Pregnant Black Coloradans have among lowest rates of prenatal care visits, highest rates of preterm births


Eli Kirshbaum


Pregnant Black Coloradans covered by Medicaid have among the lowest rates of prenatal care visits in the state, according to the Colorado Department of Health Care Policy and Financing (HCPF)’s September maternity report.

These low prenatal care rates, the report indicates, are contributors to the demographic’s leading rate of preterm births.


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The report used Medicaid claims data and birth certificates from 2019 to reveal areas where maternal health care can be improved in the state.

Non-Hispanic Black Coloradans had a 73% prenatal care visit rate, the second lowest next to Non-Hispanic American Indian/Alaska Native Coloradans at 72.1%.


Image: HCPF


The report calls prenatal care “one of the most important determinants of birth outcomes.” A lack of prenatal care has been shown to increase the risk of infant mortality. Studies have shown that pregnant individuals who don’t receive prenatal care are more likely to have children with below-average birth weights. According to a study out of the Guttmacher Institute, timely prenatal care visits are associated with lower rates of unintended pregnancy.

Lower rates of prenatal care have also been linked to higher rates of premature births. Non-Hispanic Black Coloradans enrolled in Medicaid had a 12.2% preterm birth rate — delivery prior to 37 weeks of gestation — in 2019, according to the report. By comparison, Non-Hispanic white Coloradans had a 9.9% preterm birth rate. 10.4% of births among all Medicaid-covered Coloradans were preterm, which is nearly 1% higher than the state average.


Image: HCPF


Almost 50% of all childhood neurodevelopmental disorders in Colorado are the result of preterm births, according to a report from the Colorado Department of Public Health and the Environment (CDPHE). CDPHE found that 38% of infant mortality in the state is attributable to preterm births. The department also estimates that high preterm birth rates among racial or ethnic minorities in the US are largely a result of chronic stress associated with being members of these minority populations.

This year, the Colorado Legislature passed SB 21-194, which requires carriers to reimburse providers who provide labor or delivery services that promote high quality care, are cost-effective, and prevent risk in subsequent pregnancies. The report says this legislation can help increase Colorado’s rate of prenatal care visits. The bill’s sponsor, Sen. Janet Buckner (D – Aurora), has said it will help address racial equity in maternal health outcomes.

HCPF pointed to several programs that are working to address these disparities. The federal Special Supplemental Assistance Program for Women, Infants, and Children (WIC) provides food, health care referrals, and nutrition education to pregnant Colorado Medicaid members and their children up to age five. According to the Center on Budget and Policy Priorities, WIC has reduced low birth weight rates in the US by approximately 30%.

According to the report, only 55.5% of all pregnant Colorado Medicaid members are enrolled in WIC at the time of delivery. This, HCPF says, presents a unique opportunity for targeted strategies to enroll more eligible pregnant Coloradans. Even though pregnant Black Coloradans have the second highest rate of WIC enrollment at 62.4%, this could still be an opportunity to improve maternal health outcomes for the demographic.

Another program is the Nurse-Family Partnership, where nurses visit pregnant individuals in their homes on a regular basis, providing support and resources throughout their pregnancy. Medicaid-covered individuals are eligible for this program during pregnancy and until their child is two years old. The report says this program is helping reduce low birth weights and increase interbirth intervals.

The Prenatal Plus program has also improved maternal and child health outcomes and could help reduce racial disparities. Eligible Medicaid-covered pregnant Coloradans receive prenatal care from a team of providers consisting of a mental health professional, a dietician, and a specialized care coordinator.