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State of Alaska

Complete Health Indicator Report of Health Care - No Prenatal Care in First Trimester (HA2020 Leading Health Indicator: 21)

Definition

Percentage of infants born to pregnant women who did not receive prenatal care in the first trimester as a percentage of the total number of live births.

Numerator

Number of infants born to pregnant women who did not receive prenatal care in the first trimester.

Denominator

Number of live births.

Data Interpretation Issues

Alaska populations are from the [http://laborstats.alaska.gov/pop/popest.htm Alaska Department of Labor and Workforce Development, Research and Analysis]. The transition from the 1989 revision of the U.S. Standard Certificate of Live Birth to the 2003 revision has multiple implications for tracking rates of prenatal care in the United States. First, the timing of prenatal care item has changed. For data collected using the 1989 revision (all data prior to 2003), the item was recorded as the month of pregnancy that prenatal care began as reported by the mother. In 2003 the item was changed to request the date (day/month/year) of the first prenatal care visit, as recorded in the prenatal care or medical record. As a result of these modifications, rates of prenatal care timing and adequacy from the 2003 revision are not comparable to data collected using earlier birth certificate revisions.^3^ Alaska implemented the 2003 version of the birth certificate in 2013.[[br]] [[br]] ---- {{class .SmallerFont 3. Calculations | PeriStats | March of Dimes. [http://www.marchofdimes.org/peristats/calculationsp.aspx?id=23]. Accessed July 13, 2016. }}

Why Is This Important?

Access to quality healthcare is influenced by a number of factors, including: having health insurance, having access to care, and being able to afford care.^1^ Inadequate prenatal care--including late initiation of care, infrequent prenatal visits, or no care at all--is associated with poor infant and maternal outcomes, including low birth weight or preterm infants and for the mothers an increased risk for pregnancy-related mortality and complications of childbirth.^2^ [[br]] [[br]] ---- {{class .SmallerFont 1. DeVoe, Baez A, Angier H, Krois L, et al. Insurance plus Access Does not Equal Health Care: Typology of Barriers to Health Care Access for Low-Income Families. Ann Fam Med. 2007;5(6):511-518. [http://www.medscape.com/viewarticle/567154] Accessed October 19, 2016. 2. Young MB, Perham-Hester KA, Kemberling MM. Alaska Maternal and Child Health Data Book 2011: Alaska Native Edition. Anchorage, AK: A collaboration of the Alaska Department of Health and Social Services, Division of Public Health, and the Alaska Native Tribal Health Consortium, Alaska Native Epidemiology Center. October 2011. [http://anthctoday.org/epicenter/publications/prams/pramsFullVersion.pdf] Accessed October 19, 2016. }}

Healthy People Objective: Prenatal care beginning in first trimester

U.S. Target: 77.9 percent (or 22.1 percent not beginning prenatal care in the first trimester)
State Target: Healthy Alaskans 2020 Target: 19.0% with no prenatal care in first trimester

Other Objectives

Healthy Alaskans 2020 Indicator 21: Reduce the percentage of women delivering live births who have not received prenatal care beginning in the first trimester of pregnancy to 19% by 2020.

How Are We Doing?

In 2014, over one-fifth of Alaska women who delivered a live birth did not receive prenatal care beginning in the first trimester. The percentage was 21.7% for all Alaskans and 24.0% for Alaska Native women who delivered live births. Due to the changes on the birth certificate on the timing of the first prenatal care visit, rates from 2013 and later are more precise and not directly comparable to earlier years. Nearly 30% of women giving birth in the northern and southwest regions did not receive prenatal care beginning in the first trimester for the 5-year period of 2010-2014. In reviewing the 10-year average for 2005-2014 by boroughs and census areas, areas with approximately one-third or higher rates of not receiving prenatal care in the first trimester consisted of Bethel census area, Kusilvak census area, North Slope Borough, Southeast Fairbanks census areas, and Yukon-Koyukuk census area. In the Arctic Slope Regional Corporation area, 41.9% of women lacked early prenatal care. Alaska PRAMS surveyed women who recently delivered a live birth about their ability to obtain prenatal care when they wanted it, and asked them to list the corresponding reasons if they were unable to. During 2002-2011, the prevalence of Alaskan women who received prenatal care as early as they wanted it increased from 80.4% to 85.0%. The most common reason that Alaskan women gave for not getting prenatal care as early in their pregnancy as they wanted was because they didn't know they were pregnant (36.5%). Not having a Medicaid or Denali KidCare card (35.6%) or not being able to get an appointment when they wanted one (35.0%) were also common reasons given.^4^[[br]] [[br]] ---- {{class .SmallerFont 4. Newby-Kew AJ, DeLozier DP, Prince CB, Perham-Hester KA, Young MB. Alaska Maternal and Child Health Data Book 2014: Life Course Edition. Anchorage, AK. Maternal and Child Health Epidemiology Unit, Section of Women's, Children's, and Family Health, Division of Public Health, Alaska Department of Health and Social Services, September 2014. [http://dhss.alaska.gov/dph/wcfh/Documents/mchepi/pubs/databook/MCHDataBook2014toweb.pdf]. Accessed July 13, 2016. }}

