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Use of maternal health services: comparing refugee, immigrant and US-born populations

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Abstract

Objectives To determine use of recommended maternal healthcare services among refugee and immigrant women in a setting of near-universal insurance coverage. Methods Refugee women age ≥18 years, who arrived in the US from 2001 to 2013 and received care at the same Massachusetts community health center, were matched by age, gender, and date of care initiation to Spanish-speaking immigrants and US-born controls. The primary outcome was initiation of obstetrical care within the first trimester (12 weeks gestation). Secondary outcomes were number of obstetrical visits and attending a postpartum visit. Results We included 375 women with 763 pregnancies (women/pregnancies: 53/116 refugee, 186/368 immigrant, 136/279 control). More refugees (20.6 %) and immigrants (15.0 %) had their first obstetric visit after 12 weeks gestation than controls (6.0 %, p < 0.001). In logistic regression models adjusted for age, education, insurance, BMI, and median census tract household income, both refugee (odds ratio [OR] 4.58, 95 % confidence interval [CI] 1.73–12.13) and immigrant (OR 2.21, 95 % CI 1.00–4.84) women had delayed prenatal care initiation. Refugees had fewer prenatal visits than controls (median 12 vs. 14, p < 0.001). Refugees (73.3 %) and immigrant (78.3 %) women were more likely to have postpartum care (controls 54.8 %, p < 0.001) with differences persisting after adjustment (refugee [OR 2.00, 95 % CI 1.04–3.83] and immigrant [OR 2.79, 95 % CI 1.72–4.53]). Conclusions for Practice Refugee and immigrant women had increased risk for delayed initiation of prenatal care, but greater use of postpartum visits. Targeted outreach may be needed to improve use of beneficial care.

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Authors and Affiliations

  1. Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Katherine Kentoffio

  2. Division of General Internal Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114, USA

    Seth A. Berkowitz, Steven J. Atlas & Sanja Percac-Lima

  3. Diabetes Center, Massachusetts General Hospital, 50 Staniford Street, Boston, MA, 02114, USA

    Seth A. Berkowitz & Sanja Percac-Lima

  4. Center for Community Health Improvement, Massachusetts General Hospital, 101 Merrimac Street, Boston, MA, 02114, USA

    Sarah A. Oo

  5. Massachusetts General Hospital Chelsea HealthCare Center, 151 Everett Ave, Chelsea, MA, 02150, USA

    Sarah A. Oo & Sanja Percac-Lima

Authors
  1. Katherine Kentoffio
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  2. Seth A. Berkowitz
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  3. Steven J. Atlas
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  4. Sarah A. Oo
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  5. Sanja Percac-Lima
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Corresponding author

Correspondence to Sanja Percac-Lima.

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This study was reviewed and approved by the Institutional Review Board of Partners Healthcare.

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Kentoffio, K., Berkowitz, S.A., Atlas, S.J. et al. Use of maternal health services: comparing refugee, immigrant and US-born populations. Matern Child Health J 20, 2494–2501 (2016). https://doi.org/10.1007/s10995-016-2072-3

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  • DOI: https://doi.org/10.1007/s10995-016-2072-3

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