Laura-Mae Baldwin ^1*, David C. Grossman ², Elise Murowchick ¹, Eric H. Larson ¹, Walter B. Hollow ¹, Jonathan R. Sugarman ³, William L. Freeman ⁴, L. Gary Hart ⁵

¹ University of Washington
² Group Health Cooperative
³ Qualis Health
⁴ Northwest Indian College
⁵ University of Arizona

^* To whom correspondence should be addressed. E-mail: lmb{at}u.washington.edu.

	Abstract

Objectives. We examined disparities in perinatal care, birth outcomes, and infant health between rural American Indian and Alaska Native (AIAN) persons and rural Whites over time.

Methods. We compared perinatal and infant health measures for 217064 rural AIAN births and 5032533 rural non-Hispanic White births.

Results. Among American Indians and Alaska Natives, unadjusted rates of inadequate prenatal care (1985–1987, 36.3%; 1995–1997, 26.3%) and postneonatal death (1985–1987, 7.1 per 1000; 1995–1997, 4.8 per 1000) improved significantly. However, disparities between American Indians and Alaska Natives and Whites in adjusted odds ratios (AORs) of postneonatal death (1985–1987, AOR=1.55; 95% confidence interval [CI]=1.41, 1.71; 1995–1997, AOR=1.46; 95% CI=1.31, 1.64) and adjusted risk ratios (ARRs) of inadequate prenatal care (1985–1987, ARR=1.67; 95% CI=1.65, 1.69; 1995–1997, ARR=1.84; 95% CI=1.81, 1.87) persisted.

Conclusions. Despite significant decreases in inadequate prenatal care and postneonatal death among American Indians and Alaska Natives, additional measures are needed to close persistent health gaps for this group.

Key Words: Maternal and Infant Health, Birth Outcomes, Pregnancy, Native Americans, Race/Ethnicity, Rural Health