Use of telehealth did not mitigate persistent disparities in prenatal care access among American Indian women in North Dakota

Background

In North Dakota (ND), American Indian (AI) women face a persistent disparity in prenatal care (PNC) access compared to other women. During the COVID pandemic, the expansion of telehealth emerged as a potential solution to disparate access to health care. We examined whether telehealth use mitigated disparities in PNC in ND.

Methods

Data were drawn from the 2020 to 2021 ND Pregnancy Risk Assessment Monitoring System (weighted n = 10,189). PNC initiation >13 weeks gestation or not receiving PNC was considered “late/no PNC.” Maternal race/ethnicity was self-reported. Use of telehealth for prenatal visits was self-reported and categorized as “any telehealth use” versus “no telehealth use.” Those not using telehealth self-reported eight barriers to telehealth (e.g., lacking internet, no appointments). Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs) for late/no PNC among AI and other race/ethnicity women compared to White women. Models included maternal sociodemographic and health factors. Chi-square was used to examine prevalence of telehealth barriers by race/ethnicity.

Results

Compared to White women, AI/AN women were twice as likely to receive late/no PNC (OR: 2.40; 95% CI, 1.08, 5.35). When telehealth was accounted for, the AI–White disparity was lowered by only 2% (OR: 2.35; 95% CI, 1.05, 5.26). Compared to White and other race/ethnicity women, a higher prevalence of AI/AN women reported a lack of telehealth appointments (p < 0.01), no computers (p < 0.01), no phones (p < 0.01), and no physical space (p < 0.01) as barriers to telehealth.

Discussion

The use of telehealth did not mitigate PNC disparities in ND. Infrastructure investments and culturally safe initiatives are needed to improve PNC access for AI/AN women.