Prenatal and Postpartum Care Disparities in a Large Medicaid Program

Area of Science:

• Public Health
• Health Services Research
• Maternal Health

Background:

• Pennsylvania faces significant maternal and infant mortality and preterm birth rates, disproportionately affecting racial and ethnic minorities.
• Access to timely and adequate prenatal and postpartum care is crucial for improving these adverse maternal and infant outcomes.
• Understanding disparities in care provision within state Medicaid programs is essential for targeted interventions.

Purpose of the Study:

• To assess disparities in the provision and timeliness of prenatal and postpartum care for women enrolled in Pennsylvania Medicaid.
• To identify differences in care access based on race, ethnicity, geographic region, year, and Managed Care Organization (MCO).

Main Methods:

• A cross-sectional evaluation of 12,228 women with live births in Pennsylvania Medicaid from November 2011 to 2015.
• Analysis of three binary effectiveness-of-care measures: prenatal care timeliness, frequency of prenatal care, and postpartum care timeliness.
• Logistic regression was used to assess differences in outcomes by race, ethnicity, region, year, and MCO.

Main Results:

• Compared to Black/African American women, White and Asian women had higher odds of receiving timely prenatal and postpartum care.
• Hispanic/Latina women showed a higher frequency of prenatal care compared to non-Hispanic women.
• Significant regional disparities were observed, with lower prenatal care in Southeast and lower postpartum care in Northwest Pennsylvania. MCO performance also correlated with widening racial disparities.

Conclusions:

• The study highlights persistent racial, regional, and MCO-based disparities in prenatal and postpartum care access for Pennsylvania Medicaid enrollees.
• Findings underscore the need for equity-focused interventions to address these identified gaps in care.
• Targeted strategies are required to improve maternal and infant health outcomes by reducing inequities in healthcare delivery.