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America's Health Centers: Reducing Racial and Ethnic Disparities in Perinatal Care and Birth Outcomes


  • Leiyu Shi,

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    • Address correspondence to Leiyu Shi, Dr.P.H., M.B.A., Associate Professor and Co-Director, Johns Hopkins Primary Care Policy Center, the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 406, Baltimore, MD 21205; Gregory D. Stevens, Ph.D. is at the UCLA Center for Healthier Children, Families, and Communities; John T. Wulu, Jr., Ph.D., M.Sc., M.A. and Robert M. Politzer, Sc.D., C.A.S. are at U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care; and Jiahong Xu, M.S., M.P.H. is at Johns Hopkins Bloomberg School of Public Health.

  • Gregory D. Stevens,

  • John T. Wulu Jr.,

  • Robert M. Politzer,

  • Jiahong Xu

  • This study was supported by the cooperative agreement grant (#5U30CS00189-07) from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care.


Objective. To examine whether community health centers (CHCs) reduce racial/ethnic disparities in perinatal care and birth outcomes, and to identify CHC characteristics associated with better outcomes.

Background. Despite great national wealth, the U.S. continues to rank poorly relative to other industrialized nations on infant mortality and other birth outcomes, and with wide inequities by race/ethnicity. Disparities in primary care (including perinatal care) may contribute to disparities in birth outcomes, which may be addressed by CHCs that provide safety-net medical services to vulnerable populations.

Methods. Data are from annual Uniform Data System reports submitted to the Bureau of Primary Health Care over six years (1996–2001) by about 700 CHCs each year.

Results. Across all years, about 60% of CHC mothers received first-trimester prenatal care and more than 70% received postpartum and newborn care. In 2001, Asian mothers were the most likely to receive both postpartum and newborn care (81.7% and 80.3%), followed by Hispanics (75.0% and 76.3%), blacks (70.8% and 69.9%), and whites (70.7% and 66.7%). In 2001, blacks had higher rates of low birth weight (LBW) babies (10.4%), but the disparity in rates for blacks and whites was smaller in CHCs (3.3 percentage points) compared to national disparities for low-socioeconomic status mothers (5.8 percentage points) and the total population (6.2 percentage points). In CHCs, greater perinatal care capacity was associated with higher rates of first-trimester prenatal care, which was associated with a lower LBW rate.

Conclusion. Racial/ethnic disparities in certain prenatal services and birth outcomes may be lower in CHCs compared to the general population, despite serving higher-risk groups. Within CHCs, increasing first-trimester prenatal care use through perinatal care capacity may lead to further improvement in birth outcomes for the underserved.