RACIAL DISPARITIES IN OUTCOMES OF MILITARY AND CIVILIAN BIRTHS IN CALIFORNIA

Objective: To examine racial disparities in prenatal care utilization, birth weight, and fetal and neonatal mortality in a population for wh om financial barriers to health care services are minimal. Study Desig n: Using linked birth, fetal death, and infant death certificate files , we examined prenatal care utilization, birth weight distribution, an d fetal and neonatal mortality rates for all white and black births oc curring in military hospitals in California from January 1, 1981, to D ecember 31, 1985. These patterns were compared with the experience of their civilian counterparts during the same time period. Results: Blac k mothers had higher percentages of births occurring in teenaged and u nmarried mothers than did white mothers in military and civilian popul ations. 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 blac ks were elevated in the military and civilian groups. However, the rac ial disparity in low birth weight was significantly smaller in the mil itary group (P<.01 and P<.001, respectively). Conclusions: In populati ons with decreased financial barriers to health care, racial dispariti es in prenatal care use and low birth weight were reduced. However, th e persistence of significant disparities suggests that more comprehens ive strategies will be required to ensure equity in birth and neonatal outcome.