prenatal care and income
DESCRIPTION
Prenatal Care and Income. Shy Chwen Ni, Bryan Mesina , Janice Guzman, Pak-Hun Chan, Charleen Bondoc. Background. Late prenatal care is considered a mother starting prenatal care after her first trimester. - PowerPoint PPT PresentationTRANSCRIPT
Prenatal Care and Income
Shy Chwen Ni, Bryan Mesina, Janice Guzman, Pak-Hun Chan, Charleen Bondoc
• Late prenatal care is considered a mother starting prenatal care after her first trimester.
• Mothers who fall between the Federal Poverty Level (FPL) of 0-100% receive $10,830 or less based on FPL of 2010.
Background
Too many women under the Federal
Poverty Level of 0-100% receive late or
no prenatal care.
The Problem
US poverty rate – 13.2%California poverty rate – 13.3%Arizona poverty rate – 14.7%Merced County poverty rate – 21.5%Fresno County poverty rate – 22.1%
Poverty Rates
National Statistics on Women in Poverty receiving late/no prenatal care
2004 2005 20061250
1300
1350
1400
1450
1500
1550
1600
16501605
1388 1396
National Statistics of Women Receiving late/no PNC to Poverty Level
Years
per
100,
000
wom
en
National Crude Rates
Year Rate
2004 518,557/4,112,052
2005 448,499/4,138,349
2006 451,068/4,265,555
SOURCE: DATA2010 (2006), National Vital Statistics System – Prenatal Care, CDC, NCHSAdjusted National data to no/late prenatal care to CENSUS 2000 population.Source U.S. Census Bureau: State and County QuickFacts. Data derived from Population Estimates, Census of Population and Housing, Small Area Income and Poverty Estimates, State and County Housing Unit Estimates, County Business Patterns, Nonemployer Statistics, Economic Census, Survey of Business Owners, Building Permits, Consolidated Federal Funds Report Last Revised: Thursday, 22-Apr-2010
SOURCE: DATA2010 (2006), National Vital Statistics System – Prenatal Care, CDC, NCHSSource U.S. Census Bureau: State and County QuickFacts. Data derived from Population Estimates, Census of Population and Housing,
Small Area Income and Poverty Estimates, State and County Housing Unit Estimates, County Business Patterns, Nonemployer Statistics, Economic Census, Survey of Business Owners, Building Permits, Consolidated Federal Funds Report Last Revised: Thursday, 22-Apr-2010
California vs. Arizona
2004 2005 20060
500
1000
1500
2000
2500
3000
3500
16741431 1396
31202942 2938
California vs. Arizonapoverty adjusted to no/late PNC
CalifornaLinear (Californa)ArizonaLinear (Arizona)
Years
per
100,
000
preg
nant
wom
en Crude Rate Year California Arizona
2004 0.12688 0.236392005 0.10838 0.228882006 0.10575 0.22259
California 2004 Poverty-Adjusted Rates by Age Groups
• PNC rates obtained from the CDC National Vital Statistics• Poverty rates obtained from the US Census Bureau
2004
Age GroupsLate/No PNC Rate
Poverty-Adjusted, Late/No PNC Rate(Per 100,000)
Under 15 0.486 6468
15-19 0.238 3159
20-24 0.166 2208
25-29 0.114 1519
30-34 0.087 1156
35-39 0.088 1167
40-44 0.101 1343
45-49 0.101 1341
50-54 0.108 1430
Average 0.127 1689
Under 15
15-1920-24
25-2930-34
35-3940-44
45-4950-54
Averag
e0
1000
2000
3000
4000
5000
6000
7000
Age Groups
Poverty-Ad-justed,
Late/No PNC Rate
(Per 100,000)
California 2005 Poverty-Adjusted Rates by Age Groups
• PNC rates obtained from the CDC National Vital Statistics• Poverty rates obtained from the US Census Bureau
Under 15
15-1920-24
25-2930-34
35-3940-44
45-4950-54
Averag
e0
1000
2000
3000
4000
5000
6000
Age Groups
Poverty-Ad-justed,
Late/No PNC Rate
(Per 100,000)
2005
Age Groups
Late/No PNC Rate
Poverty-Adjusted, Late/No PNC Rate (Per 100,000)
Under 15 0.414 5506
15-19 0.250 3319
20-24 0.175 2321
25-29 0.122 1626
30-34 0.091 1215
35-39 0.088 1165
40-44 0.104 1389
45-49 0.122 1625
50-54 0.040 536
Average 0.133 1772
California 2006 Poverty-Adjusted Rates by Age Groups
• PNC rates obtained from the CDC National Vital Statistics• Poverty rates obtained from the US Census Bureau
Under 15
15-1920-24
25-2930-34
35-3940-44
45-4950-54
Averag
e0
1000
2000
3000
4000
5000
6000
7000
Age Groups
Poverty-Ad-justed,
Late/No PNC Rate
(Per 100,000)
2006
Age Groups
Late/No PNC Rate
Poverty-Adjusted, Late/No PNC Rate (Per 100,000)
Under 15 0.487 6474
15-19 0.261 3477
20-24 0.183 2439
25-29 0.128 1699
30-34 0.095 1262
35-39 0.092 1220
40-44 0.108 1432
45-49 0.113 1502
50-54 0.096 1277
Average 0.140 1860
County-Level Analysis
2004 2005 20060
1000
2000
3000
4000
5000
6000
7000
8000
Merced vs FresnoPoverty-Adjusted, Late/No PNC Rates
MercedFresno
Year
Poverty-Ad-justed, Late/No
PNC Rate(Per 100,000)
2004 2005 20060
1000
2000
3000
4000
5000
6000
7000
8000
Merced vs FresnoPoverty-Adjusted, Late/No PNC Rates
MercedFresno
Year
Poverty-Ad-justed
Late/No PNC Rate
(Per 100,000)
•PNC rates obtained from the CDC National Vital Statistics•Poverty rates obtained from the US Census Bureau
Merced FresnoYear Late/No PNC Rate Late/No PNC Rate2004 0.314 0.1322005 0.328 0.1362006 0.335 0.140
National Level: From 2004-2006, there is decreasing trend in late/no PNC. It has decreased about 13.02% of people from 04’ to 06’.
