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

Over an eight-year period, pregnant immigrants faced persistent inequalities in obtaining timely prenatal care in the United States compared to native-born pregnant women, a factor that led to longstanding health disadvantages, according to an analysis published in could contribute JAMA network open on October 28th.

The study, led 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 (referred to in the study as health care for defined as pregnant). within the first trimester) was increased in states expanding Medicaid as part of the Affordable Care Act.

While access to timely prenatal care increased overall after the expansion of Medicaid, the disparities between immigrant and US-born pregnant women widened for those of Hispanic ancestry. In states where Medicaid was expanded, 76.3 percent of immigrant Hispanic pregnant women received timely prenatal care after the expansion, compared to about 81.1 percent of US-born Hispanic pregnant women.

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

“Our study shows that disqualifying immigrants from Medicaid eligibility can exacerbate inequalities,” said co-author Teresa Janevic, PhD, MPH, associate professor of obstetrics, gynecology and reproductive science, population health science and policy, and global health and health systems design Icahn Mount Sinai. “Rapid and appropriate access to prenatal care is important because it benefits mothers and infants beyond pregnancy and childbirth. We know that pre-pregnancy coverage results in earlier start of prenatal care; therefore, pre-pregnancy Medicaid insurance is an important lever to improve timely prenatal care.”

The cross-sectional analysis used data from the National Center for Health Statistics and reviewed the prenatal care of more than 6 million pregnant people before and after Medicaid expansion in 16 states, including 400,000 pregnant migrant women. The researchers also considered 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 and show that certain limitations on Medicaid coverage due to immigrant status contribute to inequalities between native-born and immigrant people seeking prenatal care in the United States take. The study also encourages health care workers and policymakers to look into how citizen-based exclusions from health care and social services contribute to structural racism faced by migrant communities, she said.

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


Mount Sinai Health System

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