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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

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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.

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Personal Responsibility and Work Opportunity Act


National Center for Health Statistics




State Children’s Health Insurance Program


Adequacy of Prenatal Care Utilization


Adequacy of Received Services


National Association for Public Health Statistics Information Systems


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Correspondence to Jonathan Drewry.

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E. Michael Foster: deceased.

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Drewry, J., Sen, B., Wingate, M. et al. 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. Matern Child Health J 19, 1464–1471 (2015).

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