Perceived Health Needs and Receipt of Services During Pregnancy --- Oklahoma and South Carolina, 2004--2007

Perceived Health Needs and Receipt of Services During Pregnancy --- Oklahoma and South Carolina, 2004--2007
Weekly
June 18, 2010 / 59(23);710-714


Prenatal care visits present an opportunity for health-care providers to offer services recommended by professional societies and educate women regarding behaviors and exposures that might affect their pregnancies. To determine whether women who identified a need for a service during pregnancy received that service, CDC analyzed 2004--2007 data (the most recent available) from the Pregnancy Risk Assessment Monitoring System (PRAMS) for Oklahoma and South Carolina, the only two states to include questions on the topic on their PRAMS questionnaires. This report summarizes the results of that analysis, which indicated substantial differences between perceived need and receipt of 1) assistance in reducing violence in the home, 2) counseling information for family or personal problems, 3) help to quit smoking, 4) help with an alcohol or drug problem, and 5) dental care. In South Carolina and Oklahoma, respectively, 1.7% and 2.9% of pregnant women stated a need for help to reduce violence in the home. Of those, only 12.8% and 21.0% reported receiving that help. In South Carolina and Oklahoma, respectively, 7.4% and 12.6% of pregnant women stated a need for help to quit smoking during pregnancy; of those, only 29.1% and 30.4% reported receiving that help. Adherence by health-care providers to established guidance for treating pregnant women might help reduce the differences between perceived need and receipt of services. Additional research to identify obstacles to receipt of services might enable state programs to further narrow these differences.

PRAMS is a population-based surveillance system that collects data on a wide range of maternal behaviors and experiences before, during, and after pregnancy. PRAMS surveys currently are conducted in 37 states and New York City. Each month, participating sites select a stratified random sample of 100--300 women with recent live births from birth certificate records. A questionnaire is mailed to the women 2--6 months after delivery. The participating sites use a standard core PRAMS questionnaire, to which they can add questions. Women receive up to three questionnaire mailings, and nonresponders receive follow-up telephone calls.

CDC analyzed PRAMS data collected from 7,824 respondents in Oklahoma and 5,474 respondents in South Carolina during 2004--2007; survey response rates ranged from 71% to 80% for Oklahoma and from 68% to 72% for South Carolina. For South Carolina, the 2006 data represented births only from April through September.

Oklahoma and South Carolina are the only two states to add PRAMS questions regarding the self-identified need for selected health services during pregnancy and the subsequent receipt of those services. Regarding needed services, all participants were asked, "During your most recent pregnancy, did you feel you needed any of the following services?" Five services with response choices of "yes" or "no" were listed in both state's surveys: help to reduce violence in your home, counseling information for family or personal problems, help to quit smoking, help with an alcohol or drug problem, and help with or information about breastfeeding. Two additional services were listed in the Oklahoma survey only: dental care and nutrition services (i.e., food stamps; Women, Infants, and Children program; or money to buy food). Two additional services also were listed in the South Carolina survey only: parenting classes and childbirth classes. Regarding receipt of services, all participants also were asked, "During your most recent pregnancy, did you receive any of the following services?" The same services were listed.

Data were weighted in each state to account for complex survey design, nonresponse, and noncoverage. The statistical significance of differences was determined using a chi-square test, with significance determined at p<0.05.

Characteristics of survey participants in Oklahoma and South Carolina during 2004--2007 relating to total number of live births and Medicaid payment for prenatal-care were similar (Table 1). However, the weighted percentages of the participant groups by race/ethnicity, age, education level, marital status, and prenatal care initiation differed significantly. For example, in Oklahoma, 67.3% of participants were non-Hispanic white, 8.3% were non-Hispanic black, 12.8% were Hispanic, and 11.7% were of other races. In contrast, in South Carolina, 56.7% of participants were non-Hispanic white, 31.8% were non-Hispanic black, 8.8% were Hispanic, and 2.6% were of other races (Table 1).

In Oklahoma, the needs most commonly reported were for dental care (50.1%), nutrition assistance (48.0%), and help with or information about breastfeeding (30.0%) (Figure). In South Carolina, the needs most commonly reported were for help with or information about breastfeeding (35.3%), childbirth classes (27.6%), and parenting classes (17.7%) (Figure).

In both states, substantial differences were observed between the percentages of women who perceived needs for services and the percentages of that group who received those services. In Oklahoma and South Carolina, the widest differences were regarding help to reduce violence in the home. Of the 2.9% of women in Oklahoma and 1.7% of women in South Carolina who identified that need during pregnancy, 21.0% and 12.8% reported receiving the service, respectively. Among women who said they needed services in Oklahoma, 27.4% reported receiving counseling information for family or personal problems; 30.4% received help to quit smoking; 34.8% received help with an alcohol or drug problem; and 38.2% received dental care (Table 2). In South Carolina, after help to reduce violence in the home, the widest differences were for help to quit smoking (29.1%) and getting counseling information for family or personal problems (30.0%) (Table 2). Among services included in the surveys of both states, the narrowest difference was observed regarding help with information about breastfeeding. In Oklahoma, 82.4%, and in South Carolina, 79.8%, of those who perceived a need for breastfeeding help received the service.

Reported by
S Dooley, MS, A Lincoln, MSW, MSPH, Oklahoma State Dept of Health. M Smith, MSPH, South Carolina Dept of Health and Environmental Control. ME O'Neil, MPH, IB Ahluwalia, PhD, DV D'Angelo, MPH, B Morrow, MA, Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

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Perceived Health Needs and Receipt of Services During Pregnancy --- Oklahoma and South Carolina, 2004--2007