Prenatal Care For Low-income Women Research Articles

Prepregnancy Insurance and Timely Prenatal Care for Medicaid Births: Before and After the Affordable Care Act in Ohio.

Background/Objective: Persistent instability in insurance coverage before and after pregnancy among low-income mothers in the United States contributes to delayed prenatal care and poor infant outcomes. States that expand Medicaid under the Affordable Care Act (ACA) make public insurance free for many low-income women regardless of parental or pregnancy status. Our objective is to analyze the effects of expanding Medicaid in Ohio on enrollment of pregnant women and receipt of recommended prenatal care. A key objective in the state is to address infant mortality as Ohio ranks above the national average and racial disparities persist. Materials and Methods: We used linked enrollment/claims/birth certificate data for women with Medicaid-paid deliveries/births, aged 19-44 years with months of last menstrual period (LMP) in calendar year 2011-2015 (N = 290,091). We used interrupted time-series analysis of enrollment prepregnancy and receipt of guideline-concordant screenings (anemia, asymptomatic bacteriuria, chlamydia, human immunodeficiency virus [HIV], and TORCH) and prenatal vitamins after versus before the expansion. We stratified by parity since first-time mothers would be impacted more. Results: We found almost a 12 percentage point increase in enrollment prepregnancy among first-time mothers compared with almost a 6 percentage point increase for parous women. We found significant increases in all screens and vitamins for both groups. TORCH screening increased 8 percentage points and receipt of prenatal vitamins almost 14 percentage points, by the end of 2015 for first-time mothers, compared with 5 and 4 percentage points, respectively, for parous women. Conclusions: Early enrollment and prenatal care for low-income women in Ohio could erode if the state's Medicaid expansion is altered.

The impact of the State Children's Health Insurance Program's unborn child ruling expansions on foreign-born Latina prenatal care and birth outcomes, 2000-2007.

The 2002 "unborn child ruling" resulted in State Children's Health Insurance Program (SCHIP) expansion for states to cover prenatal care for low-income women without health insurance. Foreign-born Latinas who do not qualify for Medicaid coverage theoretically should have benefited most from the policy ruling given their documented low rates of prenatal care utilization. This study compares prenatal care utilization and subsequent birth outcomes among foreign-born Latinas in six states that used the unborn child ruling to expand coverage to those in ten states that did not implement the expansion. This policy analysis examines cross-sectional pooled US natality data from the pre-enactment years (2000-2003) versus post-enactment years (2004-2007) to estimate the effect of the UCR on prenatal care utilization and birth outcome measures for foreign-born Latinas. Then using a difference-in-difference estimator, we assessed these differences across time for states that did or did not enact the unborn child ruling. Analyses were then replicated on a high-risk subset of the population (single foreign-born Latinas with lower levels of education). The SCHIP unborn child ruling policy expansion increased PNCU over time in the six enacting states. Foreign-born Latinas in expansion enacting states experienced increases in prenatal care utilization though only the high-risk subset were statistically significant. Birth outcomes did not change. The SCHIP unborn child ruling policy was associated with enhanced PNC for a subset of high-risk foreign-born Latinas.

