Kogan
MD, Kotelchuck M, Alexander GR, Johnson WE.
Racial disparities in reported prenatal care advice from health care
providers.
Am J Public Health 1994;84(1):82-8.
(Comment in: Am J Public Health. 1994 Sep;84(9):1521-3.)
A substantial body of scientific and medical literature has shown
significant associations between maternal health risk behaviors during pregnancy
and adverse pregnancy outcomes. Maternal smoking, alcohol consumption and
illegal drug use have been associated with high rates of prematurity, low
birth weight, fetal and infant mortality, and other adverse pregnancy outcomes.
During the past twenty years, emphasis has been consigned to the importance
of adequate prenatal care for minority populations, who are identified to
be at increased risk of adverse pregnancy outcomes. Thus, advice from health
care providers to modify adverse health behaviors
during pregnancy may be beneficial in altering these behaviors and ultimately
reducing their associated poor outcomes, particularly in minority populations.
A retrospective survey was implemented using data collected from the 1988
National and Infant Health to examine whether any racial disparities existed
with regard to advice received from health care providers during the pregnancy
on tobacco, alcohol, and drug use as well as breast feeding. The investigation
was limited to 8,310 Non-Hispanic White and Black woman whose infants were
alive at delivery and who received some prenatal care. The content of the
provided prenatal care was derived from the women’ self-report. The
study population was adjusted to be representative of Non-Hispanic White
and Black live births of United States.
The Black women who gave birth in 1988 were demographically different
from their White counterparts. They were more often single, attained lower
educational level, had lower incomes, utilized publicly funded health
care sites, and were enrolled in WIC and Medicaid programs more frequently
than the White women. Black women self reported that they received less
prenatal advice on alcohol, smoking and breast feeding than the White
women. In contrast, no racial disparity was noted for advice on illegal
drug use. After adjustment for maternal age, marital status, site of prenatal
care, type of payment, maternal health behaviors, and prior adverse pregnancy
outcomes, Black women were significantly less likely to report receiving
advice from their prenatal care provider about smoking and alcohol use
than the White women. Although breast-feeding advice did not achieve significance,
it was similarly slanted toward less advice for Black women.
Although the study implies that race is an important factor
in the content of prenatal advice, sociodemographic factors
also played a significant role. Advice on smoking and illegal
drug use was skewed toward poorer women, while advice on alcohol
intake and breast-feeding was skewed to more affluent women.
Health care providers may impart advice based upon presumed
stereotypes and not on a principal of equality. Initially,
it may appear that a major limitation of the study is that
it relied on self-reports of the women; however, a woman’s
perception of the content of advice she received from her
health care provider is more important than the actually advice.
Ultimately, it is the woman’s perception that may lead
to health behavioral modifications. Furthermore, a health
care provider’s report of the content of the prenatal
advice may also not be satisfactory since this report does
not account for whether the advice was effectively communicated
to a woman. Deficient communication skills may become more
apparent when a provider from a non-minority group is treating
women from minority populations. Thus, black women who may
benefit the most from adequate health behavior modification
information during their pregnancy are less likely to receive
this advice as part of their prenatal care.
