Prenatal Care Utilization Among Recently Admitted Refugee Women in Multnomah County, Oregon

BACKGROUND: Approximately one quarter of all births in the United States (US) are to foreign born women. Foreign born women, especially those who recently arrived in the US, are less likely to seek prenatal care services than US born women. Little is known about prenatal care (PNC) utilization among refugee women, who may have unrecognized or untreated reproductive health care needs. The objective of this study is to characterize and examine PNC utilization among recently immigrated refugee women in Multnomah County, Oregon.

METHODS: We linked electronic health screening records of all refugee women admitted to Oregon and screened at the Multnomah County refugee clinic between 2008 and 2012 to birth certificates of infants born to Multnomah County resident women during the same time period. We assessed PNC utilization by examining the following outcomes: week of PNC initiation, number of PNC visits, first trimester PNC, and adequate PNC. We defined adequacy of prenatal care using the Kotelchuck Index. We compared PNC utilization among recent refugees to foreign born women, which includes authorized and unauthorized immigrants and refugees admitted prior to 2008, and US born women using t-tests for continuous outcomes and chisq square tests for categorical outcomes.

RESULTS: We identified 188 births to recent refugee women that occurred during the study period. Refugee women emigrated primarily from Burma (33%), Somalia (15%), Ukraine (9%), Iraq (8%) and Bhutan (6%). All PNC outcomes among recent refugees differed significantly when compared to both foreign born and US born women (P<0.0001). On average, prenatal care was initiated at 16.7 weeks among recent refugees compared to 12.8 and 11.1 weeks among foreign born and US born women, respectively. Refugee women received fewer PNC visits (8.7 vs. 10.3- foreign born and 11.4-US born). PNC began during the first trimester in less than half of pregnancies among recent refugees (46.4% vs. 65%-foreign born and 77%-US born) and 45.2% received adequate PNC compared to 56.6% of pregnancies among foreign born women and 68.5% of pregnancies among US born women.

CONCLUSIONS: Our analysis illustrated alarming disparities in PNC utilization among refugee women when compared to both foreign born women and US born women. Recently immigrated refugee women may face barriers to receiving health care during pregnancy. Understanding and addressing those barriers may increase PNC utilization in Multnomah County and in other refugee communities.