LAMB Why Do Women Decline Preconception Care Counseling? The L os A ngeles M ommy and B aby Project Shin Margaret Chao, Ph.D., M.P.H. Los Angeles County.

Why Do Women Decline Preconception Care

Counseling? The Los Angeles Mommy and Baby

Project

Shin Margaret Chao, Ph.D., M.P.H.

Los Angeles County Department of Public Health

Maternal Child, and Adolescent Health Programs

This project was supported by the Health Resources and Services Administrative (HRSA) # R40MC06635, Productivity and Investment Fund, and MCAH General grants.

Background

Preconception care counseling (PCC) provides opportunities for women to gain awareness and understanding of how their health behaviors and family histories impact pregnancy

Benefits of PCC well documented

Little knowledge on who does/does not receive PCC in Los Angeles County and why

Study Questions

What are the characteristics of women who do not have preconception care counseling?

What are the reasons women do not have preconception care counseling?

Methods

LAMB INSTRUMENTPROCEDURES Questions primarily drawn

and adapted from validated survey instruments

Focus groups; piloted Survey translated into

Spanish, and Chinese. Telephone translation service for other languages.

LA resident mothers 0-7 months after a live birth

Stratified random sample Over sample LBW/PT

births, African American, Asian/PI and Native American births

Mail survey with telephone follow-up for non-respondents

$20 gift certificate

During the six months before you got pregnant with your new baby, did you talk to a doctor, nurse, or other health care worker about how to prepare for a healthy pregnancy and baby?

If yes, tell us why you did not see a doctor, nurse, or other health care worker to prepare for this baby.

Knew how to prepare myself for pregnancy already

Didn’t expect to get pregnant Did not have enough money or

insurance to pay for a check-up Did not have a regular doctor or

nurse to talk to Had no way to get to the clinic or

the doctor’s office

Couldn’t take time off from work Had no one to take care of my

children Too many other things going on Couldn’t find a doctor or nurse who

spoke my language Other

Preconception Counseling Questions

Statistical Analyses

Prevalence rates of women who had no PCC

Maternal characteristics associated with no PCC; perform multivariate analysis

Major reasons why women had no PCC

Sample weighting to adjust for sampling probabilities

Results

LAMB Demographics

Race/Ethnicity Family Income

N = 6,264

Women who had no Preconception Care Counseling, by Race/Ethnicity,

2007 LAMB Survey

N = 4,264

White mothers is the reference group

The multivariate model included: mother’s education, age, marital status, and insurance status

African American mothers more likely than white mothers to have no PCC visit

Adjusted Odds Ratios and Confidence Limits for Race/Ethnicity

Multivariate Model: Racial Disparities in no PCC

aOR

N = 4,264

<=12 yrs education

Unmarried Uninsured before

pregnancy Unintended

pregnancy Young age Not a first time

mother

Selected Maternal Characteristics by PCC Status

N = 6,264

Reasons for No PCC2007 LAMB Survey

N = 4,264

Reasons For No PCC by Race/Ethnicity2007 LAMB Survey

N = 4,264

Reasons For No PCC by Parity2007 LAMB Survey

N = 4,264

Over 70% of recently delivered mothers had no PCC

Major reasons:▫ Not expecting to get pregnant▫ Knew how to prepare▫ No regular doctor▫ Not enough money or insurance for check-up▫ Too much else going on

Racial/ethnic disparities

Younger age, lower education level, unmarried, unintended pregnancy, not a first time mother

Conclusions

Public Health Implications

Identify subpopulations of women in need of outreach during the preconception period

Integrate PCC as part of family planning services

Need for awareness campaigns on importance of PCC

Social policy changes to promote funding and access to PCC

Maximize public health surveillance and related research mechanisms to evaluate the effectiveness of PCC

Implications

Special Thanks to:

Michael C. Lu, MD, MPH2007 LAMB Principal Investigator

Cynthia Harding, MPHDirector, Los Angeles County MCAH Programs

Diana Liu, MPH, Chandra Higgins, MPH, Marian Eldahaby, BA, Carmen Gutierrez, Alex Chen, MS

Martha Martinez, Rozana Ceballos, BA

Our Community Partners

. . . and of course, mothers who completed the survey!

Contact Us

Toll-free number: 1-866-706-LAMB For information about LAMB, visit:

http://lapublichealth.org/mch/LAMB/LAMB.html

Margaret Chao [email protected]

213-639-6470