Social inequalities in use of prenatal care in Manitoba.
OBJECTIVE
Analysis of regional variations in use of prenatal care to identify individual-level and neighbourhood-level determinants of inadequate prenatal care among women giving birth in the province of Manitoba.


METHODS
Data were obtained from Manitoba Health administrative databases and the 1996 Canadian Census. An index of prenatal care use was calculated for each singleton live birth from 1991 to 2000 (N = 149,291). Births were geocoded into 498 geographic districts, and a spatial analysis was conducted, consisting of data visualization, spatial clustering, and data modelling using Poisson regression.


RESULTS
We found wide variation in rates of inadequate prenatal care across geographic areas, ranging from 1.1% to 21.5%. Higher rates of inadequate care were found in the inner-city of Winnipeg and in northern Manitoba. After adjusting for individual characteristics, the highest rates of inadequate prenatal care were among women living in neighbourhoods with the lowest average family income, the highest proportion of the population who were unemployed, the highest rates of recent immigrants, the highest percentage of the population reporting Aboriginal status, the highest percentage of single parent families, the highest percentage of the population with fewer than nine years of education, and the highest rates of women who smoked during pregnancy.


CONCLUSIONS
Social inequalities exist in the use of prenatal care among Manitoba women, despite there being a universally funded health care system. Regional disparities in rates of inadequate prenatal care emphasize the need for further research to determine specific risk factors for inadequate prenatal care in socioeconomically disadvantaged neighbourhoods, followed by provision of effective targeted services.
Heaman
Maureen I
MI
Faculty of Nursing, University of Manitoba, Winnipeg MB.
Green
Chris G
CG
Newburn-Cook
Christine V
CV
Elliott
Lawrence J
LJ
Helewa
Michael E
ME
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005843:Geography; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008350:Manitoba / Q000453:epidemiology; D016012:Poisson Distribution; D011203:Poverty / Q000706:statistics & numerical data; D011204:Poverty Areas; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards* / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D014478:Unemployment; D035862:Vulnerable Populations / Q000706:statistics & numerical data