lamb why do women decline preconception care counseling? the l os a ngeles m ommy and b aby project...
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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