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Wanda D. Barfield, MD, MPH; Paul H. Wise, MD, MPH; Frank P. Rust, PhD; Kam J. Rust, PhD; Jeffrey B. Gould, MD, MPH; Steven L. Gortmaker, PhD

Arch Pediatr Adolesc Med. 1996;150(10):1062-1067.

Abstract
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.

Arch Pediatr Adolesc Med. 1996;150:1062-1067

Author Affiliations
From the Department of Pediatrics, Joint Program in Neonatology, Harvard Medical School, Boston, Mass (Drs Barfield and Wise); (Dr Wise); the Statewide Nursing Program, California State University, Dominguez Hills (Dr F. P. Rust); Santa Barbara College of Law, Santa Barbara, Calif (Dr K. J. Rust); the Program in Maternal and Child Health, School of Public Health, University of California, Berkeley (Dr Gould); and the Department of Health and Social Behavior, Harvard School of Public Health, Boston, Mass (Dr Gortmaker). Dr Barfield is now with the Department of Pediatrics, Madigan Army Medical Center, Tacoma, Wash, and Dr Wise is now with the Department of Pediatrics, Boston Medical Center.

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