Prenatal care limited among immigrant groups

Health care disparities among immigrant groups may be caused by exclusions from Medicaid based on immigrations status, leading to imbalanced care during pregnancy, according to a recent study.

Though 1 in every 4 United States births is to a mother who is an immigrant, vital programs such as Medicaid are inaccessible to noncitizen immigrants. This keeps certain immigrants from receiving benefits that support maternal health and often improve mental health.

Timely prenatal care leads to early screening, intervention, and health education. Insurance coverage before pregnancy has been considered to increase chances of timely prenatal care because of access to regular medical care and ability to speak to a health care professional. This makes Medicaid coverage important for access to timely prenatal care.

Concerns have arisen over groups of immigrants being unable to access Medicaid. About 23% of immigrants are unauthorized for Medicaid, 5% are temporary lawful residents, 27% are not citizens despite being legal permanent residents, and 45% are naturalized citizens. Coverage for nonpregnant adult legal residents is only available in 5 states.

To evaluate the association between exclusion from Medicaid coverage and access to prenatal care, investigators conducted a study gathering data from the National Center for Health Statistics. The sample for this study consisted of singleton births from women aged 20 years or older in states that had adopted a change to the US birth certificate made in 2003.

The primary outcome was timely prenatal care, defined as prenatal care beginning during the first trimester. Individuals were defined as immigrants when born outside the United States. 

Covariates included parity, maternal educational level, and maternal age on an individual level, and state unemployment rate, state poverty rate, and the Immigrant Climate Index on a state level.

A total of 5,390,814 preexpansion women and 6,544,992 postexpansion women were included in the study. Of immigrant women, 27.3% were Asian, 7.3% Black, 49.6% Hispanic, and 15.8% White. Of US-born women, 2.5% were Asian, 12.1% were Black, 18.1% were Hispanic, and 67.3% were White. 

Overall, women born in the United States received prenatal care more often than immigrant women. This remained true across all racial and ethnic categories combined. In Hispanic immigrant women, timely prenatal care decreased postexpansion.

Timely prenatal care at baseline was given to 75.9% of immigrant women and 79.9% of US-born women. Post analysis, timely prenatal care among immigrant women decreased by 3.48 per 100 compared with US-born women. This decreased by another 1.53 per 100 among Asian immigrants and 1.18 per 100 among Hispanic immigrants.

Decrease in care worsened among women with lower education status. Education under high school level was observed in 28.7% of immigrant women and 8.7% of US-born women.

This study indicates disparities in access to timely prenatal care based on immigration status. Investigators urged policy makers to be aware of the effect exclusion to Medicaid based on immigration status has on the population.

Reference

Janevic T, Weber E, Howell FM, Steelman M, Krishnamoorthi M, Fox A. Analysis of state medicaid expansion and access to timely prenatal care among women who were immigrant vs US born. JAMA Netw Open. 2022;5(10):e2239264. doi:10.1001/jamanetworkopen.2022.39264