Racial disparities in outcomes of military and civilian births in California
W. D. Barfield, P. H. Wise, F. P. Rust, K. J. Rust, J. B. Gould and S. L. Gortmaker
Department of Pediatrics, Harvard Medical School, Boston, Mass, USA.
OBJECTIVE: To examine racial disparities in prenatal care utilization,
birth weight, and fetal and neonatal mortality in a population for whom
financial barriers to health care services are minimal. STUDY-DESIGN: Using
linked birth, fetal death, and infant death certificate files, we examined
prenatal care utilization, birth weight distribution, and fetal and
neonatal mortality rates for all white and black births occurring in
military hospitals in California from January 1, 1981, to December 31,
1985. These patterns were compared with the experience of their civilian
counterparts during the same time period. RESULTS: Black mothers had higher
percentages of births occurring in teenaged and unmarried mothers than did
white mothers in military and civilian populations. First-trimester
prenatal care initiation was lower for blacks in the military (relative
risk, 0.79; 95% confidence interval, 0.75-0.82) and civilian (relative
risk, 0.51; 95% confidence interval, 0.50-0.52) populations. However, the
scale of the disparity in prenatal care utilization was significantly
smaller (P < .001) in the military group. Rates of low birth weight and
fetal and neonatal mortality among blacks were elevated in the military and
civilian groups. However, the racial disparity in low birth weight was
significantly smaller in the military group (P < .01 and P < .001,
respectively). CONCLUSIONS: In populations with decreased financial
barriers to health care, racial disparities in prenatal care use and low
birth weight were reduced. However, the persistence of significant
disparities suggests that more comprehensive strategies will be required to
ensure equity in birth and neonatal outcome.