Evidence-based Practices

As part of the Healthy Alaskans 2020 health improvement process, groups of Alaska subject matter experts met over a period of months in a rigorous review process to identify and prioritize strategies to address the 25 health priorities. Public health partners around the state are aligning work around these approaches adapted to Alaska's unique needs. '''Strategy 1:''' [[br]]Increase the number of women of childbearing age who report having access to health care providers who support them to plan their pregnancies. '''Evidence Base:''' [[br]]The Agency for Healthcare Research and Quality describes components of health care access as follows: Access to health care means having "the timely use of personal health services to achieve the best health outcomes" (source: Millman M, ed. Institute of Medicine, Committee on Monitoring Access to Personal Health Care Services. Access to health care in America. Washington, DC: National Academy Press; 1993). Health care access is measured in several ways, including: # Structural measures of the presence or absence of specific resources that facilitate health care, such as having health insurance or a usual source of care. # Assessments by patients of how easily they are able to gain access to health care. # Utilization measures of the ultimate outcome of good access to care (i.e., the successful receipt of needed services). '''Source:''' [[br]]Agency of Healthcare Research and Quality. [http://www.ahrq.gov/research/findings/nhqrdr/nhqr08/Chap3.html Patient Safety]. In National Healthcare Quality Report, 2008 (Chapter 3). '''Strategy 2:''' [[br]]Increase the number of women who have their pregnancies confirmed by a health care provider in the first trimester. '''Evidence Base:''' [[br]]The Agency for Healthcare Research and Quality describes components of health care access as follows: Access to health care means having "the timely use of personal health services to achieve the best health outcomes" (source: Millman M, ed. Institute of Medicine, Committee on Monitoring Access to Personal Health Care Services. Access to health care in America. Washington, DC: National Academy Press; 1993). Attaining good access to care requires three discrete steps: # Gaining entry into the health care system. # Getting access to sites of care where patients can receive needed services. # Finding providers who meet the needs of individual patients and with whom patients can develop a relationship based on mutual communication and trust. '''Source:''' [[br]]Agency of Healthcare Research and Quality. [http://www.ahrq.gov/research/findings/nhqrdr/nhqr08/Chap3.html Patient Safety]. In National Healthcare Quality Report, 2008 (Chapter 3). '''Strategy 3:''' [[br]]Improve systems and services that care for women with addictions (alcohol, drugs, tobacco). '''Evidence Base:''' [[br]]The Agency for Healthcare Research and Quality describes components of health care access as follows: Access to health care means having "the timely use of personal health services to achieve the best health outcomes" (source: Millman M, ed. Institute of Medicine, Committee on Monitoring Access to Personal Health Care Services. Access to health care in America. Washington, DC: National Academy Press; 1993). Health care access is measured in several ways, including: # Structural measures of the presence or absence of specific resources that facilitate health care, such as having health insurance or a usual source of care. # Assessments by patients of how easily they are able to gain access to health care. # Utilization measures of the ultimate outcome of good access to care (i.e., the successful receipt of needed services). '''Source:''' [[br]]Agency of Healthcare Research and Quality. [http://www.ahrq.gov/research/findings/nhqrdr/nhqr08/Chap3.html Patient Safety]. In National Healthcare Quality Report, 2008 (Chapter 3).

Health Program Information

A listing of strategies, actions, and key partners on this measure can be found at: [http://hss.state.ak.us/ha2020/assets/Actions-Partners_21_Prenatal.pdf].


Related Indicators

Relevant Population Characteristics

Pregnant teens 15-19 years of age, mothers with low level of education, race other than White, Hispanic ethnicity, being unmarried, lower socio-economic status, and women who lack health insurance are less likely to get early prenatal care.

Related Relevant Population Characteristics Indicators:


Health Care System Factors

Having health insurance improves availability of prenatal care services. Lack of health insurance affects both the timing and frequency of prenatal care visits, resulting in poor pregnancy outcomes such as premature birth, low birth weight, and complicated delivery. Availability of family planning services is another system factor that reduces the risk of unintended pregnancy. If a pregnancy is planned, a woman is more likely to seek early and adequate prenatal care.

