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First trimester prenatal care

Citywide, eight in 10 pregnant Lincoln women seek prenatal care during the pivotal first three months of their pregnancy, a new Community Health Endowment report has found.  

An improving economy, targeted programming and recent state health care coverage changes led more expecting mothers to seek care in their first trimester, Community Health Endowment of Lincoln President and CEO Lori Seibel said.

"If there is exposure to drugs, or to alcohol, or poor nutrition or other stressors during that time, it can set the course for long-term health for that entire individual's life," Seibel said.

In analyzing 70 city census tracts from 2013-2017, local health researchers found the number of tracts where fewer than 70% of women received first trimester care dropped from 15 to four.

Seibel called the improvements great news for Lincoln and a testament to the value of the continued Place Matters mapping project.

The endowment began Place Matters in 2015 and unveiled the third and most recent report Tuesday. 

"Place Matters 3.0 shows us that policy changes can make a difference — rates of first trimester prenatal care improved when changes in state policy provided more pregnant women with access to care," the report said.

A 2013 state survey of pregnant women in Nebraska found about 1 in 4 didn't receive prenatal care. And about half of Nebraska women who received no prenatal care or received it late in their pregnancy said cost was a barrier. 

Beginning in 2012, state law and changes to Nebraska's Medicaid policies expanded prenatal care coverage available to low-income women.

"(Now) any woman who shows up to the doctor's office is treated as if she has health insurance because we know that if she doesn't have private insurance she will qualify for Medicaid," Dr. Bob Rauner of OneHealth Nebraska said. 

And as the economy in Lincoln improved, more people got health insurance coverage, which gives people more confidence they can pay for a doctor's visit, Rauner said.

The Affordable Care Act, otherwise known as Obamacare, helped an additional 4,000 Lincoln residents gain health care coverage, the report said.

And while these maps gave reason to celebrate progress, other Place Matters maps showing more concentrated poverty and higher numbers of people without health insurance are signs more work is needed, Seibel said. 

In 12 of the 70 census tracts analyzed, at least 30% of residents lived in poverty.

And for the first time since Place Matters research began, analysts found a tract west of the University of Nebraska-Lincoln where more than 50% of residents were living in poverty. 

Analysts defined poverty as an annual income of $25,000 or less for a family of four. 

Maps showed the highest poverty concentrated in and around downtown and UNL.

Seibel called poverty the "causes of causes," and maps showed more negative health outcomes in areas with higher poverty.

For example, researchers found that areas with more concentrated poverty also had higher youth fitness testing failure rates.

Mayor Leirion Gaylor Baird pointed to the disparate life expectancies seen within a 5-mile drive.

In the areas near downtown Lincoln, the average person lived to age 69, while the average resident on the southeast edge of town lived to 89, the latest Place Matters report found.

Gaylor Baird said the report will provide an important resource for her administration as her staff looks to improve equity in her One Lincoln initiative.

"As we provide services to the community, we will continue to ask 'Who is benefiting the most, and who may be left behind?'" the mayor said.

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Reach the writer at 402-473-2657 or rjohnson@journalstar.com.

On Twitter @LJSRileyJohnson.

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