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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 4
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Full Text | 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 4 |