1. Access to Prenatal Care in Bexar County, Texas Jaseudia S. Killion, M.P.A. Public Health Associate Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention 2015 PHAP Class Summer Seminar July 16, 2016 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. PRENATAL CARE IN BEXAR COUNTY, TEXAS An Overview:

3. Background: Prenatal Care  Prenatal Care (PNC)  Importance to maternal and child health and birth outcomes  Lack of PNC is associated with-low birth weight, pre-term delivery, neonatal and infant mortality*  Early prenatal care access preferable  Healthy People 2020 Target *Source: Science and Babies: Private Decisions, Public Dilemmas accessed here: http://www.ncbi.nlm.nih.gov/books/NBK235274/

4. *2014 data are provisional and subject to change Source: 2005-2014 birth files provided by the Texas Department of State Health Services, Center for Health Statistics, Birth Certificates Year 2020 Objective: Increase the proportion of pregnant women who receive prenatal care in the first trimester of pregnancy to 77.9 % of live births Onset of Prenatal Care, Bexar County versus Texas, 2005-2014*

5. *2014 data are provisional and subject to change Source: 2005-2014 birth files provided by the Texas Department of State Health Services, Center for Health Statistics, Birth Certificates * Percent of Total Live Births with Any Prenatal Care (Yes, None, Unknown) Bexar County, 2009-2014*

6. PRENATAL CARE IN BEXAR COUNTY, TEXAS Methods and Results:

7. Methods  Access to Prenatal Care Survey  Internal Task Force at San Antonio Metropolitan Health District (SAMHD) developed survey  Implemented at SAMHD WIC clinics and Baby Café in both Spanish and English languages  Surveyed women of child bearing age  Participation was voluntary and anonymous  Self-reported  Timeframe Survey Conducted  One week period: February 23, 2016 to March 1, 2016  Analysis Conducted  Using Microsoft Excel®  By race and ethnicity, trimester entered prenatal care, term of delivery, and identified barriers

8. Results: Demographics of Survey Respondents  Age Range of all Respondents: 16 - 49 years (N=106)  Race and Ethnicity of Respondents: * Unknown refers to the participants who opted to not provide Race/Ethnicity

9. Result: Respondents Who Received PNC During Pregnancy

10. Results: Barriers to Accessing PNC  Among all women surveyed, 48% indicated barriers (N=106)  The most common barriers to accessing PNC (N=60)  Financial 28%  Lack of insurance 22%  Unknown pregnancy status 15%  Transportation 15%

11. Results: Reasons for NOT Accessing PNC  Among all women surveyed, 4% indicated no PNC during pregnancy (N=106)  Reasons for NO PNC  No money or health insurance  Could not get an appointment with provider  Did not know pregnancy status  Did not have insurance card  Were too busy  Were using drugs  Were from out of state

12. Result: Trimester PNC Accessed of Those Who Accessed PNC

13. Result: Term Baby Delivered of Those Who Accessed PNC Term not indicated **Currently pregnant

14. PRENATAL CARE IN BEXAR COUNTY, TEXAS Conclusion and Implications for Practice

15. Conclusions and Implications for Practice  Pregnant women experience barriers to accessing PNC regardless of PNC status  Collaboration between key stakeholders is needed to address barriers  Worthy of further study locally

16. Acknowledgments SAMHD Epidemiology Analysis  Cara Hausler*  Rita Espinoza*  John Berlanga SAMHD Healthy Start  Management Staff  Healthy Start Staff SAMHD WIC Clinic and Baby Café Staff SAMHD Executive Leadership  Dr. Anil Mangla  Jennifer Herriott*  Dr. Junda Woo* CDC/OSTLTS/PHAP  Linda Kirk  PHAP Training and Education Team  PHAP Leadership

17. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Thank You! Jaseudia S. Killion, lgv1@cdc.govlgv1@cdc.gov (210) 207-5370 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support