Taylor, C. R., Alexander, G. R., & Hepworth, J. T. (2005). Maternal and Child Health Journal, 9(2), 125-133.
These investigators begin their article by citing a statistic that every year, 1.5 to 2% of pregnant women (about 70,000) in the United States do not receive any prenatal care prior to delivery. They hypothesized that women receiving no prenatal care are not a homogeneous group but comprise clusters or subgroups with distinctive behavioral, sociodemographic, and medical risks and that birth outcomes differ among the clusters. Using linked birth and death certificates for the years 1995 through 1997, they identified 126,220 White, Black, and Hispanic women who received no prenatal care and delivered a live singleton infant. The investigators then used a technique called cluster analysis to group women with similar characteristics and found six distinct clusters of no-care women. Overall, women receiving no prenatal care were more likely to be Black or Hispanic, unmarried, younger, less educated, foreign born, multiparous, and urban dwelling compared with the total population having a singleton live birth. The largest cluster consisted of young Black women with low education and high behavioral risks (smoking and alcohol use), and this cluster generally had the worst outcomes. Overall, birth outcomes for the no-prenatal-care group were two to four times worse for every measure compared with the total population. For example, preterm birth occurred at a rate of 9.6% for the total population compared with 26.9% for the no-care group (ranging among the clusters from a low of 17.6% to a high of 30.6%). The cluster of no-care women who generally had the best outcomes consisted of foreign-born Hispanic women with little education but low medical and behavioral risks. An unexpected no-care cluster consisted of older, highly educated, married, suburban, largely White and primiparous women with high behavioral and medical (diabetes, hypertension) risks. These findings "suggest that interventions should target reducing the proportion of women receiving no care and should be tailored to specific no-care clusters" (p. 125). For instance, different targeted public health messages, interventions, and outreach efforts should be developed for the older, White, highly educated cluster, the foreign-born Hispanic cluster, and the younger, less educated, urban Black cluster.
Maureen Heaman