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State of Alaska

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

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.^2^ 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.^3^ [[br]] [[br]] ---- {{class .SmallerFont 2. 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. 3. 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. }}

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 Health Analytics and Vital Records], Division of Public Health, Alaska Department of Health and Social Services

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 2013), the item was recorded as the month of pregnancy that prenatal care began as reported by the mother. With the 2003 revision, 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.^1^ Alaska implemented the 2003 version of the birth certificate in 2013. Data in which the trimester were unknown were excluded from the analyses. [[br]] [[br]] ---- {{class .SmallerFont 1. Calculations | PeriStats | March of Dimes. [http://www.marchofdimes.org/peristats/calculationsp.aspx?id=23]. Accessed July 13, 2016. }}

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.

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 2015, over one-fifth of Alaska women who delivered a live birth did not receive prenatal care beginning in the first trimester. The percentage was 20.2% for all Alaskans and 24.3% 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 (28.2%) and southwest regions (28.6%) did not receive prenatal care beginning in the first trimester for the 5-year period of 2011-2015. In reviewing the 10-year average for 2006-2015 by boroughs and census areas, areas with approximately one-third or higher rates of not receiving prenatal care in the first trimester consisted of Kodiak Island Borough (38.6%), North Slope Borough (38.1%), Southeast Fairbanks census area (36.4%), and Yukon-Koyukuk census area (37.1%). In the Arctic Slope Regional Corporation area, 37.8% of women lacked early prenatal care, followed closely by the Aleut Corporation region with 36.7%. Although there has been improvement in the rate of prenatal care beginning in the first trimester of pregnancy, particularly among Alaska Native mothers, the rates for both all Alaskan mothers and Alaska Native mothers have not declined sufficiently to make the Healthy Alaskans 2020 objective of 19%. 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^ The Adequacy of Prenatal Care Utilization (APNCU) index makes use of two types of prenatal care information obtained from birth certificate data: when prenatal care began (adequacy of initiation) and the number of prenatal visits from when prenatal care began until delivery (adequacy of received services). In 2015, only 58.4% of mothers of live births received adequate prenatal care.^5^ [[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. 5. Alaska Department of Health and Social Services, Division of Public Health, Health Analytics and Vital Records Section. Alaska Vital Statistics 2015 Annual Report. [http://dhss.alaska.gov/dph/VitalStats/Documents/PDFs/VitalStatistics_Annualreport_2015.pdf]. Accessed February 16, 2017. }}

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].
Page Content Updated On 06/27/2017, Published on 06/27/2017
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health (Ak-IBIS) web site (http://ibis.dhss.alaska.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Fri, 25 May 2018 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health web site: http://ibis.dhss.alaska.gov ".

Content updated: Tue, 27 Jun 2017 07:50:44 AKDT
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Fri, 25 May 2018 20:12:26 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information System for Public Health Web site: http://ibis.dhss.alaska.gov/ ".

Content updated: Tue, 27 Jun 2017 07:50:44 AKDT