Abstract
Background
Programs offering income supplements for lower-income pregnant women have been introduced in order to reduce the incidence of poor perinatal outcomes. This study used a population-based approach to examine the characteristics of mothers who received the Healthy Baby Prenatal Benefit in Manitoba.
Methods
All women giving birth between August 2001 and April 2003 (n=22,643) were studied using de-identified linked administrative data. Multivariate logistic regression was used to determine factors that predicted receipt of the benefit, adjusting for potential confounding effects. Separate regressions were run for all mothers, and for a group of mothers eligible to receive the benefit (N=1962).
Results
Almost 29% of mothers giving birth during the study period received the prenatal benefit. Mothers were more likely to receive the benefit if they: lived outside of Winnipeg; received income assistance during pregnancy; were younger at their first birth; were unmarried; made prenatal physician visits; experienced maternal depression; were having a first birth; and lived in the lowest income areas. Despite all being eligible, only 67% of non-Winnipeg and 80% of Winnipeg women receiving income assistance received the benefit. Factors related to benefit receipt for those eligible were: living in Winnipeg; making prenatal visits; not being a young teen at current birth; and experiencing a first birth.
Conclusion
It is important to look not only at the characteristics of benefit recipients but also at those not receiving the benefit, in order to develop strategies to reach those who may most need and benefit from the program.
MeSH terms: Maternal age, prenatal care, low-income population, social welfare
Résumé
Contexte
De nouveaux programmes offrent des suppléments de revenu aux femmes enceintes à faible revenu afin de réduire la fréquence des problèmes périnatals. Dans le cadre d’une étude représentative, nous avons examiné les caractéristiques des mères bénéficiaires des allocations prénatales du programme Bébés en santé du Manitoba.
Méthode
Nous avons étudié toutes les femmes ayant accouché entre août 2001 et avril 2003 (N=22 643) à l’aide de données administratives liées, mais non identifiées. Par régression logistique multivariée, nous avons déterminé les facteurs prédisant le fait de toucher des allocations, en tenant compte des variables confusionnelles possibles. Des analyses de régression distinctes ont été exécutées pour toutes les mères et pour un groupe de mères admissibles aux allocations (N=1 962).
Résultats
Près de 29 % des mères ayant accouché pendant la période de l’étude ont touché des allocations prénatales. Elles étaient plus susceptibles d’avoir touché ces allocations si elles: vivaient à l’extérieur de Winnipeg; avaient reçu une aide au revenu pendant leur grossesse; étaient relativement jeunes lors de leur premier accouchement; n’étaient pas mariées; avaient fait des visites prénatales chez le médecin; souffraient de dépression du post-partum; accouchaient pour la première fois; et vivaient dans une région à faible revenu. Bien qu’elles soient toutes admissibles aux allocations, seulement 80 % des femmes vivant à Winnipeg et 67 % des femmes vivant ailleurs au Manitoba qui bénéficiaient d’une aide au revenu touchaient aussi les allocations prénatales. Les facteurs liés à la perception d’allocations chez les femmes admissibles étaient les suivants: vivre à Winnipeg; avoir fait des visites prénatales; ne pas avoir été adolescentes lors de l’accouchement actuel; et en être à leur premier accouchement.
Conclusion
Il est important d’examiner non seulement les caractéristiques des bénéficiaires, mais aussi celles des mères qui ne touchaient pas d’allocations pour pouvoir élaborer des stratégies susceptibles d’atteindre les mères qui pourraient avoir le plus besoin du programme et en tirer le meilleur parti.
References
- 1.Healthy Child Manitoba Office (2004). Annual Report 2003–2004.
- 2.Finch BK. Socioeconomic gradients and low birth-weight: Empirical and policy considerations. Health Serv Res. 2003;38:1819–41. doi: 10.1111/j.1475-6773.2003.00204.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Perinatal Education Program of Eastern Ontario. Prevention of Low Birth Weight in Canada: Literature Review and Strategies. 2nd edition 2005. [Google Scholar]
- 4.Kehner BH, Wolin CM. Impact of income maintenance on low birth weight: Evidence from the Gary experiment. J Human Resources. 1980;14:434–62. [PubMed] [Google Scholar]
- 5.Rush D. Nutritional services during pregnancy and birthweight: A retrospective matched pair analysis. CMAJ. 1981;125:567–76. [PMC free article] [PubMed] [Google Scholar]
- 6.Higgins AC, Moxley JE, Pencharz PB, Mikolanis D, Dubois S. Impact of the Higgins Nutrition Intervention Program on birth weight: A withinmother analysis. J Am Diet Assoc. 1989;89:1097–103. [PubMed] [Google Scholar]
- 7.Remier DK, Glied SA. What other programs can teach us: Increasing participation in health insurance programs. Am J Public Health. 2003;93:67–74. doi: 10.2105/AJPH.93.1.67. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Roos NP, Shapiro E (Eds.). Health and health care: Experience with a population-based health information system. Med Care 1995;33(suppl). [PubMed]
- 9.Med Care. 1999.
