Maternal and Child Health Journal

, Volume 14, Issue 4, pp 618–624 | Cite as

Disparities in Initiation and Adherence to Prenatal Care: Impact of Insurance, Race-Ethnicity and Nativity

  • Marlene I. Bengiamin
  • John A. Capitman
  • Mathilda B. Ruwe


We used the intersectionality framework to examine impact of racial/ethnic, immigration, and insurance differences on the timing of initiation of prenatal care (PNC) and subsequent adherence. In this cross sectional study independent variables were women’s race/ethnicity; nativity; age; education; and insurance. The dependent variables were late initiation and non-adherence to recommended number of PNC visits. We used multivariate analysis to evaluate the impact of the independent variables on late initiation and non-adherence. Analysis revealed that race/ethnicity/nativity (RE-N) was more consistently associated with late initiation and non-adherence for privately insured than publicly insured persons. While private insurance had a positive impact on initiation and adherence overall, its impact was greater for White women. Having private insurance coverage was most beneficial to White women. We contend that the intersectional approach provides promising avenues for expanding our knowledge of health disparities and of identifying new ways of going about eliminating the persistent and pervasive social inequalities and informing efforts to reduce them.


Late initiation Non-adherence Race/ethnicity/nativity Private insurance Teen mother Education U.S. born Non-U.S. born Women of color 



This publication was made possible by a grant from the California Endowment (Grant 20031023).


