Black/white differences in prenatal care utilization: an assessment of predisposing and enabling factors.
OBJECTIVE
This article reports on analysis of the predisposing and enabling factors that affect black/white differences in utilization of prenatal care services.


METHODS
We use a secondary data source from a survey conducted by the Michigan Department of Public Health.


METHODS
The study uses multivariate analysis methods to examine black/white differences in (1) total number of prenatal care visits, (2) timing of start of prenatal care, and (3) adequacy of care received. We use the model advanced by Aday, Andersen, and Fleming (1980) to examine the effect of enabling and predisposing factors on black/white differences in prenatal care utilization.


METHODS
A questionnaire was administered to all women who delivered in Michigan hospitals with an obstetrical unit.


RESULTS
Enabling factors fully accounted for black/white differences in timing of start of prenatal care; however, the model could not fully account for black/white differences in the total number or the adequacy of prenatal care received.


CONCLUSIONS
Although there are no black/white differences in the initiation of prenatal care, black women are still less likely to receive adequate care as measured by the Kessner index, or to have as many total prenatal care contacts as white women. It is possible that barriers within the health care system that could not be assessed in this study may account for the differences we observed. Future research should consider the characteristics of the health care system that may account for the unwillingness or inability of black women to continue to receive care once they initiate prenatal care.
LaVeist
T A
TA
Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
Keith
V M
VM
Gutierrez
M L
ML
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008824:Michigan; D015999:Multivariate Analysis; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D044465:White People / Q000706:statistics & numerical data*