Who gets adequate prenatal care in Ohio? Race, education, insurance status plays a role, study shows
Ohioans who are uninsured, Black, Hispanic or American Indian or have less than a high school diploma education, are less likely to receive adequate prenatal care than their white or more educated counterparts, according to a new study by the Center for Community Solutions.
Nearly 16% of Ohio births — more than 94,000 births — were deemed to have inadequate prenatal care. That puts Ohio's rate slightly above the national rate of 14.5%, the study showed.
“That should be alarming to all of us,” said Alex Dorman, the CCS research fellow who collected the data.
CCS collected data from about 641,000 Ohio birth records from 2018 to 2022 and used a metric called the Adequacy of Prenatal Care Utilization (APNCU) Index, which rates a person’s prenatal care as either inadequate, intermediate, adequate or adequate plus. The index measurement factors in how early and how often a patient received prenatal care during a pregnancy.
Black, Hispanic and Native Ohioans were about 10 percentage points less likely to receive adequate prenatal care than their white and Asian or Pacific Islander counterparts, the data show.
The data only provides a picture of what's happening not the causes, Dorman explained.
The data "will not tell us exactly why these disparities exist, but you have to ignore the history of the racism that Black and brown people experience in our medical system to not understand why that doesn’t inform why you’re not seeing our fellow Ohioans receiving adequate prenatal care.”
The study showed stark differences in how likely
a person was to get adequate medical care based on the kind of insurance — or lack of insurance — they had.
Researchers looked at people with four different kinds of health insurance amongst birth records: those who were uninsured or paid for care themselves or had Medicaid, private insurance or another form of insurance.
Less than half, 46%, of uninsured/self-paying birthing people received adequate prenatal care compared to 70% of people with Medicaid or another type of insurance. Nearly 90% of those with private insurance received adequate care.
“People are slipping through the cracks and that should be unacceptable for all of us,” Dorman said. “Just because someone doesn’t necessarily have insurance doesn’t mean they don’t deserve a safe birth.”
The disparities were particularly apparent between patients of different educational levels, the data show.
Only 38% of people who had completed 8th grade or less received adequate prenatal care. For those who completed some high school courses, but didn't graduate, 61% received adequate care compared to 75% of high school grads.
The likelihood an Ohioan will receive adequate prenatal care gradually increases among those who earn college degrees, the data show. More than 85% of people with associate's, 87% of those with a bachelor's and 89% of people with graduate degrees received adequate care.
But at higher levels of education, Black and Hispanic patients were less likely than their white counterparts to receive adequate prenatal care, the data showed.
While people with no high school diploma were about equally likely not to receive adequate care across racial and ethnic groups, Black patients with an associate's or bachelor's degree were about twice as likely as white Ohioans to miss out on that care.
About a third of people of all groups without a diploma receive inadequate care.
That rate was 16% among Black patients with an associate's or bachelor's degree compared to 8% of white people with the same level of education; 14% of Hispanic patients did not receive adequate care.
“Data like this has a history of being misinterpreted as a way to blame the individual,” Dorman said. “This isn’t a failing of the individual. This is a failing of the system not connecting with these folks.”
The differences in prenatal care parallel the racial discrepancies in Ohio’s infant mortality rate. Black infants are 2.8 times more like to die than white infants, according to the Ohio Department of Health.
Dorman points to programs like the Ohio Equity Initiative, which is an Ohio Department of Health Program that aims to address infant mortality issues, and doulas — trained professionals who provide support during pregnancy — as things that could help address the issues regarding a lack of adequate prenatal care.