Cohort Analysis of Immigrant Rhetoric on Timely and Regular Access of Prenatal Care

Abstract

Objective. To assess whether recent anti-immigration rhetoric is significantly associated with inadequate prenatal care. Methods. This was a population-based cohort study (2011–2017). In their native language, patients were consented and queried regarding country of origin and time in the United States. Additional variables were collected or abstracted from the medical record, including documentation and timing of prenatal visits. Based on relevance and prevalence during the study period, publicly available Google search trends were mined for the terms “Make America Great Again,” “Mexico Wall,” and “Deportation” by geographic region. The time of first deviation from the mode Google search popularity value for each term was ascertained (mode inflection date). Perinatal data was averaged over 15 day moving windows, and the Adequacy of Prenatal Care Utilization Index (APNCU) was used to categorically define inadequate prenatal care by validated standards. Results. Twenty-four thousand nine hundred thirty-three deliveries occurred during the study period. A mode inflection date was extrapolated from Google trend analytics and used to define the period prior to change in trends use pre (before rhetoric) and post (after rhetoric). Coincident to the rhetoric change, there was a significant increase in days until first prenatal visit, fewer prenatal visits and a decreased trend of mean hemoglobin nadir among U.S. non-native Hispanics (p<0.001). Immigrant status was an independent predictor of inadequate prenatal care as defined by the APNCU standard with increased adjusted odds among Hispanics (aOR 1.581, 95% CI 1.407–1.7771.4–1.8) coincident with anti-immigration rhetoric. Conclusion. Our findings are of likely significant public health importance, and suggest that recent anti-immigrant rhetoric is associated with adequate, timely, and regular access to prenatal care among nearly 25,000 deliveries in Houston, Texas.

Do recent immigrants have similar obstetrical care and perinatal complications as long-term residents? A retrospective exploratory cohort study in Brussels

“…The medical care of RIs often begins later during pregnancy and is sometimes of lower quality than that of LTRs 4–6 21 23 24. We found this to be even more the case for a subgroup of pregnant women who had been immigrants for less than a year (results in the online supplementary material).…”

“…This is essentially the consequence of world conflicts and economical concerns 2. It has been reported that immigrants often encounter linguistic, social, political and economic barriers, resulting in reduced access to health systems, and increased morbidity 3–5. Some studies reported a higher prevalence of obstetrical and perinatal complications in immigrant women when compared with native residents 6 7.…”

“…Some studies reported a higher prevalence of obstetrical and perinatal complications in immigrant women when compared with native residents 6 7. Additionally, the refugee population is likely more vulnerable 5 8 9. Few studies have, however, taken into consideration the time of arrival and it is possible that the first years on arrival are associated with even greater fragility.…”

How do demographic variables affect pregnant women’s perceptions of obstetrics forceps: a cross sectional study

“…19 These examples of problematic communication likely contribute to distrust of medical professionals or the health care system by these ethnicity groups. 16,20 Our analysis of educational background suggested that only the least educated group, those without a high school diploma, were especially skeptical of forceps. This is likely due to lower health literacy.…”

The Case for Research-Informed Immigrant Health Policies Within Health Care Systems

“…Regardless of political ideology or one's opinion about ideal immigration policies, there is increasing data indicating that immigration status is associated with health and should be considered a factor in achieving the goal of optimal health for patients and communities. 1 For example, sentiments critical of undocumented immigration and fear of deportation have been associated with changes in health-seeking behaviors 2 and adverse physiological effects. 3 Given this context, health care practitioners and health systems have the opportunity to identify, address, and mitigate the negative consequences that immigration policy and sentiments critical of undocumented immigration may have on the health and well-being of immigrants.…”