Prenatal Care for Low-Income Women Enrolled in a Managed-Care Organization

Prenatal Care for Low-Income Women Enrolled in a Managed-Care Organization

Prenatal care for low-income women enrolled in a managed-care organization

Objective: To determine barriers to prenatal care among managed-care enrollees who receive Medicaid. Methods: In-person interviews were conducted with women 13–45 years old who were members of the Prudential HealthCare Community Plan in Memphis, Tennessee. Interview data were linked to medical chart reviews for 200 women who were currently pregnant or had delivered a baby since enrollment in Prudential. Factors related to untimely entry to prenatal care and inadequate prenatal visits were examined. Results: More than half of the respondents had either untimely entry to or inadequate prenatal care. Overall, 89% of respondents had favorable attitudes about prenatal care. Several system and personal factors were associated with receipt of early or adequate prenatal care. Multivariate analysis showed that one system and two personal factors remained significantly related to entry to prenatal care. Women who entered Prudential during pregnancy were 2.4 times more likely (95% CI 1.1, 5.0) to receive late care than women who enrolled before pregnancy. Women who felt too tired to go for care were 2.2 times more likely (95% CI 1.0, 4.9) to receive late care. Women who experienced physical violence during pregnancy were 3.5 times more likely (95% CI 1.0, 12.0) to receive late care. Multivariate analysis with adequacy of prenatal care as the outcome showed several personal factors that increased odds of receiving inadequate prenatal care; however, only help from the infant’s father was significantly related to adequacy of prenatal care. Women who did not have much help from the infant’s father were 1.9 times more likely not to have adequate care (95% CI 1.0, 3.6). Conclusion: Even when affordable care was available, many low-income women did not avail themselves of it. Although women knew the importance of prenatal care, there was a gap between attitudes and actually seeking appropriate care. System and personal factors need to be addressed to overcome barriers to prenatal care.

Prenatal Care for Low-Income Women and the Health Belief Model: A New Beginning

Low-income women are among those at risk for delivering low-birth-weight babies (Lia Hoagberg et al., 1990; Miller, Magolis, Schwethelm, & Smith, 1989; St. Clair, Smeriglio, Alexander, Connell, & Niebyl, 1990). These women tend to use prenatal care less often, perceive more barriers to care, have less positive reinforcement for receiving care, have less access to care, have lower education levels, maintain less healthy lifestyles, and have lower compliance with recommendations (Henderson, 1994; Koska, 1990; Lia-Hoagberg et al., 1990; Miller et al., 1989). This article will highlight three attributes of the problem of low-income women and prenatal care. First, low-income pregnant women are at risk for delivering low-birth-weight and preterm babies, which usually leads to expensive subsequent care. Second, an unhealthy maternal lifestyle increases the risk of delivering a low-birthweight or preterm baby. Third, there are social, programming, and lifestyle barriers that low-income women face in receiving prenatal care. Finally, this article examines the use of the Health Belief Model as a theoretical basis for future prenatal care programming for low-income women.

Local Responses to Expanded Medicaid Coverage for Pregnant Women

Concern about high infant mortality and morbidity in the United States, combined with the erosion of private insurance coverage, sparked major expansions in the Medicaid program in the 1980s. This study examines how the Medicaid expansions for pregnant women affected access to prenatal care for low-income women through case studies conducted in four states early in 1991. Despite the significantly greater share of births covered by Medicaid in the period 1986 to 1991, the timely initiation of prenatal care improved in only one state. Although prenatal services increased in some areas, significant problems persisted in others. The growth in capacity of the prenatal care system was greatest when state and local policies designed to increase supply were also instituted. While the Medicaid expansions eliminated significant barriers to prenatal care for low-income women, other policies that have been designed to reduce the remaining barriers may be necessary in order significantly to expand access to prenatal care and to improve birth outcomes.

Influencing Community Leaders toward the Promotion of Prenatal Care at the Community Level

The threefold goal of this quasi-experimental study was to have an impact on knowledge, beliefs and intentions of community leaders related to promoting prenatal care for low-income women. Using a twenty-one community leaders from a selected urban community in Wisconsin participated in an educational intervention that used a pre- and post-test design. The primary goal of the intervention (based on change theory) was to increase community leaders' motivation and decrease their resistance to promoting prenatal care for low-income women in their communities. Various media were used to illustrate and emphasize important prenatal concepts. Community leaders were also given information on the status of maternal and infant statistics and health practices in their communities. This intervention significantly increased community leaders' general knowledge related to prenatal issues; positive beliefs toward the promotion of prenatal care; and intent to engage in activities to promote prenatal care for low-income women. This study reveals that community health nurses can function effectively as agents of change with community leaders.