Related Health Care System Factors Indicators:


Risk Factors

The risk factors for late entry identified by the Alaska Pregnancy Risk Assessment Monitoring System (PRAMS) and from the birth certificate are: - women less than 20 years of age - women with less than 12 years of education - non-White women - Hispanic women - unmarried women - women with an annual household income less than $15,000/year - unintended pregnancy - women who had no private insurance prior to conception

Related Risk Factors Indicators:


Health Status Outcomes

Prenatal care can improve birth outcomes and prevent medical complications and their costs associated with premature births, low birth weight births, and maternal and infant mortality and morbidity.



Graphical Data Views

Percentage of women delivering live births who have not received prenatal care beginning in first trimester of pregnancy, all Alaskans and Alaska Natives, 2001-2020

::chart - missing::

Alaska ComparisonsYearPercentage of women not receiving prenatal care in first trimesterNumer- ator
Record Count: 36
All Alaskans200119.1%
All Alaskans200219.5%
All Alaskans200319.9%
All Alaskans200418.9%
All Alaskans200519.5%
All Alaskans200618.7%
All Alaskans200719.7%
All Alaskans200820.2%
All Alaskans200919.7%
All Alaskans201021.3%2,248
All Alaskans201122.5%2,451
All Alaskans201223.3%2,430
All Alaskans201320.6%2,215
All Alaskans201421.7%2,361
Alaska Native people200127.9%
Alaska Native people200229.8%
Alaska Native people200329.2%
Alaska Native people200429.0%
Alaska Native people200528.2%
Alaska Native people200627.3%
Alaska Native people200730.1%
Alaska Native people200832.3%
Alaska Native people200927.0%
Alaska Native people201027.3%767
Alaska Native people201125.4%697
Alaska Native people201227.1%735
Alaska Native people201323.8%665
Alaska Native people201424.0%673
Healthy Alaskans Goal201319.0%
Healthy Alaskans Goal201419.0%
Healthy Alaskans Goal201519.0%
Healthy Alaskans Goal201619.0%
Healthy Alaskans Goal201719.0%
Healthy Alaskans Goal201819.0%
Healthy Alaskans Goal201919.0%
Healthy Alaskans Goal202019.0%

Data Notes

Data from before 2013 were obtained using the 1989 revision of the U.S. Standard Certificate of Live Birth in which only the month in which prenatal care began was collected. Data from before 2013 may not be comparable to the information from 2013 and later based upon the 2003 revision of the certificate that requested the date of the first prenatal care visit.

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Alaska Bureau of Vital Statistics], Division of Public Health, Alaska Department of Health and Social Services


Percentage of women delivering live births who have not received prenatal care beginning in first trimester of pregnancy, by Alaska Economic Regions, all Alaskans, 2010-2014 (5-year average)

::chart - missing::
confidence limits

Percentage of women not receiving prenatal care in first trimesterLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 7
Anchorage - Mat-Su21.0%20.5%21.5%5,88428,046
Gulf Coast21.6%20.5%22.8%1,1265,203
Interior21.4%20.6%22.3%1,9128,934
Northern29.4%27.8%31.0%8702,958
Southeast16.5%15.4%17.6%7144,340
Southwest29.5%28.1%30.8%1,2334,185
Statewide21.9%21.5%22.2%11,74353,680

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Alaska Bureau of Vital Statistics], Division of Public Health, Alaska Department of Health and Social Services


Percentage of women delivering live births who have not received prenatal care beginning in first trimester of pregnancy, by Boroughs/Census Areas, all Alaskans, 2005-2014 (10-year average)

