North Carolina Trends in Prenatal Care: The Need for Greater Equity in Prenatal Care Access for Women of Color

Abstract

Prenatal care (PNC) is a core element of preventive care and is vital in identifying and managing conditions that can put maternal and fetal health at risk. However, not all women benefit from this basic healthcare service. This study explores trends in access to PNC amidst racial inequities and challenges among social determinants of health. To examine the study aim, we analyzed birth records from the North Carolina Pregnancy Risk Assessment Monitoring System from 2017 to 2021. The primary outcome of interest was the adequacy of PNC, using the Kotelchuck Prenatal Care Index. One-way analysis of variance, chi-square, and logistic regression models were employed to address the study objective. The study included 587,028 women; White women had higher adjusted odds (aOR 1.33 to 1.18; p < .001) of receiving adequate PNC compared to other groups. Black women had lower odds of receiving adequate PNC (aOR = 0.75 to 0.85; p < .001) during the study period. While trends suggested the odds of Black women receiving adequate care are improving over time (p < .001), they remain lower than those of White and Hispanic women. Factors associated with inadequate access to PNC included having less than a high school diploma (p = .004), being unmarried (p < .001), and having Medicaid coverage (p < .001). Equitable prenatal care is essential to reducing maternal health disparities among women of color. This requires diverse healthcare staffing, implicit bias training, technology-supported care options, and addressing social determinants of health.

Keywords: Maternal health; Prenatal care; Racism; Trends.