Prenatal care and pregnancy outcomes during the recession: the Washington State experience.

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Abstract
To determine whether changes in prenatal care utilization and adverse pregnancy outcomes occurred among poor residents of Washington State during the recent recession, we examined all births occurring from 1980 to 1983 to women in the poorest census tracts of the three major metropolitan counties in Washington State (N = 15,735). A comparison sample consisted of all births occurring in the highest income census tracts (N = 16,295). Because the impact of the recession was hypothesized to be greatest in 1982, rates in 1982 were compared with rates in 1980. The proportion of births receiving late or no prenatal care increased in both the low-income tracts (6.2 per cent to 8.2 per cent) and the high-income tracts (1.6 per cent to 2.3 per cent). The proportion of low birthweight infants increased only in the low-income tracts (6.3 per cent to 7.4 per cent). The prevalence of maternal anemia (hematocrit less than 30) also increased only in the low-income tracts (0.7 per cent to 1.7 per cent). While we were unable to ascertain the financial status of the individuals who suffered the adverse outcomes, the findings for the low-income census tracts are consistent with the hypothesis that an increase in adverse pregnancy outcomes occurred among the poor in Washington State during the recent recession.