Disparities in Initiation and Adherence to Prenatal Care: Impact of Insurance, Race-Ethnicity and Nativity
- 867 Downloads
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.
KeywordsLate 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).
- 5.Department of Health and Human Services (DHHS). (2004). Healthy people 2010, conference edition. http://www.health.gov/healthypeople/Document/tableofcontents.htm. Accessed on Jan 2004.
- 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
- 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
- 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.Quinn, K. (2000). Working without benefits: The health insurance crisis facing Hispanic Americans. Cambridge, Mass.: Abt Associates.Google Scholar
- 23.Kaiser Commission on Medicaid and the Uninsured. (2000). Immigrants’ health care: Coverage and access. Washington: Kaiser Family Foundation.Google Scholar
- 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.Torres, R. D., Mirón, L. F., & Inda, J. (1999). Race, identity, and citizenship: A reader. Cambridge, USA, Oxford, UK: Blackwell Publishers.Google Scholar
- 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. http://www.hsph.harvard.edu/Organizations/healthnet/WoC/feminisms/crenshaw.html.
- 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.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.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.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.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.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.Sood, S. (1990). Violence against women. Jaipur, India: Arihant Publishers.Google Scholar