Immigrant women are less likely to receive access to timely prenatal care than those born in the United States, especially in communities such as Asians and Latinos, according to a study.
The findings revealed that disparities in health care among immigrant groups may be caused by Medicaid exclusions based on immigration status, leading to unbalanced care during pregnancy, according to the study published in JAMA Network last October 28.
Although, 1 in 4 births in the United States is to an immigrant mother. However, non-citizen immigrants are excluded from critical safety net programs that low-income US citizens can access, including health care through Medicaid.
The text details that timely prenatal care is critical because it enables early detection, intervention, and health education that can benefit mothers and babies beyond birth. Increasing the proportion of women receiving early and appropriate prenatal care is a Healthy People 2030 goal.
Increased insurance coverage prior to pregnancy is thought to improve timely prenatal care because women who have a regular source of medical care are better positioned to receive pregnancy tests and an appointment with a health professional during pregnancy more quickly.
It is believed that approximately 23 percent of immigrants in the US are not eligible for Medicaid, 5 percent are temporary legal residents, 27 percent are legal permanent residents but not citizens, and 45 percent are naturalized citizens, so the potential influence of these exclusions on the health of the population is great.
Only 5 states allow coverage for non-pregnant adult legal permanent residents, and only the District of Columbia allows coverage for non-pregnant unauthorized immigrants.
To assess the association between exclusion from Medicaid coverage and access to prenatal care, researchers conducted a study collecting data from the National Center for Health Statistics. The sample for this study consisted of single births to women age 20 and older in states that had adopted a change to the US birth certificate made in 2003.
The primary outcome was timely prenatal care, defined as prenatal care started during the first trimester. People were defined as immigrants when they were born outside the United States.
Covariates included parity, mother's education level, and mother's age at the individual level, and the state unemployment rate, state poverty rate, and state-level immigrant climate index.
The study included a total of 5,390,814 women before the Medicaid expansion and 6,544,992 women after the expansion. Of the immigrant women, 27.3 percent were Asian, 7.3 percent black, 49.6 percent Hispanic, and 15.8 percent white. Of the US-born women, 2.5 percent were Asian, 12.1 percent black, 18.1 percent Hispanic, and 67.3 percent white.
Overall, the study found that US-born women received prenatal care more often than immigrant women. This remained true across all racial and ethnic categories combined. In Hispanic immigrant women, timely prenatal care decreased after the expansion.
The text notes that timely prenatal care was provided at baseline to 75.9 percent of immigrant women and 79.9 percent of women born in the US After analysis, timely prenatal care among immigrant women decreased by 3.48 percent compared to US-born women. This decreased by another 1.53 percent among Asian immigrants and 1.18 percent among Hispanic immigrants.
At the same time, it details that the decrease in attention worsened among women with a lower educational level, since education below the secondary level was observed in 28.7 percent of immigrant women and in 8.7 percent of those born in the american union.
To this, the researchers added that some immigrant women have worse maternal outcomes compared to those born in the US, for example, higher rates of preeclampsia, gestational diabetes, and severe maternal morbidity.
This study has implications for a variety of policies that deny benefits to people based on their immigration status. Legislation to extend Medicaid coverage during pregnancy into the postpartum period is currently being considered in many states.
"Policymakers and advocates need to be aware that the exclusion of people based on citizenship could have a profound influence," they said.
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