title: Perceived access to health services and provider information and adverse birth outcomes: findings from LaPRAMS, 2007-2008.
abstract: OBJECTIVE
  Despite targeted public health efforts, racial disparities and poor birth outcomes are still apparent, particularly in the southern United States. Previous research through qualitative and modest quantitative research demonstrates a possible link between disparities in patient-provider conversations during prenatal visits, perceived access to prenatal care, and poor birth outcomes.
  
  
  METHODS
  A secondary analysis was conducted using data from the 2007-2008 Louisiana Pregnancy Risk Assessment Monitoring System to examine perceived access to healthcare services and information received and its impact on birth outcomes. Respondents consisted of 2460 white and black American women who recently experienced a live birth in the state of Louisiana.
  
  
  RESULTS
  Racial disparities among Louisiana mothers were evident, with black mothers experiencing significant perceived lack of services or access to resources from a healthcare or insurance provider and poorer birth outcomes. White mothers reported experiencing less access based on the lack of vital prenatal care information from a healthcare provider. Self-perceived access was significantly associated with preterm birth for black women (odds ratio 2.94, 95% confidence interval 1-8; P < 0.05) and infant mortality for white women (odds ratio 340.5, confidence interval 36-999); P < 0.05).
  
  
  CONCLUSIONS
  Findings support the need for a better understanding of discriminatory experiences and their impact on women's experiences during prenatal care and poor birth outcomes.
authors.affiliation: From the Center for Health Research, Ochsner Clinic Foundation, New Orleans, Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, and the School of Social Work, Tulane University, New Orleans, Louisiana.
authors.forename: Rachael L
authors.initials: RL
authors.lastname: Ruiz
authors.affiliation: From the Center for Health Research, Ochsner Clinic Foundation, New Orleans, Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, and the School of Social Work, Tulane University, New Orleans, Louisiana.
authors.forename: Monisha K
authors.initials: MK
authors.lastname: Shah
authors.affiliation: From the Center for Health Research, Ochsner Clinic Foundation, New Orleans, Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, and the School of Social Work, Tulane University, New Orleans, Louisiana.
authors.forename: Marva L
authors.initials: ML
authors.lastname: Lewis
authors.affiliation: From the Center for Health Research, Ochsner Clinic Foundation, New Orleans, Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, and the School of Social Work, Tulane University, New Orleans, Louisiana.
authors.forename: Katherine P
authors.initials: KP
authors.lastname: Theall
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008145:Louisiana / Q000453:epidemiology; D008875:Middle Aged; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011295:Prenatal Care / Q000523:psychology / Q000706:statistics & numerical data; D063505:Racism / Q000706:statistics & numerical data; D018570:Risk Assessment; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American