Maternal and Child Health Journal

, Volume 4, Issue 4, pp 251–259 | Cite as

Risk Factors for Late or No Prenatal Care Following Medicaid Expansions in California

  • Melissa Nothnagle
  • Kristen Marchi
  • Susan Egerter
  • Paula Braveman


Objectives: To describe the characteristics and risk factors of women with only third-trimester (late) or no prenatal care. Methods: A statewide postpartum survey was conducted that included 6364 low-income women delivering in California hospitals in 1994 and 1995. Results: The following factors appeared most important, considering both prevalence and association with late or no care: poverty, being uninsured, multiparity, being unmarried, and unplanned pregnancy. Forty-two percent of women with no care were uninsured, and uninsured women were at dramatically increased risk of no care. Over 40% of uninsured women with no care had applied for Medi-Cal prenatally but did not receive it. Risks did not vary by ethnicity except that African American women were at lower risk of late care than women of European background. Child care problems were not significantly associated with either late or no care, and transportation problems (not asked of women with no care) were not significantly related to late care. Conclusions: Lack of insurance appeared to be a significant barrier for the 40% of women with no care who unsuccessfully applied for Medi-Cal prenatally, indicating a need to address barriers to Medi-Cal enrollment. However, lack of financial access is unlikely to completely explain the dramatic risks associated with being uninsured. In addition to eliminating barriers to prenatal coverage, policies to reduce late/no care should focus on pre-pregnancy factors (e.g., planned pregnancy and poverty reduction) rather than on logistical barriers during pregnancy.

Third-trimester prenatal care late or no prenatal care access Medicaid Medi-Cal 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Greenberg RS. The impact of prenatal care in different social groups. Am J Obstet Gynecol 1983;145:797–801.Google Scholar
  2. 2.
    US Congress, Office of Technology Assessment. Healthy children: Investing in the future. OTA-H-345.Washington, DC: US Government Printing Office, 1988.Google Scholar
  3. 3.
    Institute of Medicine. Prenatal care: Reaching mothers, reaching infants. Washington, DC: National Academy Press, 1988.Google Scholar
  4. 4.
    Murray JL, Bernfield M. The differential effect of prenatal care on the incidence of low birthweight among blacks and whites in a prepaid health plan. N Engl J Med 1988;319:1385–91.Google Scholar
  5. 5.
    Ventura SJ, Martin JA, Curtin SC, Mathews TJ, Park MM. Births: Final data for 1998. National Vital Statistics Reports. Hyattsville, MD: National Center for Health Statistics, 2000.Google Scholar
  6. 6.
    Cooney JP.What determines the start of prenatal care? Prenatal care, insurance, and education. Med Care 1985;23:986–97.Google Scholar
  7. 7.
    Braveman PB, Bennett T, Lewis C, Egerter S, Showstack J. Access to prenatal care following major Medicaid eligibility expansions. JAMA 1993;269:1285–9.Google Scholar
  8. 8.
    Mor J, Kieffer E. Determinants of prenatal care use in Hawaii: Implications for health promotion. Am J Prev Med 1995;11:79–85.Google Scholar
  9. 9.
    D'Ascoli PT, Alexander GR, Petersen DJ, Kogan MD. Parental factors influencing patterns of prenatal care utilization. J Perinatol 1997;17:283–7.Google Scholar
  10. 10.
    Conrad JK, Hollenback KA, Fullerton JT, Feigelon HS. Use of prenatal services by Hispanic women in San Diego County: A comparison of urban and rural settings. J Nurse Midwifery 1988;43:90–96.Google Scholar
  11. 11.
    Poland ML, Ager JW, Olson J. Barriers to receiving adequate prenatal care. Am J Obstet Gynecol 1987;157:297–303.Google Scholar
  12. 12.
    Kalmuss D, Fennelly K. Barriers to prenatal care among low income women in New York City. Fam Plann Perspect 1990;22:215–31.Google Scholar
  13. 13.
    Scupholme A, Robertson EG, Kamons AS. Barriers to prenatal care in a multiethnic, urban sample. J Nurse Midwifery 1991;36:111–16.Google Scholar
  14. 14.
    Zaid A, Fullerton JT, Moore T. Factors affecting access to prenatal care for US/Mexico border-dwelling Hispanic women. J Nurse Midwifery 1996;41:277–84.Google Scholar
  15. 15.
    Tyson H, Higgins RD, Tyson I. Family dysfunction and Native American women who do not seek prenatal care. Arch Fam Med 1999;8:111–17.Google Scholar
  16. 16.
    Sable MR, Stockbauer JW, Schramm WF, Land GH. Differentiating the barriers to adequate prenatal care in Missouri, 1987–88. Public Health Rep 1990;105:549–55.Google Scholar
  17. 17.
    Mayer JP. Unintended childbearing, maternal beliefs, and delay of prenatal care. Birth 1997;24:247–52.Google Scholar
  18. 18.
    Elam-Evans LD, Adams MM, Garguillo PM, Kiely JL. Heterogeneity between women who received prenatal care in the third trimester and those who received no prenatal care. J Am Med Wom Assoc 1995;50:175–7.Google Scholar
  19. 19.
    Byrd TL, Mullen PD, Selwyn BJ, Lorimor R. Initiation of prenatal care by low-income Hispanic women in Houston. Public Health Rep 1996;111:536–40.Google Scholar
  20. 20.
    Braveman P, Egerter S, Marchi K. The prevalence of low income among childbearing women in California: Implications for the private and public sectors. Am J Public Health 1999;89:868–74.Google Scholar
  21. 21.
    SUDAAN. Software for Statistical Analysis of Correlated Data. Release 7.11 ed. Research Triangle Park, NC: Research Triangle Institute, 1997.Google Scholar
  22. 22.
    SAS: Proprietary Software Release 6.11. Cary, NC: SAS Institute, Inc., 1996.Google Scholar
  23. 23.
    Hosmer DW, Lemeshow S. Applied logistic regression. New York: Wiley, 1989.Google Scholar
  24. 24.
    Braveman P, Marchi K, Egerter S, Pearl M, Neuhaus J. Non-insurance barriers to timely prenatal care: The importance of pre-pregnancy factors. Obstetrics and Gynecology 2000;95:874–80.Google Scholar
  25. 25.
    Forrest JD, Singh S. Timing of prenatal care in the United States: How accurate are our measurements? Health Services Research 1987;22:235–53.Google Scholar
  26. 26.
    Curtin SC, Martin JA. Births: Preliminary data for 1999. National Vital Statistics Reports; 48(14), Hyattsville, MD: National Center for Health Statistics, 2000.Google Scholar

Copyright information

© Plenum Publishing Corporation 2000

Authors and Affiliations

  • Melissa Nothnagle
    • 1
  • Kristen Marchi
    • 2
  • Susan Egerter
    • 2
  • Paula Braveman
    • 3
  1. 1.Department of Family MedicineBrown UniversityProvidence
  2. 2.Department of Family and Community MedicineUniversity of CaliforniaSan Francisco
  3. 3.Department of Family and Community MedicineUniversity of CaliforniaSan Francisco

Personalised recommendations