Intersecting social inequalities in prenatal and postnatal care: Examining race, ethnicity, socioeconomic status, and geographic location.

Existing research document disparities in prenatal and postnatal care utilization. This research introduces a novel approach for examining maternal healthcare disparities by integrating multiple structural factors that inhibit care usage. Principally, we examine intersecting social inequalities to understand how race/ethnicity, socioeconomic status, and geographic location interactively shape obstetric care usage for individuals who give birth. Drawing data from the 2016-2021 Pregnancy Risk Assessment Monitoring System (PRAMS) (N = 177,480), the Gadson conceptual model, and intersectional approach, we examine the racial divide in the effects of documented education status and residence on obstetric care usage in the United States. We found a significantly lower likelihood of both prenatal and postnatal care utilization among marginalized racial/ethnic groups, including non-Latina Black, non-Latina 'Other', and Latinas, as compared to non-Latina White individuals. These groups also had lower utilization of adequate, adequate plus prenatal (more than recommended), and post-natal care (for only Latinas), even when highly educated (16 years of education and more). We further documented the rural-urban gaps in the effect of education where rural non-Latina Black individuals with more years of education (16 years and more), rural Latina and rural non-Latina other who are slightly educated (9-11 years of education) had a relatively lower likelihood of using adequate plus prenatal care, as compared to rural non-Latina White with similar education characteristics. We call for reforms in healthcare and other factors affecting health that prioritize inclusivity and equality, and reduce bias and perceptions of bias to improve maternal healthcare and outcomes among vulnerable groups.