Timely postpartum care is critical for identifying and treating pregnancy-related conditions and complications and for reducing maternal morbidity and mortality. Attendance at postpartum visits can be particularly challenging for low-income individuals, who often face economic, social, and structural barriers to care. This study used the Andersen Behavioral Model of Health Services Use to examine factors associated with postpartum care visit non-attendance in a cohort of underserved women.
The analysis included 671 women who were enrolled during pregnancy in the South Carolina Midlands Healthy Start Program between 2019 and 2024. Midlands Healthy Start is a federally funded program aimed at improving perinatal outcomes through enhanced care coordination and case management for underserved pregnant and postpartum women. Participant characteristics reported in the source indicate a predominantly non-Hispanic Black sample (87.5%) and a largely low-income population, with 90.9% receiving Medicaid.
The Andersen Behavioral Model of Health Services Use guided the investigation of correlates of postpartum visit non-attendance. This model frames utilization of health services in terms of predisposing characteristics, enabling resources, and need factors, and supports multilevel assessment of individual, familial, and contextual determinants of health-care use.
Data were drawn from program enrollment and follow-up information for participants in the Midlands Healthy Start Program. The primary outcome was non-attendance at a postpartum care visit within 12 weeks of delivery. Key explanatory variables reported in the source and examined in multivariable models included race/ethnicity, educational attainment, partner involvement, and experiences of discrimination, the latter measured using the Everyday Discrimination Scale. Other demographic details included the high prevalence of Medicaid coverage in the sample.
The investigators used multiple logistic regression models to identify correlates of postpartum visit non-attendance. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported for associations between participant characteristics and the odds of not attending a postpartum visit within the 12-week postpartum window.
Overall, 27.0% of participants did not attend a postpartum care visit within 12 weeks of delivery.
Race/ethnicity: Compared with non-Hispanic White participants, non-Hispanic Black participants had lower odds of non-attendance (AOR: 0.48; 95% CI: 0.25, 0.94). Hispanic participants also had lower odds of non-attendance relative to non-Hispanic White participants (AOR: 0.12; 95% CI: 0.02, 0.66).
Education: Participants with a high school diploma/GED or less had higher odds of postpartum visit non-attendance (AOR: 1.83; 95% CI: 1.23, 2.71).
Partner involvement: Lack of partner involvement was associated with increased odds of non-attendance (AOR: 1.95; 95% CI: 1.14, 3.32).
Discrimination: Frequent experiences of discrimination, as measured by the Everyday Discrimination Scale, were associated with higher odds of non-attendance (AOR: 2.79; 95% CI: 1.22, 6.38).
These findings identify several independent correlates of failing to attend a postpartum visit among a low-income cohort.
The reported associations suggest that social and structural influences are important determinants of postpartum care engagement among underserved women. Education level, partner support, and lived experiences of discrimination were independently associated with non-attendance, indicating that interventions to improve postpartum visit uptake should address social context in addition to individual outreach.
The finding that non-Hispanic Black and Hispanic participants had lower odds of non-attendance compared with non-Hispanic White participants in this cohort may reflect sample composition, programmatic engagement patterns within the Midlands Healthy Start Program, or other contextual factors reported in the source. The high prevalence of Medicaid coverage in the cohort confirms the low-income status of most participants and highlights the role of safety-net programs in perinatal service delivery.
Clinicians, care coordinators, and program planners can consider strategies that enhance partner involvement, screen for and mitigate discrimination-related barriers, and tailor education or navigation services to women with lower formal education to improve postpartum visit attendance.
Strengths noted in the source include use of data from a federally funded perinatal support program focused on underserved women and application of the Andersen Behavioral Model to organize multilevel correlates of health service use. The dataset included demographic, social, and discrimination measures enabling adjusted analyses.
The abstract does not report detailed limitations such as potential selection bias, measurement limitations, or generalizability beyond the Midlands Healthy Start participant population; these specifics were not provided in the source summary and therefore are not described here.
In this cohort of 671 low-income women enrolled in the Midlands Healthy Start Program (2019–2024), 27.0% did not attend a postpartum care visit within 12 weeks of delivery. Key correlates of non-attendance included lower educational attainment, lack of partner involvement, and frequent experiences of discrimination, while non-Hispanic Black and Hispanic participants had lower odds of non-attendance compared with non-Hispanic White participants. The results underscore the need to address individual, familial, and contextual factors to improve postpartum care engagement among underserved populations.