Disparities in Initiation and Adherence to Prenatal Care: Impact of Insurance, Race-Ethnicity and Nativity

We used the intersectionality framework to examine impact of racial/ethnic, immigration, and insurance differences on the timing of initiation of prenatal care (PNC) and subsequent adherence. In this cross sectional study independent variables were women's race/ethnicity; nativity; age; education; and insurance. The dependent variables were late initiation and non-adherence to recommended number of PNC visits. We used multivariate analysis to evaluate the impact of the independent variables on late initiation and non-adherence. Analysis revealed that race/ethnicity/nativity (RE-N) was more consistently associated with late initiation and non-adherence for privately insured than publicly insured persons. While private insurance had a positive impact on initiation and adherence overall, its impact was greater for White women. Having private insurance coverage was most beneficial to White women. We contend that the intersectional approach provides promising avenues for expanding our knowledge of health disparities and of identifying new ways of going about eliminating the persistent and pervasive social inequalities and informing efforts to reduce them.