Equity in maternity care under universal health coverage: prenatal care utilization and obstetric outcomes among migrant women in Korea, 2022

Prior studies have reported higher rates of pregnancy complications among racially and ethnically minoritized populations, highlighting structural inequities and social determinants of health. Migrant women may represent a socially vulnerable group with potential disparities in access to and utilization of maternity care. Although Korea operates a universal health coverage system that provides comprehensive maternity services to all pregnant women, including migrants, non-financial barriers may still influence care utilization and outcomes. This study evaluated prenatal care utilization and obstetric complications among migrant women in Korea. We conducted a nationwide, population-based cross-sectional study using National Health Insurance claims data in Korea. Migrant women were defined as foreign-national women registered in Korea’s resident registration system. Prenatal care utilization was assessed based on the number of prenatal visits, and obstetric complications were defined as the occurrence of any major pregnancy- or delivery-related complication. Prenatal care utilization and obstetric complications were compared between migrant women and Korean-born women, and adjusted odds ratios with 95% confidence intervals were estimated. Of 202,690 deliveries, 10,772 (5.3%) were to migrant women. Migrant women were younger than Korean-born women (mean age, 30.46 vs. 32.97 years; P < 0.001) and were more likely to receive Medical Aid and receive care at medical institutions located in city/rural areas. Migrant women had fewer prenatal care visits than Korean-born women (mean, 14.97 vs. 18.11 visits; P < 0.001). However, migrant women were not at increased risk of overall obstetric complications compared with Korean-born women (aOR, 0.91; 95% CI, 0.87–0.95), including gestational hypertension and obstructed labor. The association differed by maternal age, with lower odds observed among women younger than 35 years but not among those aged 35 years or older. In this nationwide cross-sectional study, migrant women had lower prenatal care utilization but did not have higher odds of any obstetric complication than Korean women. Associations varied by specific complications and maternal age groups. Despite universal health coverage, persistent disparities in prenatal care utilization highlight the need to identify and address barriers to equitable maternity care for migrant women.