State Level: California’s low-income women are receiving are twice as more PNC than Arizona. Both states show a slight decrease between the years 2004 and 2006.
County Level: Both Merced and Fresno County show an increase in women that receive no/late PNC. However, Merced county shows 2x more women receiving no/late PNC than Fresno county.
Trend
Individual behavioral intervention A study at Oregon Health Sciences University investigated
women, regardless of risk profile showed that there was a coorelation between low birthweight due to late/no PNC due to psychosocial factors.
-Pyschosocial factors – Maternal behavior (timing, participation in PNC ), Depression, Drug use
Studies showed that women who received more than 45 min of psychosocial services decreased the rate of low birth weights of infants, regardless of the womens risks factors. Even after controlling for number of PNC visits, having pshychosocial services still lowered the amount of low birth weights. SOURCE: Low birthweight in a public prenatal care program:
Behavioral and psychosocial risk factors and psychosocial intervention By Melanie J. Zimmer-Gembeck and Mark Helfand; Oregon Health Sciences University, Biomedical Information Communication
Individual behavioral intervention A study at Oregon Health Sciences University investigated
women, regardless of risk profile showed that there was a coorelation between low birthweight due to late/no PNC due to psychosocial factors.
-Pyschosocial factors – Maternal behavior (timing, participation in PNC ), Depression, Drug use
Studies showed that women who received more than 45 min of psychosocial services decreased the rate of low birth weights of infants, regardless of the womens risks factors. Even after controlling for number of PNC visits, having pshychosocial services still lowered the amount of low birth weights. SOURCE: Low birthweight in a public prenatal care program:
Behavioral and psychosocial risk factors and psychosocial intervention By Melanie J. Zimmer-Gembeck and Mark Helfand; Oregon Health Sciences University, Biomedical Information Communication
Community behavioral Intervention After a study by UCDavis of why low income women receive
late/no PNC, 4 topics were identified as the most relevant to communicate to the community:
-Health services use -The mother's weight gain -Nutrition and anemia -Symptoms of high-risk complications during pregnancy.
A poster, a calendar, a brochure, and two radio songs were produced and pretested in focus groups with low-income women. Each medium included one or more messages addressing informational, attitudinal, or behavioral needs, or all three, of the target population.
SOURCE: Designing prenatal care messages for low-income Mexican women. By R Alcalay, A Ghee, and S ScrimshawUniversity of California, Davis. 1993
Organizational behavioral Intervention A study by The American College of Obstetricians and Gynecologists
found that even when affordable care was available to many low income women did not make themselves available to them. Even though many women knew the importance of PNC, there were sociodemographic factors, system barriers, and cultural or personal barriers that caused them to not seek PNC.
To address these issues regarding the barriers between organizations and individuals, in 1994 the state of Tennesee implemented TennCare
- Provided mandatory managed-care coverage for Medicaid and uninsured populations.
Additionally they wanted to understand the barriers for people to did not receive adequte PNC care.
-Conducted interviews with women of reproductive age to collect information about women who wished to enter health services, and how they could address any barriers.
SOURCE: Prenatal Care for Low-Income Women Enrolled in a Managed-Care Organization. By GAZMARARIAN, JULIE A. MPH, PhD et al. 1999
Have clinics that provide PNC, information, and one-on-one sessions with other mothers that may benefit low-income women by extending their hours and work days on weekends. This will increase the number of women receiving PNC due to time barriers being removed . This will also change the behavioral aspect of women by being able to make appointments earlier in their pregnancy since they will have the time to see a doctor.
Recommendations