Timely Access to Prenatal Care:

Prime Necessity for Latina Mothers

David E. Hayes-Bautista

Cristina Gamboa

Mariam Iya Kahramanian

Maria Hayes-Bautista

Paul Hsu

Introduction

For the past decade, around a half million babies have been born in California each year. Continuing that trend, in 2002 mothers in the state gave birth to 529,245 babies. For the last two quarters of that year, more than 50 percent of those mothers were Latina. As Latinas become the majority of all mothers in the state, their birth outcomes will begin to be the birth outcomes for the average mother in the state. While Latina birth outcomes are generally quite good, there is one worrisome trend in an otherwise hopeful picture: the lack of access to timely prenatal care, which leads to an increased risk for complications of the pregnancy.¹

Data taken from the California 2002 Master Birth File show an increased risk of pregnancy complications for Latinas who do not receive prenatal care in the first trimester of pregnancy.

Timely Access to Prenatal Care

Access to timely prenatal care is essential to ensure good birth outcomes. Unfortunately for Latino birth outcomes, Latina mothers are much less likely than non-Hispanic white mothers to receive timely prenatal care. While 89.5 percent of non-Hispanic white mothers began their prenatal care in the first trimester (three months) of pregnancy, only 82.2 percent of Latino mothers managed to do so. By comparison, 86.5 percent of non-Hispanic Asian/Pacific Islander mothers, 80.9 percent of non-Hispanic African-American mothers and 74.5 percent of non-Hispanic American Indian mothers receive first-trimester prenatal care.

Not only do Latina mothers have the third lowest percentage of receiving first-trimester prenatal care, but this low percentage also translates into a large number of Latina mothers who receive care only in the second or third trimester of pregnancy, or who do not receive any care at all. Figure 1 shows the number of women receiving late prenatal care: 40,888 Latinas, compared to 15,662 non-Hispanic whites, 5,189 non-Hispanic African-Americans, 7,627 non-Hispanic Asian/Pacific Islanders and 534 non-Hispanic American Indians.

Timely Prenatal Care Reduces Pregnancy Complications

The positive effects of timely prenatal care are seen in Figure 2. Latinas who initiated prenatal care in the first trimester had the lowest rate of pregnancy complications: 77.6 complications per 1,000 live births. Those initiating care in the second trimester (months four through six) had a higher rate of complications — 87 per 1,000 live births — as did those starting care in the last trimester — 86.4 per 1,000 live births. Latinas who did not receive prenatal care at all had an extremely high rate of complications; at 134.1 birth complications per 1,000 live births, they experienced nearly twice the complication rate of those starting care during the first trimester.

Where Do Latinas Without Timely Prenatal Care Live?

From the data in the Master Birth File, we were able to identify the zip code of residence of the Latina mothers living in Los Angeles, Orange and Riverside counties who did not receive timely prenatal care. The top 30 zip codes are listed in Table A. The zip code with the greatest number of late-care receivers — 299 Latina mothers — was 90011 in Los Angeles County. The zip codes shown in Table A are in descending order by number of Latina mothers receiving late prenatal care.

The Growing Risk: U.S.-Born Latina Mothers

Ever since the late 1980s, around 125,000 baby girls every year have been born to Latina mothers. For the past two decades, the great majority of the Latina mothers giving birth have been immigrant mothers. Their babies were, of course, U.S.-born citizens.

This distinction between U.S.-born and immigrant Latina mothers is important. Overall, U.S.-born Latina mothers have higher rates of pregnancy complications than immigrant Latina mothers: 90.5 complications per 1,000 live births compared to 71.8. Specific problem areas are shown in Figure 3. Compared to immigrant Latina mothers, U.S.-born Latina mothers are 350 percent more likely to smoke, 125 percent more likely to have a sexually transmitted disease, 24 percent more likely to be unmarried and 17 percent more likely to have a low birth-weight baby.

When the majority of Latina mothers giving birth were immigrants, the overall complication rate for Latino births has been low. However, beginning in 2003, the U.S.‑born babies of these immigrant mothers will begin to enter the age of fertility — 15 to 45 years. In fact, around 125,000 U.S.-born Latina girls will turn 15 every year for the next two decades. By 2020 the vast majority of Latina mothers will be U.S.-born Latinas. If current trends continue, the Latino pregnancy complication rate is likely to increase dramatically, as the proportion of U.S.-born Latinas increases.

Timely prenatal care will become even more important in the future than it is now, to reduce the level of complications among Latina mothers.

Why Do Latina Mothers Not Receive Timely Care?

The Master Birth File only tells us which mothers did not receive timely prenatal care; it provides no information as to why they did not. In order to provide some insight, we conducted a series of focus groups with Latinas who had recently given birth to probe their perceptions of, and experiences with, prenatal care.

Delay in Seeking Care. Focus group participants were forthright in addressing why many Latinas may delay their prenatal care. One set of descriptions revolved around not realizing that one was pregnant. This situation was described by two types of women:

Older, unmarried women. These had not received a great deal of sex education, and, even though they were older, had not been aware of their pregnancy due to their inexperience.

— Y, yo soy, era una de las personas que andaba mucho con mi mes. Y me dijo, [el medico] ‘Estás embarazada.’ Le digo, ‘¡No!’. ‘¿Te cuidas?’, ‘No’, le dije, ‘pero no estoy embarazada porque yo tenía 8 meses de no cuidarme ... Entonces dije, Yo ya no voy a salir.’

