Written by: Melissa Eggen, PhD, Assistant Professor, University of Louisville, School of Public Health and Information Sciences
Between 2018 and 2021, an average of 21% of infants in Kentucky were born to women who received less than adequate prenatal care, meaning they began care after the fourth month of pregnancy and attended fewer than 80% of the recommended visits. Some counties in Kentucky like Allen (32%), Bath (34.6%), and Perry (31%) had even higher rates of less than adequate prenatal care. One reason for this is the growing number of maternity care deserts in Kentucky. A maternity care desert is a county with no hospital or birthing center providing obstetric care and no obstetric provider. Kentucky has more maternity care deserts (45.8%) than the national average (32.6%) and the shortage is worsening due to myriad factors including the landmark 2022 Dobbs v. Jackson decision.
Recently, the Association of American Medical Schools reported a 23% decrease in applications for Kentucky OB-GYN residencies in the 2023-2024 academic year compared to the 2022-2023 academic year. Studies have attributed declines in OB-GYN residency applications in several states, including Kentucky, to abortion restrictions that limit the scope of training for medical residents, prevent providers from giving the best care to patients, and puts providers at risk of liability. We might expect, then, that maternity care shortages, and access to prenatal care, will worsen in the coming years unless we work together to create and implement innovative solutions.
Before we can create solutions, though, we need to understand the challenges, including for whom and where the most disproportionate impact is experienced. Early prenatal care, initiated in the first trimester of pregnancy, is associated with better outcomes for moms and babies and is important for building the patient-provider relationship. Yet, many women in Kentucky do not initiate early, or any, prenatal care during pregnancy. This is especially true for those in low-wage jobs with limited or no time off to attend prenatal care visits, those living in rural and urban areas who may need to travel long distances to care but are without reliable transportation or childcare, and those from disenfranchised or underserved communities who may not trust or lean on the healthcare system to provide care.
For the past year, I have been using Kentucky Pregnancy Risk Assessment Monitoring System (PRAMS) data to understand factors associated with the timing of prenatal care initiation in Kentucky. Here are a few of my findings:
· A much higher percentage of women covered by Medicaid (62.5%) initiated prenatal care after the first trimester, compared to those with private insurance (19.2%).
· Women with no insurance during pregnancy initiated care three weeks later, on average, than those with private insurance.
· Women who reported not wanting to be pregnant at the time of pregnancy or anytime were 65.9% less likely to receive prenatal care in the first trimester compared to women who wanted to be pregnant.
I will be presenting these findings, and more information about future research that can support community-based work, at the KHC 2024 Annual Conference in September. What I look forward to most is engaging with conference attendees to interpret these findings and using them to catalyze a conversation about solutions to remove barriers to care so that all pregnant people can access the care they need to have the best outcome for themselves and their babies.
Please join Melissa Eggen and other thought leaders September 18-19 at the Galt House Hotel to continue discussions on Whole Person Health.