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  • Title: Factors associated with postpartum care among Massachusetts users of the Maternal and Infant Care Program.
    Author: Kogan MD, Leary M, Schaetzel TP.
    Journal: Fam Plann Perspect; 1990; 22(3):128-30. PubMed ID: 2379570.
    Abstract:
    Records of the 21 Maternal and Infant Care (MIC) offices run by the Massachusetts Department of Public Health located in community-based facilities in high-risk areas provided data for the period 1985-87. MIC services include a postpartum visit within 2-6 weeks after birth. 24% of the deliveries in the MIC program were to teenagers. Unmarried women, high school dropouts, and minority group members were greatly overrepresented in the MIC program. 78% (10,854) of the women who received MIC care returned for a postpartum visit. Maternal age, educational status, parity, ethnicity, primary language, adequacy of prenatal care, length of maternal hospitalization, transfer of the infant to a neonatal intensive care unit, length of pregnancy, birth outcome, type of delivery, and birth weight were factors studied. The largest effect appeared to be correlated with adequacy of prenatal care utilization (the Kessner Index is used). Only 63% of women with inadequate utilization returned, compared with 76% of those with intermediate care and 86%, adequate care. The higher the women's level of education, the more likely she was to have a postpartum visit. The more children she had, the less likely she was to return. 82% of those with 1st births returned and 70% of those with 4 or more children. Women who did not speak English were more likely to return, (82%) than those who did (78%). NonEnglish speaking Asian women had the highest return rate (92%). Women under age 26 were likely to return than older ones. Factors associated with postpartum care were analyzed by year of delivery, so time trends could be seen. In 1985 and 1986, 78.9% returned for postpartum care; in 1987, the figure decreased to 76.4%. The % with adequate prenatal care who returned for postpartum care declined each year, from 87.4% in 1985 to 85.9% in 1986, and 83.8% in 1987. This was statistically significant. The % of Blacks who received postpartum care also declined, significantly. There was no change in the proportion getting adequate postpartum care among nonBlack groups. Factors associated with the lack of postpartum care in the multivariate analysis included Hispanic ethnicity, or later birth, and having a repeat cesarean section. The findings were shown to be stable across the years. In 1986 and 1987, women on the Healthy Start (a state-funded reimbursement program that pays for obstetric care of women with incomes between 100 and 185% of the poverty level) were less likely to miss their postpartum visit than those with commercial insurance.
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