Disparities and Barriers Encountered by Immigrant Mothers Accessing Health Services

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1 Disparities and Barriers Encountered by Immigrant Mothers Accessing Health Services José F. Colón Burgos, MS Doctoral Student Social Determinants of Health Program University of Puerto Rico Graduate School of Public Health

2 Madres Antillanas La mano que mece la cuna es la misma que gobierna el mundo Wallace, W. La frase madre trabajadora es redundante

3 Introduction The growing feminization of migratory flows has intensified the need to reduce disparities in the access and quality of prenatal services (Balbuena, 2003; Villa & Martínez, 2001). A sizable amount of scientific evidence show that there are large disparities in access to services between migrants and nonmigrants (Malin & Gissler, 2009) Only a few studies have examined disparities in the use of prenatal services associated with immigration.

4 Introduction The Dominican population residing in Puerto Rico constitutes the most important migrant community in the island. Currently, the Dominican community represents 1.5% of the population of Puerto Rico, of which 55% is female (US Census, 2000). In this study we compared the utilization of prenatal care services of Dominican immigrant mothers with that of Puerto Rican mothers.

5 Methods

6 Methods This study examined the birth certificates of : Children of women born in the Dominican Republic (N = 13,450 ) Children of women born in Puerto Rico (N = 402,213) During the period of 1995 to Study Design Non-experimental Observational, Transeccional

7 Puerto Rican Birth Certificate The birth certificate has 66 items divided in the following sections: 1. Information of the children and the parents 2. Information of the person that recognize the children 3. Mothers reproductive and obstetric history 4. Birth information 5. Infant information 6. Information of the person that attended and certify the birth

8 Adequacy of Prenatal Care Utilization Index (APCUI) The main response variable was the Kotelchuck index of adequate prenatal care in terms of the use of services. This index is based on three variables found in the certificates of births: 1. month in which prenatal care began 2. number of prenatal visits made by the mother 3. the baby's gestational age APCUI has been frequently used to assess adequacy of prenatal care as it conforms to the recommendations of the American College of Obstetrics and Gynecology (ACOG).

9 Theoretical Model The Behavioral Model of Health Services Use (Andersen, 2008) was utilized to identify theory-based predictors of service utilization and to examine the association of place of birth and use of prenatal services after controlling for those predictors.

10 Analytical Model

11 Theory and practice In this study we show the value of using a theoretical conceptual model and an administrative database to evaluate adequacy of preventive health services in two different population. Theory helps us guide the thinking process in attempting to explain events or behaviors and in proposing hypotheses that we can then test. That s why in this study we focus on the behavioral model of health services use by Andersen.

12 Findings

13 Predisposing Factors

14

15

16

17 Factors that inhibit or facilitate use

18

19 Need Factors

20

21

22 Prenatal use measures

23

24 Multivariate analysis

25 Results of logistic model regressing adequate prenatal care against factors that predispose, facilitate or inhibit, and need factors. Factors OR p-value Age Adolescent 0.9 <.001 Adult 0.9 <.001 Mature Adult* 1.0 Education level Primary school* 1.0 Intermediate school 1.2 <.001 High School 1.7 <.001 Associate Degree 2.1 <.001 Bachelors or more 3.0 <.001 Health Insurance Traditional Public System 0.6 <.001 Public Health Insurance 1.5 <.001 Private health insurance 2.5 <.001 No insurance* 1.0 Marital Status Married* 1.0 Consensual 0.7 <.001 Separated 0.6 <.001 Medical Risk of the Mother 1.1 <.001 Pregnancy complications Place of birth 0.6 <.001 *reference categories

26 Conclusions A substantial disparity on the adequate use of prenatal care by Dominican mothers was found. The results suggest important inequities by immigrant status and by socioeconomic status. The need for specific health policies that seek the eradication of health disparities is imminent. More studies that address this public health problem on different countries of the world are needed. Further studies on migration should look forward to use The Behavioral Model Of Health Service Use.

27 De que vale las estadísticas y las publicaciones cuando el acceso a servicios de salud es inalcanzable a la población que lo necesita (Anónimo, 2010). What is the value of statistics and publications when access to health care is unattainable to those in need (Anonymous, 2010).

28 References Andersen, RM. (2008). National Health Surveys and the Behavioral Model of Health Services Use. Medical Care, 46:7, Balbuena, P. (2003). Feminización de las migraciones: Del espacio reproductivo nacional a lo reproductivo internacional. Revista Aportes Andinos, 7(Globalización, migración y derechos humanos.). Villa, M. Martinez, J. (2001). El mapa migratorio internacional de américa latina y el caribe:patrones, perfiles, repercusiones e incertidumbres. Centro Latinoamericano y Caribeño De Demografía (CELADE) y División De Población De La Comisión Económica Para América Latina y El Caribe (CEPAL) Santiago De Chile. Malin, M. & Gissler, M. (2009). Maternal care and birth outcomes among ethnic minority women in finland. BMC Public Health, 9(84), 3-14.

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