Worsened disparities in prenatal care among individuals with low educational attainment during the COVID-19 pandemic in the US: a repeated cross-sectional study

Background The coronavirus pandemic was a major event that severely disrupted the health care system in the USA. Understanding the impact, especially among socioeconomically disadvantaged individuals, is necessary for informing health care and public health policy. This study evaluates changes in adequate prenatal care (PNC) across education levels after the 2020 pandemic.Methods The key outcome was adequate PNC utilization using the Kotelchuck index. A repeated cross-sectional study of before and after the COVID pandemic among individuals with low educational attainment compared to those with a college degree or above was used to estimate changes in adequate PNC use.Results A decrease in adequate PNC use after 2020 was greater (-4.4%) for less than high school graduation, compared to higher education levels (-2.0% to -0.8%). The difference in adjusted changes reaffirmed that having less than high school graduation was associated with a greater decrease in adequate PNC by -3.7 percentage points (95%CI -5.8, -1.5) compared to obtaining college degrees after 2020.Conclusion Disparities in access to care are persistent and further deteriorate among individuals of low educational attainment after the 2020 pandemic. An innovative, robust healthcare model is vital to reduce barriers to and disparities in access to care.