Racial and ethnic disparities in the use of pregnancy-related health care among Medicaid pregnant women

To assess the extent to which racial and ethnic disparities exist in the use of prenatal services among Medicaid pregnant women. Medicaid claims data for Florida, Georgia, New Jersey, and Texas, with linked birth certificate data for Georgia and Texas, were used to investigate the use of selected prenatal services, including the initiation and adequacy of prenatal care visits; prescriptions for multiple vitamins and iron supplements; and claims for complete blood cell counts, blood type and RH status, hepatitis B surface antigen, ultrasound, maternal serum alphafetoprotein, drug screening, and HIV tests. We computed raw and adjusted odds ratios of having the health service of interest during pregnancy for women in three minority groups: black non-Hispanics, Hispanics, and Asian/Pacific Islanders. We found racial and ethnic disparities in the use of every health service investigated. Compared with white non-Hispanics, minority women were less likely to receive services that the woman initiates, discretionary services, and services potentially requiring specialized follow-up care, whereas they were more likely to receive screening tests for diseases related to high-risk behaviors. Disparities were generally larger, more consistent across states, and less likely to be explained by other factors among black non-Hispanics than among either Hispanics or Asian/Pacific Islanders. Even among women who are provided equal financial access to health care services, unexplained racial and ethnic disparities persist in the initiation and use of both routine and specialized prenatal care services.