Objectives: Social and structural barriers drive disparities in prenatal care utilization among minoritized women in the United States. This study examined the impact of Arizona's Health Start Program, a community health worker (CHW) home visiting intervention, on prenatal care utilization among an ethno-racially and geographically diverse cohort of women.
Methods: We used Health Start administrative and state birth certificate data to identify women enrolled in the program during 2006-2016 (n = 7,117). Propensity score matching was used to generate a statistically-similar comparison group (n = 53,213) of women who did not participate in the program. Odds ratios were used to compare rates of prenatal care utilization. The process was repeated for select subgroups, with post-match regression adjustments applied where necessary.
Results: Health Start participants were more likely to report any (OR 1.24, 95%CI 1.02-1.50) and adequate (OR 1.08, 95%CI 1.01-1.16) prenatal care, compared to controls. Additional specific subgroups were significantly more likely to receive any prenatal care: American Indian women (OR 2.22, 95%CI 1.07-4.60), primipara women (OR 1.64, 95%CI 1.13-2.38), teens (OR 1.58, 95%CI 1.02-2.45), women in rural border counties (OR 1.45, 95%CI 1.05-1.98); and adequate prenatal care: teens (OR 1.31, 95%CI 1.11-1.55), women in rural border counties (OR 1.18, 95%CI 1.05-1.33), primipara women (OR 1.18, 95%CI 1.05-1.32), women with less than high school education (OR 1.13, 95%CI 1.00-1.27).
Conclusions for practice: A CHW-led perinatal home visiting intervention operated through a state health department can improve prenatal care utilization among demographically and socioeconomically disadvantaged women and reduce maternal and child health inequity.
Keywords: Home visiting; community health worker; prenatal care; propensity score matching.
© 2022. The Author(s).