Effect of prior family planning participation on prenatal care use and low birth weight

              interval from previous delivery or other pregnancy
termination to conception, participation in WIC
and maternity care coordination, and age under 18.
These comparisons were made using information
from the birth certificates. Logistic regression analysis
was used to control for other low birth weight risk
factors and assess the independent effect ofprevious
family planning participation on low birth weight.
RESULTS
Table 1 shows the distribution of race and other
risk factors related to poor pregnancy outcomes in
the family planning and non-family-planning groups.
The groups are fairly similar in terms of education,
Medicaid enrollment, smoking, medical risk factors
(from birth certificate), and previous fetal death or
live born who died. The only risk factor that was
very different between the two groups was race: 64
percent of the family planning participants were
black and 48 percent of the nonparticipants were
black. [Note: The data shown in this paper are
actually for all races other than white. Since 93
percent of births for races other than whites are to
blacks, we will refer to this population as black.]
Six intermediate measures thought to be related to
birth outcomes were analyzed: young maternal age,
WIC participation, maternity care coordination, less
than adequate prenatal care as determined by the
Kessner Index, early initiation of prenatal care, and
birth-to-conception intervals (Table 2). Whites and
blacks were analyzed separately since there are sig-nificant
differences between the races in terms ofout-comes
and the racial distribution in the groups with
and without family planning is different (Table 1).
Table 2 shows that among both whites and blacks,
a smaller proportion of family planning participants
were under the age of 18, received less than adequate
prenatal care as determined by the Kessner Index,
and initiated prenatal care after the first trimester
compared to their counterparts who did not partici-pate
in family planning. All of these differences were
statistically significant for whites and blacks.
The birth-to-conception interval, also shown in
Table 2, is the amount of time from the previous
birth or other pregnancy termination to the calculated
date of conception. Among the births that were
second or higher-order pregnancies, a smaller propor-tion
of family planning participants had a birth-to-conception
interval ofsix months or less, as compared
to nonparticipants. This difference was statistically
significant for whites and blacks. In addition, a
greater proportion of family planning participants
were enrolled in WIC and received maternity care
coordination services than those women who had
not used family planning services.
Table 3 shows the percentages of women who
delivered a low birth weight baby. Among both
whites and blacks, a smaller proportion of women
who had received family planning services delivered
a low birth weight baby than those who had not
received services. The difference was significant
(p < .05) only for blacks.
A logistic regression analysis was performed to
statistically adjust for race and other risk factors in
assessing a possible effect of family planning on
subsequent birth outcomes. The analysis controlled
for six risk factors: black race, education of less than
12 years, unmarried, smoking, presence of at least
one medical risk factor, and a previous fetal death or
live born who died. Initially, maternal age of 35 years
or greater and Medicaid participation were controlled,
but were left out of the model since they were shown
not to affect it.
Results of the logistic regression are shown in
Table 4. With the six risk factors statistically
controlled, women who had not received family
planning services were 1 .09 times as likely to have a
low-weight birth as were those who had received
family planning services. This association of family
planning participation with birth weight was statisti-cally
significant. The race-specific odds ratio for low
birth weight was statistically significant for blacks,
but not for whites.
DISCUSSION
The women who received family planning services
in public clinics are comparable to those who did not
receive family planning services in terms ofeducation,
Medicaid coverage, marital status, smoking history,
medical risk factors, and previous fetal death or live
born who died. The family planning group, however,
had a higher proportion of black women. This is
consistent with other studies that show that of all
women below the poverty level who seek family
planning services, over 50 percent of blacks and
about 25 percent of whites obtain family planning
services from public clinics.23
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