::chart - missing::
confidence limits

Percentage of women who have not received prenatal care in first trimesterLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 30
Aleutians East Borough17.8%12.4%23.2%34191
Aleutians West CA26.7%21.9%31.6%85318
Anchorage Municipality18.7%18.3%19.0%8,01842,939
Bethel CA32.7%31.3%34.1%1,3774,214
Bristol Bay Borough22.9%14.8%30.9%24105
Denali Borough22.3%16.4%28.0%46206
Dillingham CA26.4%23.6%29.2%260985
Fairbanks North Star Borough19.1%18.5%19.8%3,03815,874
Haines Borough21.1%15.5%26.7%43204
Hoonah-Angoon CA23.5%18.1%28.9%55234
Juneau City and Borough11.9%10.9%12.9%4623,895
Kenai Peninsula Borough18.7%17.8%19.6%1,2566,722
Ketchikan Gateway Borough14.2%12.6%15.8%2591,820
Kodiak Island Borough17.3%15.7%18.8%3742,168
Kusilvak CA40.2%38.2%42.2%9112,267
Lake and Peninsula Borough20.9%16.2%25.6%61292
Matanuska-Susitna Borough20.6%19.9%21.3%2,52012,231
Nome CA24.6%22.9%26.4%5612,278
North Slope Borough38.7%36.4%41.0%6691,729
Northwest Arctic Borough27.7%25.7%29.7%5431,961
Petersburgh Borough20.7%16.5%24.9%75362
Prince of Wales-Hyder CA25.8%22.7%28.8%203788
Sitka City and Borough14.3%12.3%16.4%1581,104
Skagway Municipality19.2%11.2%27.1%1894
Southeast Fairbanks CA36.4%33.5%39.2%4031,108
Valdez-Cordova CA18.4%16.2%20.5%2271,237
Wrangell City and Borough14.0%9.5%18.6%31221
Yakutat City and Borough31.7%21.4%41.9%2579
Yukon-Koyukuk CA38.6%35.3%41.9%324840
Alaska Total20.7%20.5%21.0%22,067106,497

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Alaska Bureau of Vital Statistics], Division of Public Health, Alaska Department of Health and Social Services


Percentage of women delivering live births who have not received prenatal care beginning in first trimester of pregnancy, by Native Regional Corporations, all Alaskans, 2010-2014 (5-year average)

::chart - missing::
confidence limits

Lower LimitUpper LimitNumer- atorDenom- inator
Record Count: 13
AHTNA Inc.22.2%16.2%28.2%41185
Aleut Corp.33.3%27.3%39.4%77231
Arctic Slope Regional Corp.41.9%38.6%45.2%361861
Bering Straits Native Corp.24.7%22.2%27.2%2791,129
Bristol Bay Native Corp.25.8%22.5%29.0%178691
Calista Corp.29.8%28.2%31.4%9633,233
Chugach Alaska Corp..25.0%21.8%28.2%177708
Cook Inlet Region Inc.21.0%20.6%21.5%6,55431,204
Doyon Ltd.21.4%20.6%22.3%1,9118,927
Koniag Inc.20.4%18.0%22.7%2241,100
NANA Regional Corp.23.5%20.8%26.3%220935
Sealaska Corp.16.3%15.2%17.4%7074,327
Alaska21.9%21.5%22.2%11,74353,680

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Alaska Bureau of Vital Statistics], Division of Public Health, Alaska Department of Health and Social Services

References and Community Resources

'''References:''' 1. DeVoe, Baez A, Angier H, Krois L, et al. Insurance plus Access Does not Equal Health Care: Typology of Barriers to Health Care Access for Low-Income Families. Ann Fam Med. 2007;5(6):511-518. [http://www.medscape.com/viewarticle/567154] Accessed October 19, 2016. 2. Young MB, Perham-Hester KA, Kemberling MM. Alaska Maternal and Child Health Data Book 2011: Alaska Native Edition. Anchorage, AK: A collaboration of the Alaska Department of Health and Social Services, Division of Public Health, and the Alaska Native Tribal Health Consortium, Alaska Native Epidemiology Center. October 2011. [http://anthctoday.org/epicenter/publications/prams/pramsFullVersion.pdf] Accessed October 19, 2016. 3. Calculations | PeriStats | March of Dimes. [http://www.marchofdimes.org/peristats/calculationsp.aspx?id=23]. Accessed July 13, 2016. 4. Newby-Kew AJ, DeLozier DP, Prince CB, Perham-Hester KA, Young MB. Alaska Maternal and Child Health Data Book 2014: Life Course Edition. Anchorage, AK. Maternal and Child Health Epidemiology Unit, Section of Women's, Children's, and Family Health, Division of Public Health, Alaska Department of Health and Social Services, September 2014. [http://dhss.alaska.gov/dph/wcfh/Documents/mchepi/pubs/databook/MCHDataBook2014toweb.pdf]. Accessed July 13, 2016.

More Resources and Links

Alaska and national goals may be found at the following sites:

Alaska health promotion resources may be found at the following site:

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Maps of health indicators for various subdivisions of Alaska may be found at the following site:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

For an on-line medical dictionary, click on this Dictionary link.

AK-IBIS Web Citation

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Page Content Updated On 10/19/2016, Published on 10/19/2016
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Content updated: Wed, 19 Oct 2016 07:52:34 AKDT
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Content updated: Wed, 19 Oct 2016 07:52:34 AKDT