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Existing research has documented disparities in prenatal and postnatal care utilization across racial and ethnic groups. These disparities reflect systemic inequities that disproportionately affect marginalized communities. This research introduces a novel methodology for examining maternal healthcare disparities by integrating multiple structural factors that inhibit care usage among racially minoritized populations. The purpose of this study was to apply a conceptual framework that accounts for the influence of structural factors and use intersectional approach to inform methodology to explore the following questions:
- Do race and ethnicity, education, and residence correlate with prenatal and postnatal care utilization in the USA?
- Are there racial and ethnic variations in the influence of education on prenatal and postnatal care use?
- Are there racial and ethnic variations in the influence of location of residence on prenatal and postnatal care use?
- How do these intersecting axes (race and ethnicity, residence, and education) jointly shape the likelihood of women having and utilizing prenatal and postnatal care?
Methods
Drawing data from the Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-2021 (n=177,642), we applied the Gadson conceptual model through an intersectional framework to examine how race and ethnicity, socioeconomic status, and geographic location independently & interactively shape obstetric care access and utilization. We generated descriptive statistics, regression, and predictive margin estimates to analyze prenatal and postnatal care utilization. We specifically analyzed the racial divide in the effects of educational attainment and residential location on obstetric care usage in the United States.
Results
We found that individuals who identified as Black, Latina, and 'Other' races all had a lower likelihood of utilizing both pre-and postnatal care compared to their White counterparts, highlighting persistent structural racism in healthcare access. Educational attainment had a weaker association with the likelihood of both pre-and postnatal visits for Latina and 'Other' race individuals and postnatal visits for Black individuals. Even when these individuals had higher education levels, they didn't see the same boost in healthcare utilization that White people with similar education experienced. Rural residence further compounded these disparities, demonstrating how geographic isolation intersects with racial marginalization.
Conclusions and Implications
These findings reveal how structural racism operates through multiple pathways to limit maternal healthcare access for racially minoritized groups. We call for urgent policy reforms in healthcare delivery that prioritize racial equity, cultural responsiveness, and community-centered approaches. The recent discontinuation of the PRAMS data collection by the CDC represents a significant setback for monitoring and addressing maternal health disparities. This decision will further disconnect researchers, policymakers, and advocates from critical data needed to track inequities and develop evidence-based interventions for racially marginalized communities. Social work practice and policy advocacy must not only address healthcare system barriers but also challenge the defunding of vital public health surveillance systems that document racial disparities. Without robust data collection mechanisms like PRAMS, structural racism in maternal healthcare may become increasingly invisible in policy discussions, potentially deepening existing inequities for Black, Latina, and other racially minoritized birthing people.