I am, was, one of those women with very heavy menstrual periods. And he [the doctor] told me, “You are pregnant.” I said, “No!” [Then he asked] “Do you take precautions?” “No,” I said, “but I am not pregnant, because it had been eight months since I had taken precautions.” So I said, “I am not going to get pregnant.”)

Teenaged women. These women were going to school and may have been exhibiting what we would term “denial” about being pregnant.

— I was very young, and in my home my mom never told me to go. How was I supposed to know that I was pregnant? At eight months my girl was born … I looked very bad.

— When I was pregnant with my girl, I didn’t even find out until the fourth month that I was pregnant. I would go to school; I did what I had to do; I would pick up everything.

Insurance changes cause delay. Respondents also described delay caused by changes in their insurance.

— Como a la semana de ir, pero que mi aseguranza, El Grupo de México, que me tocaba, it went out of business. So I had to wait until they assigned me a new one, y se tardó casi meses.

(About a week before I was going to go [for prenatal care], my insurance company, which used to be assigned to me, the Mexican Group, it went out of business. So I had to wait until they assigned me a new one, and it took months.)

Attitudes About Prenatal Care

Young Latinas described the importance of early and regular care in order to give birth to a healthy baby, and they desired such care.

— Well, for me it is very important that as soon as you find out that you are pregnant you go to a clinic so that you can get checked up, so that they can also check up your baby and to see how your pregnancy is going. Because the first time they check you, they look at the baby’s heart and all. That is why it is important to go right away and not wait.

One respondent described her situation: She had not received timely prenatal care for her first birth. Luckily, while there were complications, they were not serious. She learned her lesson, and started timely care with her second child.

— I have a six-year-old daughter, and I never went to the doctor ... They had to do a C-section; I had a hemorrhage; I was anemic, high cholesterol, high blood pressure, I had everything, but it was because I never went to the doctor. Now with my son, I knew right away that I was pregnant and went to go get checked.

Nutrition was cited as an important concern for pregnant mothers.

— For me prenatal care is very important. There they give you vitamins, the supplements that one really needs. Not only for us but for the development of your baby.

Check-ups, many feel, prevent complications in pregnancy. There is a great deal of concern about possible problems, particularly deformities. A mother must do everything to reassure herself that her baby is all right.

— For me it was very important because we see so many things on television about children being born stuck together or with defects. It is very important to get check-ups on time to prevent all the complications of pregnancy.

— On my husband’s side of the family, an uncle of his had Downs Syndrome; and when I went to get a pregnancy test for this baby, I asked if there was a risk of the baby being born like that. In reality, no one really knows.

Conclusion

Every day, more than 112 Latinas give birth in California without having had access to prenatal care in a timely fashion. Each of these births is at increased risk for complications. The rate of complications most likely will increase in the future, as data have shown that U.S.-born Latinas are much more likely to smoke, have an STD or have a low birth-weight baby than immigrant Latina mothers. With more and more U.S.-born Latinas now entering the age of fertility without timely prenatal care, the rates of pregnancy complications and adverse outcomes for these women will only increase. It is imperative that outreach programs be developed that can bring more of these women into prenatal care in a timely fashion. The data have shown that, with early prenatal care, the rate of pregnancy complications is significantly reduced. When a pregnant woman seeks prenatal care late or receives none at all, the health of the mother and child may be in jeopardy; thus, the likelihood of having a complication increases. We have identified Latina mothers from Los Angeles, Orange and Riverside counties as those with the greatest number of late prenatal care births. First efforts need to concentrate on these areas to ensure that timely access to prenatal care is available. Without these efforts, the health and the future of Latinos are in jeopardy.

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1. Complications/concurrent illnesses of pregnancy include: preeclampsia, eclampsia, chronic hypertension, renal disease, pyelonephritis, anemia, cardiac disease, lung disease, diabetes, Rh sensitization, hemoglobinopathy, uterine bleeding before labor, polyhydramnios/oligohydramnios, incompetent cervix, premature labor, genital herpes, other sexually transmitted diseases, hepatitis B, rubella, tobacco use during pregnancy.

Table A: Top 30 zip codes in Los Angeles, Orange, and Riverside counties with the greatest number of Latinas with late or no prental care.

Rank	Number of Latina mothers with late or no prental care	MOMZIP	County
1	299	90011	Los Angeles
2	283	92201	Riverside
3	268	91331	Los Angeles
4	253	90201	Los Angeles
5	233	92704	Orange
6	207	92703	Orange
7	192	90280	Los Angeles
8	192	91766	Los Angeles
9	189	92701	Orange
10	182	92805	Orange
11	180	92236	Riverside
12	174	91744	Los Angeles
13	173	90063	Los Angeles
14	172	91342	Los Angeles
15	169	90022	Los Angeles
16	167	92707	Orange
17	166	90044	Los Angeles
18	160	92509	Riverside
19	152	90650	Los Angeles
20	151	91706	Los Angeles
21	148	93550	Los Angeles
22	142	91732	Los Angeles
23	138	90262	Los Angeles
24	137	92274	Riverside
25	135	90744	Los Angeles
26	134	90003	Los Angeles
27	132	90813	Los Angeles
28	131	90805	Los Angeles
29	130	90001	Los Angeles
30	129	90255	Los Angeles

TIMELY ACCESS TO PRENATAL CARE:

PRIME NECESSITY FOR LATINA MOTHERS

David Geffen School of Medicine at UCLA