  1. 1.
    Murray, J., & Bernfield, M. L. (1988). The differential effect of prenatal care on the incidence of low birth weight among Blacks and Whites in a prepaid health care plan. New England Journal of Medicine, 319, 1385–1391.PubMedCrossRefGoogle Scholar
  2. 2.
    Kogan, M. D., Alexander, G. R., Jack, B., & Allen, M. (1998). The association between adequacy of prenatal care utilization and subsequent pediatric care utilization in the United States. Pediatrics, 102(1), 25–30. July.CrossRefPubMedGoogle Scholar
  3. 3.
    Swigonski, N. L., Skinner, C. S., & Wolinsky, F. D. (1995). Prenatal health behaviors as predictors of breast-feeding, injury, and vaccination. Archives of Pediatrics and Adolescent Medicine, 149, 380–385.PubMedGoogle Scholar
  4. 4.
    Kotelchuck, M. (1994). An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. American Journal of Public Health, 84, 1414–1420.CrossRefPubMedGoogle Scholar
  5. 5.
    Department of Health and Human Services (DHHS). (2004). Healthy people 2010, conference edition. Accessed on Jan 2004.
  6. 6.
    Howell, E. (2001). The impact of the medicaid expansions for pregnant women: A synthesis of the evidence. Medical Care Research and Review, 58(1), 3–30.PubMedGoogle Scholar
  7. 7.
    Dubay, L., Joyce, T., Kaestner, R., & Kenney, G. (2001). Changes in prenatal care timing and low birth weight by race and socioeconomic status: Implications for the medicaid expansions for pregnant women. Health Services Research, 36(2), 373–403.PubMedGoogle Scholar
  8. 8.
    Kramer, M., Seguin, L., Lydon, J., & Goulet, L. (2000). Socio-economic disparities in pregnancy outcome: Why do the poor fare so poorly? Paediatric and Perinatal Epidemiology, 14(3), 194–210.CrossRefPubMedGoogle Scholar
  9. 9.
    Egerter, S., Braveman, P., & Marchi, K. (2002). Timing of insurance and use of prenatal care among low-income women. American Journal of Public Health, 92(3), 423–427.CrossRefPubMedGoogle Scholar
  10. 10.
    Braveman, P., Marchi, K., Sarnoff, R., Egerter, S., & Rittenhouse, D. (2003). Promoting access to prenatal care: Lessons from the California experience. Washington, DC: The Henry J. Kaiser Family Foundation.Google Scholar
  11. 11.
    Gortmaker, S. L. (1979). The effects of prenatal care upon the health of the newborn. American Journal of Public Health, 69(7), 653–660.CrossRefPubMedGoogle Scholar
  12. 12.
    Greenberg, R. S. (1983). The impact of prenatal care in different social groups. American Journal of Obstetrics and Gynecology, 145(7), 797–801.PubMedGoogle Scholar
  13. 13.
    Showstack, J., Budetti, P. R., & Minkler, D. (1984). Factors associated with birth weight: An exploration of the roles of prenatal care and length of gestation. American Journal of Public Health, 74(9), 1003–1008.CrossRefPubMedGoogle Scholar
  14. 14.
    Department of Health and Human Services (DHHS). (2003). National healthcare disparities report. Rockville, MD: Department of Health and Human Services, Agency for Healthcare Research and Quality.Google Scholar
  15. 15.
    Alexander, G. R., Kogan, M. D., & Nabukera, S. (2002). Racial differences in prenatal care use in the United States: Are disparities decreasing? American Journal of Public Health, 92(12), 1970–1975.CrossRefPubMedGoogle Scholar
  16. 16.
    Goldenberg, R. L., & Rouse, D. J. (1998). Prevention of premature birth. New England Journal of Medicine, 339(5), 313–320.CrossRefPubMedGoogle Scholar
  17. 17.
    Ickovics, J. R., Kershaw, T. S., Westdahl, C., Rising, S. S., Klima, C., Reynolds, H., et al. (2003). Group prenatal care and preterm birth weight: Results from a matched cohort study at public clinics. Obstetrics and Gynecology, 102, 1051–1057.CrossRefPubMedGoogle Scholar
  18. 18.
    Kogan, M. D., Alexander, G. R., Kotelchuck, M., & Nagey, D. A. (1994). Relation of the content of prenatal care to the risk of low birth weight. Maternal reports of health behavior advice and initial prenatal care procedures. JAMA, 271(17), 1340–1345.CrossRefPubMedGoogle Scholar
  19. 19.
    McCormick, M. C., & Siegel, J. E. (2001). Recent evidence on the effectiveness of prenatal care. Ambulatory Pediatrics, 1(6), 321–325.CrossRefPubMedGoogle Scholar
  20. 20.
    Alexander, G. R., & Korenbrot, C. C. (1995). The role of prenatal care in preventing low birth weight. The Future Children, 5(1), 103–120.CrossRefGoogle Scholar
  21. 21.
    U.S. Commission on Civil Rights. (1999). The health care challenge: Acknowledging disparity, confronting discrimination, and ensuring equality: Vol. I, the role of governmental and private health care programs and initiatives. Washington: U.S. Commission on Civil Rights.Google Scholar
  22. 22.
    Quinn, K. (2000). Working without benefits: The health insurance crisis facing Hispanic Americans. Cambridge, Mass.: Abt Associates.Google Scholar
  23. 23.
    Kaiser Commission on Medicaid and the Uninsured. (2000). Immigrants’ health care: Coverage and access. Washington: Kaiser Family Foundation.Google Scholar
  24. 24.
    Guinier, L., & Torres, G. (2003). The miner’s canary: Enlisting race, resisting power, transforming democracy (The Nathan I. Huggins Lectures). Harvard University Press.Google Scholar
  25. 25.
    Torres, R. D., Mirón, L. F., & Inda, J. (1999). Race, identity, and citizenship: A reader. Cambridge, USA, Oxford, UK: Blackwell Publishers.Google Scholar
  26. 26.
    Crenshaw, K. (1994). Mapping the margins: Intersectionality, identity politics, and violence against women of color. In M. Fineman & R. Mykitiuk (Eds.), The public nature of private violence (pp. 93–118). Routledge: New York.
  27. 27.
    LaVeist, T. A., Keith, V. M., & Gutierrez, M. L. (1995). Black/White differences in prenatal care utilization: An assessment of predisposing and enabling factors. Health Services Research, 30(1 Pt 1), 43–58.PubMedGoogle Scholar
  28. 28.
    Bengiamin, M, Capitman, J. A., Paul, C. M., Riordan, D. G., & Curtis, K. A. (2005). Healthy people 2010: A 2005 profile of health status in the San Joaquin Valley. Fresno, CA: California State University, Fresno.Google Scholar
  29. 29.
    Capitman, J., Bengiamin, M., Curtis, K., & Iqbal, S. (2005). Birth patterns in the San Joaquin Valley: Adequate care and pre-term births. Proceedings of the 26th annual California research symposium. California State University, Fresno, CA.Google Scholar
  30. 30.
    Galbraith, A. (2005). Out-of-pocket financial burden for low-income families with children: Socioeconomic disparities and effects of insurance. Health Services Research.Google Scholar
  31. 31.
    Ku, L., & Broaddus, M. (2008). Public and private health insurance: Stacking up the costs. Health Affairs, 27(4), w318–w327 [published online 24 June 2008,  10.1377/hlthaff.27.4.w318].
  32. 32.
    Almeida, R. V. (1998). The dislocation of women’s experience in family therapy. Journal of Feminist Family Therapy, 10(3), 1–19.Google Scholar
  33. 33.
    Miller, B. D. (1992). Wife-beating in India: Variations on a theme. In D. Ayers Counts, J. K. Brown, & J. C. Campbell (Eds.), Sanctions and sanctuary: Cultural perspectives on the beating of wives (pp. 173–184). Boulder, San Francisco & Oxford: Westview Press.Google Scholar
  34. 34.
    Sood, S. (1990). Violence against women. Jaipur, India: Arihant Publishers.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Marlene I. Bengiamin
    • 1
  • John A. Capitman
    • 1
  • Mathilda B. Ruwe
    • 1
  1. 1.Central Valley Health Policy Institute, Central California Center for Health and Human Services, College of Health and Human ServicesCalifornia State University, FresnoFresnoUSA

Personalised recommendations