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State of Alaska

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

Utilization of 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^ This report also includes data on early and adequate prenatal care using the Adequacy of Prenatal Care Utilization (APNCU) index that additionally accounts for the reported number of prenatal visits. [[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. [https://www.ncbi.nlm.nih.gov/pubmed/18025488] Accessed September 14, 2018. 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://dhss.alaska.gov/dph/wcfh/Pages/mchepi/mchdatabook/2011.aspx] Accessed September 14, 2018. }}
The measure shown in the graph is women who reported receiving prenatal care beginning in the second or third trimester of pregnancy. Excludes live births with missing data on timing of first prenatal care.

Notes

Data for prenatal care indicators updated by Maternal and Child Health Health Epidemiology Unit (MCH-Epi), Section of Women's, Children's and Family Health in December 2018. [SAS Analysis in December 2018] Birth certificate data updated by HAVRS on November 14, 2018.   Starting in 2013, Alaska birth certificates allowed for one or more races to be identified. We use a prioritized race classification starting with any mention of Alaska Native, followed by any mention of Black, then by any mention of Asian or Pacific Islander, and ending with any mention of White. All other or unknown races are excluded. This method is preferred over the race alone or bridged race methods because the denominators more closely align with the preceding years. It also eliminates the chance of including the same person in 2 or more races.

Data Interpretation Issues

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 (for Alaska, 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 may not be comparable to data collected using earlier birth certificate revisions.^1^ Alaska implemented the 2003 revision of the birth certificate in 2013. Some states began the revision process in 2003, but full implementation in all states was phased in over several years. By 2016, all states were using the same version. [[br]] [[br]] ---- {{class .SmallerFont 1. Calculations | PeriStats | March of Dimes. [http://www.marchofdimes.org/peristats/calculationsp.aspx?id=23]. Accessed October 12, 2018. }}

Definition

The percentage of women delivering live births who have not received prenatal care in the first trimester of pregnancy.

Numerator

Number of women delivering lives births who reported not receiving prenatal care in the first trimester of pregnancy for a specific time period.

Denominator

Number of live births for a specific time period.

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 People Objective 10.2: Increase the proportion of pregnant women who receive early and adequate prenatal care. '''U.S. Target:''' 77.6 percent 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?

Statewide, there has been steady improvement in the rate of prenatal care beginning in the first trimester of pregnancy, In 2017, Alaska's rate for this indicator (19.2%) approached the Healthy Alaskans 2020 objective of 19%. That same year, 22.4% of Alaska Native women who had delivered live births had not received prenatal care beginning in the first trimester - a 9% decrease since 2013. Thirty percent of women giving birth in the southwest regions did not receive prenatal care beginning in the first trimester for the 5-year period of 2013-2017. In reviewing the 10-year average for 2008-2017 by boroughs and census areas, areas with approximately one-third or higher rates of not receiving prenatal care in the first trimester consisted of Kusilvak census area (38.3%), North Slope Borough (37.1%), Southeast Fairbanks census area (36.9%), Yukon-Koyukuk census area (36.0%), and Aleutians West census area (33.8%). 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 2017, only 64.3% of Alaska women who had delivered a live birth were categorized as receiving 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 October 12, 2018. 5. Alaska Department of Health and Social Services, Division of Public Health, Health Analytics and Vital Records Section. Alaska Vital Statistics 2017 Annual Report. [http://dhss.alaska.gov/dph/VitalStats/Documents/PDFs/VitalStatistics_Annualreport_2017.pdf]. Accessed November 13, 2018. }}

How Do We Compare With the U.S.?

In 2017, 19.2% of Alaska women delivering lives births did not receive prenatal care in the first trimester of pregnancy, compared to 22.7% in the U.S. In 2016, 64.6% of Alaska women who had delivered a live birth were categorized as receiving early and adequate prenatal care (APNCU index), compared to 75.6% in the U.S.^6^ [[br]] [[br]] ---- {{class .SmallerFont 6. Osterman MJK, Martin JA. Timing and adequacy of prenatal care in the United States,2016. National Vital Statistics Reports, vol 67 no 3. Hyattsville, MD: National Center for Health Statistics. 2018 Available from [https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_03.pdf]. Accessed October 12, 2018. }}

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. '''Strategy 2:''' [[br]]Increase the number of women who have their pregnancies confirmed by a health care provider in the first trimester. '''Strategy 3:''' [[br]]Improve systems and services that care for women with addictions (alcohol, drugs, tobacco). '''Source:''' [[br]]Agency of Healthcare Research and Quality. Patient Safety.[http://www.ahrq.gov/research/findings/nhqrdr/nhqr08/Chap3.html] 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]. Accessed October 19, 2018.
Page Content Updated On 02/14/2019, Published on 02/14/2019
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, 23 August 2019 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: Thu, 14 Feb 2019 13:26:09 AKST
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, 23 August 2019 16:08:48 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: Thu, 14 Feb 2019 13:26:09 AKST