- 10.Brownell MD, Martens PJ, Kozyrskyj A (Eds.). Improving Children’s Health. How Populationbased Information Can Inform Policy: The Manitoba Experience. Can J Public Health 2002;93(Suppl. 2).
- 11.Roos LL, Nicol PJ. A research registry: Uses, development, and accuracy. J Clin Epidemiol. 1999;52(1):39–47. doi: 10.1016/S0895-4356(98)00126-7. [DOI] [PubMed] [Google Scholar]
- 12.Roos LL, Nicol JP, Cageorge SM. Using administrative data for longitudinal research: Comparisons with primary data collection. J Chron Dis. 1987;40:41–49. doi: 10.1016/0021-9681(87)90095-6. [DOI] [PubMed] [Google Scholar]
- 13.Brownell MD, Mayer T, Martens PJ, Kozyrskyj A, Fergusson P, Bodnarchuk J, et al. Using a population-based health information system to study child health. Can J Public Health. 2002;93(Suppl.2):S9–S14. doi: 10.1007/BF03403612. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Mustard CA, Derksen S, Berthelot JM, Wolfson M. Assessing ecologic proxies for household income: A comparison of household and neighbourhood level income measures in the study of population health status. Health & Place. 1999;5:157–71. doi: 10.1016/S1353-8292(99)00008-8. [DOI] [PubMed] [Google Scholar]
- 15.Daponte BO, Sanders S, Taylor L. Why do lowincome households not use food stamps? J Human Resources. 1998;34:612–28. doi: 10.2307/146382. [DOI] [Google Scholar]
- 16.Stewart PJ, Dulberg C, Niday P, Nimrod C, Tawagi G. Population attributable risk for prematurity and small for gestation age babies. Final report. 1994. [Google Scholar]
- 17.Kogan MD, Martin JA, Alexander GR, Kotechuck M, Venture SJ, Frigoletto FD. The changing pattern of prenatal care utilization in the United States, 1981–1995, using different prenatal care indices. JAMA. 1998;279:1623–28. doi: 10.1001/jama.279.20.1623. [DOI] [PubMed] [Google Scholar]
- 18.Mustard CA, Roos NP. The relationship of prenatal care and pregnancy complications to birthweight in Winnipeg, Canada. Am J Public Health. 1994;84:1450–57. doi: 10.2105/AJPH.84.9.1450. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Larson EH, Hart LG, Rosenblatt RA. Is non-metropolitan residence a risk factor for poor birth outcome in the U. S.? Soc Sci Med. 1997;45(2):171–88. doi: 10.1016/S0277-9536(96)00332-2. [DOI] [PubMed] [Google Scholar]
- 20.Delvaux T, Buekens P, Godin I, Boutsen M. Study Group on Barriers and Incentives to Prenatal Care in Europe. Am J Prev Med. 2001;21(1):52–59. doi: 10.1016/S0749-3797(01)00315-4. [DOI] [PubMed] [Google Scholar]
- 21.Blundell R, Fry V, Walker I. Modelling the takeup of means-tested benefits: The case of housing benefits in the United Kingdom. Econ J. 1988;98(Suppl390):58–74. doi: 10.2307/2233304. [DOI] [Google Scholar]
- 22.Garrett B, Glied S. Does state AFDC generosity affect child SSI participation? J Policy Analysis Manage. 2000;19:275–95. doi: 10.1002/(SICI)1520-6688(200021)19:2<275::AID-PAM6>3.0.CO;2-7. [DOI] [Google Scholar]
- 23.Dion RM, Pavetti L. Access to and Participation in Medicaid and the Food Stamp Program: A Review of the Recent Literature. Washington, DC: Mathematica Policy Research Inc.; 2000. [Google Scholar]
- 24.Alexander GR, Kotelchuck M. Assessing the role and effectiveness of prenatal care: History, challenges, and directions for future research. Public Health Reports. 2001;116:306–16. doi: 10.1016/S0033-3549(04)50052-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Coley RL, Chase-Lansdale L. Adolescent pregnancy and parenthood. Recent evidence and future directions. Am Psychologist. 1998;53:152–66. doi: 10.1037/0003-066X.53.2.152. [DOI] [PubMed] [Google Scholar]
- 26.Jaffee S, Caspi A, Moffitt TE, Belsky J, Silva P. Why are children born to teen mothers at risk for adverse outcomes in young adulthood: Results from a 20-year longitudinal study. Development and Psychopathology. 2001;13:377–97. doi: 10.1017/S0954579401002103. [DOI] [PubMed] [Google Scholar]
- 27.Levine JA, Pollack H, Comfort ME. Academic and behavioral outcomes among the children of young mothers. J Marriage Fam. 2001;63:355–69. doi: 10.1111/j.1741-3737.2001.00355.x. [DOI] [Google Scholar]