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Timing of prenatal coverage affects initiation of prenatal care among low-income pregnant women

By 1994-1995, about 5 years after California's Medicaid Program, Medi-Cal, expanded maternity care coverage for low-income pregnant women, only 2 percent of such women were uninsured throughout their pregnancy. However, one-fifth actually lacked coverage during the critical first trimester, and this decreased their likelihood of obtaining timely prenatal care in the first trimester, according to a study supported in part by the Agency for Healthcare Research and Quality (HS07910).

Rates of untimely prenatal care (begun after the first trimester) were highest (64 percent or more) among women who were uninsured throughout their pregnancy or whose coverage began after the first trimester. Rates of untimely care were lowest (about 10 percent) among women who obtained coverage during the first trimester. Previously uninsured women who obtained either Med-Cal or private coverage after their first trimester were much more likely than women with continuous coverage to receive untimely care, even after accounting for a wide range of maternal characteristics.

These findings illustrate the importance of knowing the timing of prenatal care coverage when making inferences about lack of coverage as a barrier to prenatal care, suggest Susan Egerter, Ph.D., Paula Braveman, M.D., M.P.H., and colleagues at the University of California, San Francisco. They examined the relationship between timing of insurance coverage and prenatal care among 5,455 low-income women who participated in a larger Statewide survey of postpartum women in California during 1994-1995.

Overall, 45 percent of women studied were uninsured just before pregnancy, and 21 percent remained uninsured throughout their first trimester. The percentages of low-income women without coverage decreased to 6 percent and 2 percent during the second and third trimesters, respectively.

See "Timing of insurance coverage and use of prenatal care among low-income women," by Susan Egerter, Ph.D., Dr. Braveman, and Kristen Marchi, M.P.H., in the March 2002 American Journal of Public Health 92(3), pp. 423-427.

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