Social determinants of late initiation of prenatal care in Taiwan: A nationwide study

Abstract Objective: Late initiation of prenatal care (LIPC; i.e., initiation of the first prenatal visit after the first trimester) is a major public health concern for pregnant mothers and fetuses. This study examined the social determinants of LIPC in Taiwan, where universal health coverage has been provided since 1995. Methods: The study population comprised 185,855 babies born in 2017 to mothers who were Taiwanese nationals. Data from several databases, namely the Birth Registration Database, Birth Certificate Application Database, Low- and Middle-Low-Income Households Database, Persons with Disabilities Database, and National Health Insurance Research Database, were retrieved to link data on social determinants to medical claims. The gradient effect of each investigated social determinant was assessed using the Cochran–Armitage trend test in SAS 9.4. Results: The overall incidence rate of LIPC in Taiwan was 8.6% in 2017. Notably, the disparities in the initiation of prenatal care were closely associated with social disadvantages. In particular, extraordinarily high LIPC rates were identified among teenagers (40.0%), mothers with drug addiction problems (31.9%), unmarried mothers (27.6%), mothers from low income (23.0%), mothers with a high school or lower level of education (23.0%), migrants (19.2%), and mothers with disabilities (18.9%). Several social determinants had significant adverse gradient effects on LIPC, namely employment (P < .0001), education (P < .0001), socioeconomic status (P < .0001), and urbanization (P < .0001). Logistic regression revealed higher odds of LIPC among the mothers in the poorest 20% (adjusted odds ratio [aOR], 1.52; 95% confidence interval [CI], 1.43–1.61), those with a parity of >3 (aOR, 1.99; 95% CI, 1.89–2.09), unmarried mothers (aOR, 2.88; 95% CI, 2.73–3.04), mothers with drug addiction problems (aOR, 5.24; 95% CI, 4.78–5.75), mothers aged <19 years (aOR, 5.30; 95% CI, 4.84–5.81) or 20–24 years (aOR, 1.77; 95% CI, 1.67–1.89), and mothers with disabilities (aOR, 1.64; 95% CI, 1.41–1.92). Conclusions: The findings of this study highlight the social inequalities in the initiation of prenatal care in Taiwan, indicating that the maternal and child health-care system in Taiwan should be further improved.