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Women's Health

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Lack of insurance may not be the only barrier to timely prenatal care for low-income women

Doctors recommend at least one prenatal care visit during the first trimester of pregnancy. Expanded Medicaid eligibility for low-income pregnant women was initiated during the late 1980s/early 1990s to improve timely prenatal care, given that the lack of insurance is considered to be a key barrier to timely care.

A recent study of women covered by private insurance or California Medicaid suggests an important role for other barriers to care in addition to lack of insurance. It found that low-income women with unwanted or unplanned pregnancies, no regular provider before pregnancy, and less than a high school education were significantly less likely to have timely prenatal care than other low-income women with continuous prenatal insurance coverage, either private or California Medicaid (Medi-Cal).

Apparently, focusing on noninsurance barriers to care just during pregnancy may not be the best approach to improving timely prenatal care. Instead, broad social and health policies need to focus on low-income women before they become pregnant. These include reducing barriers to effective family planning, increasing the proportions of nonpregnant women who have a regular source of health care, and reducing the disadvantages associated with lack of education beyond high school, according to study leader Paula Braveman, M.D., M.P.H., and her colleagues at the University of California, San Francisco.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (HS07910), the researchers analyzed survey responses from 3,071 low-income women in California who had Medi-Cal or private insurance coverage throughout pregnancy. The women were interviewed after delivery during 1994-1995. After controlling for numerous sociodemographic and logistical obstacles that might deter seeking care, the following were significant risk factors for untimely care that were experienced by more than one-fifth of the women: unwanted or unplanned pregnancy (affecting 43 and 66 percent of women, respectively), no regular provider before pregnancy (22 percent), and no schooling beyond high school (76 percent). The only significant logistical barrier to timely prenatal care involved transportation problems, which affected 8 percent of the women.

See "Barriers to timely prenatal care among women with insurance: The importance of prepregnancy factors," by Dr. Braveman, Kristen Marchi, M.P.H., Susan Egerter, Ph.D., and others, in the June 2000 Obstetrics and Gynecology 95, pp. 874-880.

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