Prenatal care initiation among very low-income women in the aftermath of welfare reform: does pre-pregnancy Medicaid coverage make a difference?
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Objectives: To examine pre-pregnancy Medicaid coverage and initiation of prenatal care among women likely eligible for Medicaid coverage regardless of pregnancy. Methods: The Pregnancy Risk Assessment Monitoring System (PRAMS) was used to identify very low-income women with Medicaid payment for delivery. We then compared prenatal care initiation among women with (Non-GAP) and without (Medicaid GAP) pre-pregnancy Medicaid coverage. Results: Rates of first trimester prenatal care were 47.3% for women in the Medicaid GAP, 70.0% for women who were not. The adjusted odds ratio for being in the Medicaid GAP and delayed prenatal care was 2.7 (95% CI 1.2, 6.2), although this varied by race/ethnicity and education. The relationship was strongest among White and Hispanic women with less than a high school education: OR=13.8, (95% CI 3.0, 62.7) and OR=19.0 (95% CI 2.4, 149.2), respectively. Conclusions: Pre-pregnancy Medicaid coverage appears to be associated with early initiation of prenatal care. Almost a decade after welfare reform, it is essential to preserve the Medicaid expansions for pregnant women, foster Medicaid family planning waivers, and promote access to primary care and early prenatal care, particularly for very low-income women.
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- Prenatal care initiation among very low-income women in the aftermath of welfare reform: does pre-pregnancy Medicaid coverage make a difference?
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Volume 11, Issue 1 , pp 11-17
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- 1. Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor, Chicago, Illinois, 60612,, USA
- 2. Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor, Chicago, Illinois, 60612,, USA
- 3. Center for the Advancement of Distance Education, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor, Chicago, Illinois, 60612,, USA
- 4. Institut National de la Sante et de la Recherche Medicale (INSERM), Unite 149, 123 boulevard de Port Royal, Paris, 75014,, France
- 5. Emory School of Public Health, 1518 Clifton Road, N.E., Atlanta, Georgia, 30322, USA