Association for Public Policy Analysis & Management

Introduction: Improving prenatal care (PNC) utilization, particularly among disadvantaged populations, has been a major focus of clinical and health policy in the United States over the past several decades. Non-white and foreign-born women are far less likely to initiate first-trimester care, have adequate numbers of PNC visits or have any PNC at all. Advice received during prenatal visits can greatly impact pregnant mothers’ health behaviors. However, while significant attention has been paid to disparities in the timing and number of prenatal care visits, much less is known about disparities in the content of prenatal care.

Objective: In this paper we investigate the roles of race/ethnicity, nativity and English proficiency in the receipt of self-reported prenatal care counseling on various topics related to the wellbeing of the mother and the child.

Data and Methods: We performed empirical analyses using data from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B). Mothers who gave birth to a child during the year 2001 were part of the sample. We excluded the mothers who had twins or had missing information for study variables (N=8,100). We examined the receipt of prenatal advice on following topics: 1) What to eat during pregnancy 2) Smoking during pregnancy 3) Drinking during pregnancy 4) Breastfeeding 5) Medications during pregnancy 6) Development of the baby and finally 7) Early or premature labor. We performed logistic regression models to predict the likelihood of receipt of each type of advice by mothers and controlled for various factors such as income, education, type of insurance and location of prenatal visits.

Results: Relative to non-Hispanic whites, non-Hispanic black mothers are more likely to receive prenatal counseling on nearly every dimension, including smoking, drinking, breastfeeding, healthy diet, baby development and early labor. Hispanic women are more likely to receive advice on smoking and drinking. We found no evidence that foreign-born status was associated with the receipt of prenatal counseling. Similarly, English language proficiency of the mother was not associated with receipt of prenatal advice on any of the topics studied. Although non-Hispanic black mothers are more likely to receive prenatal counseling, we found little evidence of systematic differences between U.S.- and foreign-born mothers.

Conclusions: The results suggest that nativity of the mother and her English language proficiency do not seem to impact the type and the content of the prenatal advice received. When designing policies to improve prenatal care utilization, policymakers should be mindful of the racial/ethnic background of pregnant mothers.