Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project
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Why Do Women Decline Preconception Care Counseling? The L os A ngeles M ommy and B aby Project. Shin Margaret Chao, Ph.D., M.P.H. Los Angeles County Department of Public Health Maternal Child, and Adolescent Health Programs .

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Why Do Women Decline Preconception Care Counseling? The L os A ngeles M ommy and B aby Project

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Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

Why Do Women Decline Preconception Care Counseling? TheLosAngelesMommyand BabyProject

Shin Margaret Chao, Ph.D., M.P.H.

Los Angeles County Department of Public Health

Maternal Child, and Adolescent Health Programs


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

This project was supported by the Health Resources and Services Administrative (HRSA) # R40MC06635, Productivity and Investment Fund, and MCAH General grants.


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

Background

  • Preconception care counseling (PCC) provides opportunities for women to gain awareness and understanding of how their health behaviors and family histories impact pregnancy

  • Benefits of PCC well documented

  • Little knowledge on who does/does not receive PCC in Los Angeles County and why


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

  • Study Questions

  • What are the characteristics of women who do not have preconception care counseling?

  • What are the reasons women do not have preconception care counseling?


Methods

PROCEDURES

Methods

LAMB INSTRUMENT

Questions primarily drawn and adapted from validated survey instruments

Focus groups; piloted

Survey translated into Spanish, and Chinese. Telephone translation service for other languages.

LA resident mothers 0-7 months after a live birth

Stratified random sample

Over sample LBW/PT births, African American, Asian/PI and Native American births

Mail survey with telephone follow-up for non-respondents

$20 gift certificate


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

During the six months before you got pregnant with your new baby, did you talk to a doctor, nurse, or other health care worker about how to prepare for a healthy pregnancy and baby? If yes, tell us why you did not see a doctor, nurse, or other health care worker to prepare for this baby.

Preconception Counseling Questions

  • Knew how to prepare myself for pregnancy already

  • Didn’t expect to get pregnant

  • Did not have enough money or insurance to pay for a check-up

  • Did not have a regular doctor or nurse to talk to

  • Had no way to get to the clinic or the doctor’s office

  • Couldn’t take time off from work

  • Had no one to take care of my children

  • Too many other things going on

  • Couldn’t find a doctor or nurse who spoke my language

  • Other


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

Statistical Analyses

  • Prevalence rates of women who had no PCC

  • Maternal characteristics associated with no PCC; perform multivariate analysis

  • Major reasons why women had no PCC

  • Sample weighting to adjust for sampling probabilities


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

Results


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

LAMB Demographics

Race/Ethnicity

Family Income

N = 6,264


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

Women who had no Preconception Care Counseling, by Race/Ethnicity, 2007 LAMB Survey

N = 4,264


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

Multivariate Model:

Racial Disparities in no PCC

Adjusted Odds Ratios and Confidence Limits for Race/Ethnicity

aOR

N = 4,264

  • White mothers is the reference group

  • The multivariate model included: mother’s education, age, marital status, and insurance status

  • African American mothers more likely than white mothers to have no PCC visit


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

Selected Maternal Characteristics by PCC Status

  • <=12 yrs education

  • Unmarried

  • Uninsured before pregnancy

  • Unintended pregnancy

  • Young age

  • Not a first time mother

N = 6,264


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

Reasons for No PCC

2007 LAMB Survey

N = 4,264


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

Reasons For No PCC by Race/Ethnicity

2007 LAMB Survey

N = 4,264


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

Reasons For No PCC by Parity

2007 LAMB Survey

N = 4,264


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

Conclusions

  • Over 70% of recently delivered mothers had no PCC

  • Major reasons:

    • Not expecting to get pregnant

    • Knew how to prepare

    • No regular doctor

    • Not enough money or insurance for check-up

    • Too much else going on

  • Racial/ethnic disparities

  • Younger age, lower education level, unmarried, unintended pregnancy, not a first time mother


Public health implications

Public Health Implications


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

Implications

  • Identify subpopulations of women in need of outreach during the preconception period

  • Integrate PCC as part of family planning services

  • Need for awareness campaigns on importance of PCC

  • Social policy changes to promote funding and access to PCC

  • Maximize public health surveillance and related research mechanisms to evaluate the effectiveness of PCC


Special thanks to

Michael C. Lu, MD, MPH

2007 LAMB Principal Investigator

Cynthia Harding, MPH

Director, Los Angeles County MCAH Programs

Diana Liu, MPH, Chandra Higgins, MPH, Marian Eldahaby, BA, Carmen Gutierrez, Alex Chen, MS

Martha Martinez, Rozana Ceballos, BA

Our Community Partners

. . . and of course, mothers who completed the survey!

Special Thanks to:


Why do women decline preconception care counseling the l os a ngeles m ommy and b aby project

Contact Us

  • Toll-free number: 1-866-706-LAMB

  • For information about LAMB, visit: http://lapublichealth.org/mch/LAMB/LAMB.html

  • Margaret Chao [email protected]

    213-639-6470


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