Sociodemographic Determinants and Inequities in Prenatal Healthcare in the Canadian Province of Manitoba: A Population-Based Cohort Study 2010-2022
Author(s)
Laila Aboulatta, PharmD1, Kaarina Kowalec, PhD2, Lara Haidar, MSc, PharmD2, Payam Peymani, PhD2, Qier Tan, PhD2, Sherif Eltonsy, PhD2;
1University of Manitoba, PhD student, Winnipeg, Canada, 2University of Manitoba, Winnipeg, MB, Canada
1University of Manitoba, PhD student, Winnipeg, Canada, 2University of Manitoba, Winnipeg, MB, Canada
OBJECTIVES: Access to prenatal care (PNC) services is essential for the health and safety of mothers and their infants, as it helps reduce complications and adverse pregnancy outcomes. Investigating maternal clinical and demographic determinants that influence the adequacy of PNC services is important to ensure equitable access in Manitoba, Canada. This study aimed to investigate rates and determinants of inadequate care among all women giving birth in Manitoba.
METHODS: We conducted a retrospective cohort study using province-wide mother-infant-linked administrative health databases from January 2010 to March 2022. We identified inadequate prenatal care using the Revised Graduated Prenatal Care Utilization Index (R-GINDEX), and the monthly rates were examined. Multivariable logistic regression models were used to identify determinants of inadequate care.
RESULTS: Amongst 192,274 pregnancies, 10.4% (n=19,926) had inadequate care compared to 33.9% (n=65,143) had adequate care. Over the study period, we observed a significant increase in the rate of inadequate care among all pregnant women from 10.5% to 12.3% (p<0.001). Pregnant women living in rural (adjusted Odds Ratio [aOR]=2.30,95% Cl: 2.06-2.57) or northern rural areas (aOR=2.3, 95% Cl:2.04-2.61) were more likely to receive inadequate care compared to urban areas. Similarly, pregnant women with lower income had higher odds of inadequate care compared to those of higher income (aOR=1.97,95%Cl:1.89-2.04). Older maternal age and comorbid diseases such as diabetes, maternal psychological distress, and hypertension were significantly associated with a reduced likelihood of inadequate care. Women with a parity of 2 or more were significantly more likely to experience inadequate care (aOR=4.31,95%CI:4.14-4.48).
CONCLUSIONS: This study highlights significant inequities in prenatal care access in Manitoba, with lower-income women and those living in rural and northern rural regions experiencing higher odds of inadequate care. Further research is needed to identify additional factors contributing to this inequity and assess the association between inadequate care and adverse pregnancy outcomes.
METHODS: We conducted a retrospective cohort study using province-wide mother-infant-linked administrative health databases from January 2010 to March 2022. We identified inadequate prenatal care using the Revised Graduated Prenatal Care Utilization Index (R-GINDEX), and the monthly rates were examined. Multivariable logistic regression models were used to identify determinants of inadequate care.
RESULTS: Amongst 192,274 pregnancies, 10.4% (n=19,926) had inadequate care compared to 33.9% (n=65,143) had adequate care. Over the study period, we observed a significant increase in the rate of inadequate care among all pregnant women from 10.5% to 12.3% (p<0.001). Pregnant women living in rural (adjusted Odds Ratio [aOR]=2.30,95% Cl: 2.06-2.57) or northern rural areas (aOR=2.3, 95% Cl:2.04-2.61) were more likely to receive inadequate care compared to urban areas. Similarly, pregnant women with lower income had higher odds of inadequate care compared to those of higher income (aOR=1.97,95%Cl:1.89-2.04). Older maternal age and comorbid diseases such as diabetes, maternal psychological distress, and hypertension were significantly associated with a reduced likelihood of inadequate care. Women with a parity of 2 or more were significantly more likely to experience inadequate care (aOR=4.31,95%CI:4.14-4.48).
CONCLUSIONS: This study highlights significant inequities in prenatal care access in Manitoba, with lower-income women and those living in rural and northern rural regions experiencing higher odds of inadequate care. Further research is needed to identify additional factors contributing to this inequity and assess the association between inadequate care and adverse pregnancy outcomes.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EPH174
Topic
Epidemiology & Public Health
Disease
SDC: Pediatrics, SDC: Reproductive & Sexual Health