BLACK-WHITE DIFFERENCES IN PRENATAL-CARE UTILIZATION - AN ASSESSMENT OF PREDISPOSING AND ENABLING FACTORS

Objective. This article reports on analysis of the predisposing and en abling factors that affect black/white differences in utilization of p renatal care services. Data Sources. We use a secondary data source fr om a survey conducted by the Michigan Department of Public Health. Stu dy Design. The study uses multivariate analysis methods to examine bla ck/white differences in (1) total number of prenatal care visits, (2) timing of start of prenatal care, and (3) adequacy of care received. W e use the model advanced by Aday, Andersen, and Fleming (1980) to exam ine the effect of enabling and predisposing factors on black/white dif ferences in prenatal care utilization. Data Collection. A questionnair e was administered to all women who delivered in Michigan hospitals wi th an obstetrical unit. Principal Findings. Enabling factors fully acc ounted for black/white differences in timing of start of prenatal care ; however, the model could not fully account for black/white differenc es in the total number or the adequacy of prenatal care received. Conc lusion. Although there are no black/white differences in the initiatio n of prenatal care, black women are still less likely to receive adequ ate care as measured by the Kessner index, or to have as many total pr enatal care contacts as white women. It is possible that barriers with in the health care system that could not be assessed in this study may account for the differences we observed. Future research should consi der the characteristics of the health care system that may account for the unwillingness or inability of black women to continue to receive care once they initiate prenatal care.