title: Use of maternal health services: comparing refugee, immigrant and US-born populations.
abstract: Objectives To determine use of recommended maternal healthcare services among refugee and immigrant women in a setting of near-universal insurance coverage. Methods Refugee women age ≥18 years, who arrived in the US from 2001 to 2013 and received care at the same Massachusetts community health center, were matched by age, gender, and date of care initiation to Spanish-speaking immigrants and US-born controls. The primary outcome was initiation of obstetrical care within the first trimester (12 weeks gestation). Secondary outcomes were number of obstetrical visits and attending a postpartum visit. Results We included 375 women with 763 pregnancies (women/pregnancies: 53/116 refugee, 186/368 immigrant, 136/279 control). More refugees (20.6 %) and immigrants (15.0 %) had their first obstetric visit after 12 weeks gestation than controls (6.0 %, p < 0.001). In logistic regression models adjusted for age, education, insurance, BMI, and median census tract household income, both refugee (odds ratio [OR] 4.58, 95 % confidence interval [CI] 1.73-12.13) and immigrant (OR 2.21, 95 % CI 1.00-4.84) women had delayed prenatal care initiation. Refugees had fewer prenatal visits than controls (median 12 vs. 14, p < 0.001). Refugees (73.3 %) and immigrant (78.3 %) women were more likely to have postpartum care (controls 54.8 %, p < 0.001) with differences persisting after adjustment (refugee [OR 2.00, 95 % CI 1.04-3.83] and immigrant [OR 2.79, 95 % CI 1.72-4.53]). Conclusions for Practice Refugee and immigrant women had increased risk for delayed initiation of prenatal care, but greater use of postpartum visits. Targeted outreach may be needed to improve use of beneficial care.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Kentoffio
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114, USA.|Diabetes Center, Massachusetts General Hospital, 50 Staniford Street, Boston, MA, 02114, USA.
authors.forename: Seth A
authors.initials: SA
authors.lastname: Berkowitz
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
authors.affiliation: Center for Community Health Improvement, Massachusetts General Hospital, 101 Merrimac Street, Boston, MA, 02114, USA.|Massachusetts General Hospital Chelsea HealthCare Center, 151 Everett Ave, Chelsea, MA, 02150, USA.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Oo
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, 02114, USA. spercaclima@mgh.harvard.edu.|Diabetes Center, Massachusetts General Hospital, 50 Staniford Street, Boston, MA, 02114, USA. spercaclima@mgh.harvard.edu.|Massachusetts General Hospital Chelsea HealthCare Center, 151 Everett Ave, Chelsea, MA, 02150, USA. spercaclima@mgh.harvard.edu.
authors.forename: Sanja
authors.initials: S
authors.lastname: Percac-Lima
mesh_terms: D000328:Adult; D001631:Bhutan / Q000208:ethnology; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D007493:Iraq / Q000208:ethnology; D008404:Massachusetts / Q000453:epidemiology; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D011181:Postnatal Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012036:Refugees / Q000706:statistics & numerical data*; D012998:Somalia / Q000208:ethnology
keywords: Health services access; Immigrants; Maternal health; Refugees