to disparities between the native-born and immigrants seeking prenatal care in the United States. The study also encourages health care workers and policymakers to address how citizen exclusions from health care and benefits contribute to the structural racism faced by immigrant communities, she said.

“Non-citizens face many barriers to obtaining health coverage during and outside of pregnancy,” said co-corresponding author Ashley M. Fox, PhD, MA, associate professor of public administration and politics at the University of Albany, SUNY. “The pathways available to immigrants to access care are often complex and vary by qualifying status, time spent in the country, and state or locality of residence. Recent policy changes that have expanded eligibility to Medicaid, both before and during the COVID-19 pandemic, have often excluded immigrants, either inadvertently or inadvertently.”


Mount Sinai Health System

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