Unpacking Racial/Ethnic Disparities in Prenatal Care Use: The Role of Individual-, Household- and Area-Level Characteristics

Objective: To identify the contributions of individual-, household-, and area-level characteristics to disparities in the use of prenatal care (PNC). Methods: This study used individual-level data from the 2001 Early Childhood Longitudinal Study-Birth Cohort linked to county-level U.S. Census data (N approximate to 5,200). I used nonlinear regression decomposition to quantify the contributions of several groups of factors-maternal health and pregnancy characteristics, preconception health behaviors, insurance coverage, PNC location, socioeconomic status (SES), and the social/economic and healthcare environments-to PNC disparities. Results: Relative to whites, blacks and Hispanics were less likely to initiate first-trimester PNC and to have adequate PNC. The models explained 61.20%-79.90% and 52.15%-79.09% of the disparities in PNC initiation and adequacy, respectively. The most important factor was SES, which explained 50.68%-79.92% of the black-white gap and 37.50%-49.51% of the Hispanic-white gap in PNC use. Location of care, insurance status, and pregnancy characteristics also made significant contributions to these disparities. Conclusion: SES is a key driver of inequality in PNC, particularly black-white inequality. Addressing socioeconomic factors may improve PNC use among minorities.