Promoting Prenatal Care: What Do Community Leaders Know and Believe About It? (Community Leader Beliefs About Promotion)

Community leaders directly affect prenatal services in their local communities. Twenty-nine leaders in an urban community and 47 in a rural community in Wisconsin were interviewed to determine their knowledge and beliefs about and intent to promote prenatal care for low-income women in their communities. The findings showed that leaders generally assigned high importance to prenatal care for low-income women and intended to promote it during the next six months; and they demonstrated good general knowledge about prenatal care and perceived broad-based community support for their decision to promote it. Disturbingly, many community leaders did not know what percentage of local pregnant women entered prenatal care late or how many medical care providers were available to their constituents on Medicaid, cost was cited as a disadvantage to promoting prenatal care for low-income women, and several leaders in both communities believed that promoting prenatal care would result in low-income women wanting to have more babies or increasing their dependence on free programs. Public health nurses can use the findings of this study in their work with community leaders to ensure prenatal services for low-income populations.

Health Status and nming of Onset of Prenatal Care: Is There an Association Among Low‐Income Women?

We examined medical obstetric conditions predating pregnancy and current symptoms as predictors of the timing of the start of prenatal care among low-income women in Snohomish County, Washington. The investigation was a cross-sectional survey with retrospective record review. Subjects were 473 women who sought care through the community health center network, which was the only provider of prenatal care for low-income women in the county at the time of the study. Women with a history of two or more medical or obstetric conditions were more likely than those without such histories to seek prenatal care early in pregnancy. Women who, in the current pregnancy, had few physical symptoms were more likely to delay seeking prenatal care than symptomatic women. Among this relatively homogeneous group, sociodemographic characteristics were not associated with the timing of entry into prenatal care. The findings help to explain the patterns of prenatal care use of certain groups, and suggest avenues for intervention to improve use among low-income women.

Prenatal Care among Low-Income Women

Forty low-income pregnant women were interviewed about the personal, family, and provider rewards and costs they experienced in obtaining prenatal care. The women identified important rewards as the health of their babies, their own health, partner's desire for a healthy baby, monitoring of the pregnancy by qualified healthcare personnel, and the evaluation of problems by health-care providers. The authors suggest strategies to strengthen personal, family, and provider rewards aimed at achieving a high level of prenatal care for low-income women.

Randomized Trial of Comprehensive Prenatal Care for Low-Income Women

MCLAUGHLIN, J. JOSEPH; ALTEMEIER, WILLIAM A.; CHRISTENSEN, MYRA J.; SHERROD, KATHRYN B.; DIETRICH, MARY S.; STERN, DAVID T. Author Information

Randomized Trial of Comprehensive Prenatal Care for Low-Income Women: Effect on Infant Birth Weight

The effect of comprehensive prenatal care on birth weight was examined using a prospective randomized design. A total of 428 pregnant women were randomly assigned to comprehensive prenatal care (n = 217) or standard prenatal care (n = 211). Comprehensive care was provided by a multidisciplinary team of nurse-midwives, social workers, a nutritionist, paraprofessional home visitors, and a psychologist. Standard prenatal care consisted of medical care provided by obstetric residents. Multiple regression analysis using behavioral, demographic, and medical variables showed a strong relationship between the set of predictors and birth weight. Comprehensive care was related to higher birth weights for primiparous but not multiparous mothers. Separate analyses of variance for primiparas and multiparas similarly showed a favorable effect of comprehensive care on birth weight for primiparous but not multiparous mothers.

Barriers and motivators to prenatal care among low-income women

Substantial evidence exists which links prenatal care to improved birth outcomes. However, low-income and nonwhite women in the United States, who are at greatest risk for poor birth outcomes, continue to receive the poorest prenatal care. The purpose of this study was to identify and compare barriers and motivators to prenatal care among women who lived in low-income census tracts. The stratified sample included recently delivered white, black and American Indian women who received adequate, intermediate, and inadequate prenatal care. Interviews were conducted which focused primarily on the women's perceptions of problems in obtaining prenatal care and getting to appointments. Results indicated that women with inadequate care identified a greater number of barriers and perceived them as more severe. Psychosocial, structural, and socio-demographic factors were the major barriers, while the mother's beliefs and support from others were important motivators. The predictive power of selected barrier variables was examined by a regression analysis. These variables accounted for 50% of the variance in prenatal care use. The results affirm the complexity of prenatal care participation behavior among low-income women and the dominant influence of psychosocial factors. Comprehensive, coordinated and multidisciplinary outreach and services which address psychosocial and structural barriers are needed to improve prenatal care for low-income women.