![]() Despite the emphasis placed on the value of prenatal care, a portion of the childbearing population continues to receive inadequate prenatal care, defined as receiving no prenatal care, initiating care later than the first trimester, or, given a first trimester start of care, receiving less than the recommended number of visits. The Marmot Review, “Fair Society, Healthy Lives,” emphasized the importance of ensuring high quality maternity services across the social gradient. Prenatal care is important to achieving a healthy pregnancy and birth and positively influencing the health of the fetus and child. These findings can inform policy makers and program planners about regions and populations most at-risk for inadequate prenatal care and assist with development of initiatives to reduce inequities in utilization of prenatal care. Inadequate prenatal care was associated with several individual indicators of social disadvantage, such as low income, education less than high school, and social isolation. Rates of inadequate prenatal care varied across geographic regions, indicating persistent inequities in use of prenatal care. Factors associated with inadequate prenatal care included geographic, demographic, socioeconomic, and pregnancy-related factors. The rate of inadequate prenatal care in Manitoba ranged from 10.5–12.5%, and increased significantly over the study period. In the subset model ( N = 55,048), the previous factors remained significant, with additional factors being maternal education less than high school, social isolation, and prenatal smoking, alcohol, and/or illicit drug use. Medical conditions such as multiple birth, hypertensive disorders, antepartum hemorrhage, diabetes, and prenatal psychological distress were associated with lower odds of inadequate prenatal care. Factors associated with inadequate prenatal care in the population-based model ( N = 64,166) included northern or rural residence, young maternal age (at current and first birth), lone parent, parity 4 or more, short inter-pregnancy interval, receiving income assistance, and living in a low-income neighborhood. Overall, 11.5% of women in Manitoba received inadequate, 51.0% intermediate, 33.3% adequate, and 4.1% intensive prenatal care ( N = 68,132). Multivariable logistic regressions were used to identify factors associated with inadequate prenatal care for the population, and for a subset with more detailed risk information. The proportion of women receiving inadequate prenatal care was calculated using a utilization index. We studied women giving birth in Manitoba from 2004/05–2008/09 using data from a repository of de-identified administrative databases at the Manitoba Centre for Health Policy. The purpose of this population-based retrospective cohort study was to describe prenatal care utilization among women giving birth in Manitoba, and to determine individual-level factors associated with inadequate prenatal care. Despite a universal health care system, previous research shows neighborhood-level inequities in utilization of prenatal care in Manitoba, Canada. ![]() Ensuring high quality and equitable maternity services is important to promote positive pregnancy outcomes. ![]()
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