Latina prenatal care PRAMS 2000

1. Latina prenatal care PRAMS 2000 June 18, 2003 Suzanne Yusem, Research Analyst

2. Contents • Overview of PRAMS • Prenatal, pregnancy, and postnatal access to care for the Hispanic women

3. PRAMS: Pregnancy Risk Assessment Monitoring System • Survey women 2-6 months after birth • About 180 women/month • Started by Oregon in 1998 - 3 cohorts • Integrated with CDC: 2002

4. Methods • In English and Spanish • Stratified random sample of births every month • Oversampling for racial and ethnic minority (Hisp, Afr/Am, Am/In, Asian/PI)

5. Methods: Response Rate By mother’s race/ethnicity • Hispanics 83% • Non-Hispanic African American 60% • Non-Hispanic American Indian 73% • Non-Hispanic Asian/PI 59% • Non-Hispanic White 80%

6. Vital Stats reports that in 2000… • 45,786 births to Oregon residents • Total births from Hispanic mothers: 7,397 (16.1%) • Proportion of births from Hispanic mothers has doubled in less than 10 years

7. PRAMS • 6,515 Hispanics mothers are represented • 80% of Hispanic mothers are foreign-born • Almost 93% of the foreign-born mothers were born in Mexico

8. Analysis is based on Hispanic moms: 5,045 Mexican moms non-Hispanic moms: 36,755 whose baby is alive and with them

9. PRAMS: points of analysis • Before pregnancy • During pregnancy • After baby’s birth

10. Before pregnancy

11. PRAMS: Before pregnancy Just before you got pregnant, did you have health insurance?

12. PRAMS: Before pregnancy Just before you got pregnant, did you have health ins. through OHP?

13. PRAMS: Before pregnancy Where were you/your partner getting BC? Check all that apply

14. PRAMS: Before pregnancy Did you know there was free or low cost BC at HD and PP clinics?

15. PRAMS: Before pregnancy Have you ever read or heard about emergency BC?

16. During pregnancy

17. PRAMS: During pregnancy At the time of your first pregnancy test, were you insured for PNC?

18. PRAMS: During pregnancy Did OHP pay for any portion of your prenatal care?

19. PRAMS: During pregnancy About how many weeks pregnant were you when you had your first visit for prenatal care?

20. PRAMS: During pregnancy Did you get prenatal care as early as you wanted?

21. PRAMS: During pregnancy Did any of these things keep you from getting PNC as early in your pregnancy as you wanted? Check all that apply. Hisp non-Hisp • I couldn’t get an appt earlier in my pregnancy 23.6% 13.3% • I didn’t have enough $ to pay for my PNC visits 8.4% 8.5% • I didn’t have ins. to pay for my PNC visits 5.5% 13.0% • I didn’t know I was pregnant 9.2% 10.4% • No, I got PNC as early as I wanted 48.9% 62.5%

22. PRAMS: During pregnancy Where did you go most of the time for your PNC visits? Check one.

23. PRAMS: During pregnancy Information received during prenatal care – check each item 70% or more of the Hispanic women recalled being told about… • nutrition • breastfeeding the baby • use of BC after delivery • how smoking during pregnancy could affect the baby • how secondhand smoke could affect your baby after birth

24. Information received during prenatal care – continued • how drinking alcohol could affect the baby • how using illegal drugs could affect your baby • doing genetic tests to screen for birth defects • getting tested for HIV and protecting themselves from contracting it • use of seat belt during pregnancy

25. Information received during prenatal care – continued Only 30% recalled hearing about the importance of seeing a dentist during pregnancy Only 44% recalled hearing about domestic violence

26. PRAMS: During pregnancy If you were in WIC during this pregnancy, how many weeks/months pregnant were you when you had your first WIC visit?

27. PRAMS: During pregnancy Things that happened to you before or during your last pregnancy Hisp non-Hisp • You got separated/divorced from partner 9.4% 9.3% • You moved to a new address 42.2% 42.1% • You were homeless 7.9% 2.0% • Your partner lost a job 19.9% 15.1% • You lost your job even though you wanted 21.9% 10.2% to go on working

28. PRAMS: During pregnancy Things that happened to you before or during your last pregnancy--continued Hisp non-Hisp • Your partner said he did not want you to 6.1% 7.4% get pregnant • You had a lot of bills you couldn’t pay 31% 27.9% • You were involved in a physical fight 4.4% 2.3% • You or your partner went to jail 4.2% 3.1%

29. PRAMS: During pregnancy Do you think you were treated differently by health care providers during prenatal care, labor or delivery because of your : Hisp non-Hisp • race 4.3% 1.0% • culture 4.8% 1.3% • ability to speak/ 11.9% 1.4% understand English • insurance status 6.4% 6.8%

30. PRAMS: During labor and delivery What type of insurance paid for your delivery? Check all that apply

31. After baby’s birth

32. PRAMS: After baby’s birth Where do you take your baby for routine well baby care? Check all.

33. PRAMS: After baby’s birth What is your insurance now?

34. PRAMS: After baby’s birth Are you or your partner using any kind of BC now?

35. PRAMS: After baby’s birth Where are you or your partner getting your BC method now? Check all

36. Summary • Hispanic women access health care services (birth control, prenatal care and baby routine care) at county Health Departments and Community Health Centers much more than non-Hispanic women • Hispanic women are covered for labor and delivery with OHP (via CAWEM) but do not have OHP for prenatal care

37. Summary -ctned • Hispanic women do not know about emergency contraception • Hispanic women access WIC services much more than non-Hispanic women, and they do so more often after 19 weeks