A study by the Oklahoma State Department of Health (OSDH) Pregnancy Risk Assessment Monitoring System (PRAMS) shows although rates of prenatal care are generally the same for African American and white women in Oklahoma, one in five African American women face significant barriers beginning prenatal care. These include transportation problems, not being able to get an appointment when wanted, and not being able to begin prenatal care as early as wanted.

These issues negatively impact attempts to improve access to prenatal care and its potential to reduce infant mortality in Oklahoma. OSDH public health officials say that early and routine prenatal care is important because of the early screening, diagnosis and treatment of potential risks like high blood pressure and diabetes that can impact healthy birth outcomes.

In 2004, the national infant mortality rate was 6.8 deaths per 1,000 live births. For African Americans the rate was double, 13.6 per 1,000 live births, and for white women the rate was 5.7 per 1000 live births. In Oklahoma, the infant mortality rate of African American babies over a three-year span from 2004-2006 was 15.1 per 1,000 live births compared to 6.5 per 1,000 live births for white babies and the overall rate in Oklahoma was 8.0 per 1,000 live births.

Infants born to African American women are twice as likely to be born low birth weight when compared to white women in the United States. Also, they are 3.9 times more likely to die from complications of being born low birth weight compared to those infants born to white women.

According to Oklahoma PRAMS data, African American women were less likely to use tobacco or alcohol before or during pregnancy, less likely to have taken a multivitamin prior to pregnancy, and they were more likely for their pregnancy to be unintended when compared to white women.

The most alarming trend in this PRAMS study is the increased use of cigarettes during pregnancy among African American women from 1996 to 2006. Smoking is a risk factor for low birth weight and African American women are at a higher risk for low birth weight infants

than the general population. As smoking rates go up among pregnant women, this risk will only increase. Therefore health care providers must address it before, during and after pregnancy, beyond the minimal advice to quit.

In Oklahoma:

- African American women were less likely to smoke during pregnancy than white women, although the number of African American pregnant smokers is on the rise.

- African American mothers are less likely to drink during the three months prior to pregnancy compared to white women (41.8 percent vs. 50.6 percent).

- African American women were as likely to receive adequate levels of prenatal care as white women.

- African American women were less likely to receive prenatal care as early in their pregnancy as they desired when compared to white women. The most commonly cited barrier to obtaining prenatal care as early as desired was not being able to get an appointment when wanted.

Recommendations

- Continue research into health disparities, stressors, and social determinants of health care, poverty, and social support on outcomes in maternal and child health, and access to quality prenatal care for African American women.

- Target smoking cessation activities toward African American women and refer all pregnant smokers to the free Tobacco Helpline 1-800-QUIT NOW. Pregnant smokers should be offered effective smoking cessation interventions that exceed the minimal advice to quit.

- Increase efforts of health care providers to identify underlying factors that contribute to tobacco use before, during and after pregnancy in African American women.

- Develop culturally sensitive, evidenced-based preconception care tools, media messages and practices for African American women before and between pregnancies.

- Examine clinic or office guidelines and customer service practices to eliminate any potential barriers to early prenatal care for patients.

- Identify and leverage evidence-based teen pregnancy prevention programs that are culturally sensitive for African American youth.

- Fully fund programs like Children First, Office of Child Abuse Prevention (OCAP) and Healthy Start, which all make home visits, to ensure new mothers in Oklahoma get the information they need for healthy pregnancies and learn to develop relationships with health care providers.

PRAMS is an ongoing, population-based study designed to collect information about maternal behaviors and experiences before, during and after pregnancy. To read the entire report, view this Web site: mchs.health.ok and click on "Data and Evaluation" to find PRAMS reports. For information about women's health and family planning, contact: Maternal Child Health Service, Women's Health Service Director Jill Nobles-Botkin at (405) 271-4476.

Oklahoma State Department of Health