TABLE 3.
Probability of perinatal care among postpartum Hispanic individuals by an estimated proxy of likely citizenship and immigrant Medicaid coverage status.
| Perinatal care utilization and quality | Adjusted predicted probabilities (95% CI) a | |||||
|---|---|---|---|---|---|---|
| Likely noncitizen b (n = 7003) | Likely citizen b (n = 28,776) | |||||
| No immigrant Medicaid coverage c (n = 2405) | Immigrant Medicaid coverage d (n = 4598) | Adjusted difference (95% CI) a | No immigrant Medicaid coverage c (n = 10,155) | Immigrant Medicaid coverage d (n = 18,621) | Adjusted difference (95% CI) a | |
| Poor care utilization | ||||||
| No preconception visits | 55.8 (51.6,60.0) | 55.4 (52.2,58.5) | 0.5 (−3.8, 4.7) | 42.8 (41.0,44.6) | 43.6 (42.1,44.6) | ‐0.8 (−3.0,1.5) |
| No prenatal care visits | 0.7 (0.3,1.1) | 0.4 (0.1,0.7) | 0.3 (−0.3,0.8) | 0.8 (0.4,1.2) | 0.5 (0.3,0.6) | 0.3 (−0.1,0.8) |
| Prenatal care began after first trimester* | 18.2 (15.1,21.4) | 15.0 (12.9,17.1) | 3.3 (0.2,6.3) * | 10.5 (9.3,11.6) | 10.6 (9.7,11.6) | −0.2 (−1.6,1.3) |
| Received less than adequate prenatal care (APNCU)** | 41.5 (37.3,45.7) | 32.5 (29.6,35.4) | 9.0 (4.8,13.1) *** | 31.7 (30.0,33.5) | 30.7 (29.3,32.0) | 1.1 (−1.1,3.2) |
| No postpartum care visits* | 17.6 (14.7,20.5) | 12.2 (10.5,13.8) | 5.4 (2.6,8.3) *** | 15.8 (14.4,17.3) | 13.7 (12.6,14.7) | 2.1 (0.4,3.8) * |
| Poor care quality (received <75% of recommended care components during visit(s)) | ||||||
| Preconception visits | 76.6 (71.4,81.9) | 70.1 (65.5,74.8) | 6.5 (1.0,11.9) * | 80.4 (78.5,82.3) | 74.4 (72.7,76.1) | 5.9 (3.4,8.5) *** |
| Prenatal visits | 34.3 (30.1,38.5) | 25.8 (23.0,28.6) | 8.5 (4.5,12.6) *** | 35.6 (33.7,37.4) | 26.2 (24.9,27.5) | 9.4 (7.2,11.6) *** |
| Postpartum visit | 60.1 (55.5,64.7) | 53.6 (50.0,57.1) | 6.6 (1.9,11.2) ** | 60.9 (59.0,62.9) | 52.9 (51.4,54.4) | 8.0 (5.6,10.5) *** |
Note: Bolded values indicate statistical significance at p < 0.05.
Source: Authors' analysis of data from the Pregnancy Risk Assessment Monitoring System (PRAMS), 2016–20. APNCU: Adequacy of Prenatal Care Utilization (Kotelchuck Index), CI: confidence interval. N are unweighted, percentages use PRAMS survey weights, which account for variation in sampling rates, stratification schemes, and nonresponse across sites. Asterisks next to perinatal care utilization and quality labels indicate significant multiplicative interaction between immigrant Medicaid coverage status and likely citizenship status.
Adjusted for rurality, region, race, age, education, marital status, parity, pregnancy intention, and pre‐pregnancy abuse, depression, diabetes, high blood pressure, obesity, and smoking.
Likely citizenship was created by examining reported Hispanic ethnicity, language, and education. Those reporting Hispanic ethnicity, Spanish language, and less than a high school degree were considered likely noncitizens.
States with no immigrant Medicaid coverage with PRAMS data available include Alaska, Alabama, Arkansas (2016), Arizona, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, Missouri, Mississippi, Montana, North Dakota, New Hampshire, Oklahoma, Rhode Island, South Dakota, Tennessee, Texas, Utah.
States with immigrant Medicaid coverage (coverage for lawfully residing immigrants without the 5‐year waiting period) with PRAMS data available include Arkansas (2018–20), Colorado, Connecticut, District of Columbia, Delaware, Hawaii, Maine, Maryland, Massachusetts, Minnesota, North Carolina, Nebraska, New Jersey, New Mexico, New York, Oregon (2018–20), Pennsylvania, Virginia, Washington, Wisconsin, West Virginia, Wyoming.
p < 0.05;
p < 0.01;
p < 0.001.