Association of Maternal Language Spoken at Home with Prenatal Care and Delivery Outcomes among Asian and Pacific Islander Populations in Kansas

Abstract

Introduction. In the United States, limited English proficiency (LEP) and provider-patient language discordance are associated with poorer medical outcomes when compared to English-proficient and language-concordant patients. Asia American and Pacific Islanders (AAPI) have higher than average rates of LEP and therefore may be more vulnerable to these poorer outcomes. This study sought to identify differences in risk factors, medical care, and delivery outcomes between those giving birth who spoke English at home and those who spoke Asian or Pacific Islander languages at home in Kansas.

Methods. De-identified birth and death certificate data from January 1, 2005 to December 31, 2018 were provided by the Kansas Department of Health and Environment with a sample size of 17,067. Controlling for race, a comparison of risk factors, medical care, and delivery outcomes was made between speakers of AAPI languages and English-speakers using Likelihood Chi-square and Fisher’s exact test.

Results. Non-English-speakers tended to initiate prenatal care later (p<0.0001) and have less adequate prenatal care (p<0.0001). They also had increased incidence of forceps- and vacuum-assisted deliveries (p<0.0001) and were more likely to experience third- or fourth-degree perineal lacerations compared to English-speakers (p<0.0001). Neonatal outcomes between groups were largely similar.

Conclusion. Controlling for race, speakers of AAPI languages were more likely to experience poorer maternal delivery outcomes (including forceps- and vacuum-assisted delivery and third- or fourth-degree perineal laceration) compared to those who spoke English at home. This may be due to patient-provider language discordance limiting patient autonomy and/or affecting medical decision-making in urgent and emergent situations.