Maternal and Child Health Journal

, Volume 1, Issue 1, pp 25–34 | Cite as

The Influence of Site of Care on the Content of Prenatal Care for Low-Income Women

  • Milton Kotelchuck
  • Michael D. Kogan
  • Greg R. Alexander
  • Brian W. Jack
Article

Abstract

Objective: To assess whether site of prenatal care influences the content of prenatal care for low-income women. Design: Bivariate and logistic analyses of prenatal care content for low-income women provided at five different types of care sites (private offices, HMOs, publicly funded clinics, hospital clinics, and other sites of care), controlling for sociodemographic, behavioral, and maternal health characteristics. Participants: A sample of 3405 low-income women selected from a nationally representative sample of 9953 women surveyed by the National Maternal and Infant Health Survey, who had singleton live births in 1988, had some prenatal care (PNC), Medicaid participation, or a family income less than $12,000/year. Outcome Measures: Maternal report of seven initial PNC procedures (individually and combined), six areas of PNC advice (individually and combined), and participation in the Women Infant Children (WIC) nutrition program. Results: The content of PNC provided for low-income women does not meet the recommendations of the U.S. Public Health Service, and varies by site of delivery. Low-income women in publicly funded clinics (health departments and community health centers) report receiving more total initial PNC procedures and total PNC advice and have greater participation in the WIC program than similar women receiving PNC in private offices. Conclusions: Publicly funded sites of care appear to provide more comprehensive prenatal care services than private office settings. Health care systems reforms which assume equality of care across all sites, or which limit services to restricted sites, may foster unequal access to comprehensive PNC.

Prenatal care low-income women site of care Medicaid WIC content of prenatal care 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. 1.
    Committee to Study Prenatal Care. Prenatal Care. Institute of Medicine. National Academy Press, Washington, D.C., 1988.Google Scholar
  2. 2.
    Committee to Study the Prevention of Low Birth Weight. Preventing Low Birth Weight. Institute of Medicine. National Academy Press, Washington, D.C., 1985.Google Scholar
  3. 3.
    Sokol RJ, Woolf RB, Rosen MG, Weingarden K. Risk, antepartum care and outcome: Impact of a maternity and infant care project. Obstet Gynecol 1980;56:150–6.Google Scholar
  4. 4.
    Korenbrot CC. Risk reduction in pregnancy of low-income women. Mobius 1984;4:35–43.Google Scholar
  5. 5.
    Buescher PA, Goforth CM, Roth MS, Williams D. An evaluation of the impact of maternity care coordination on Medicaid birth outcomes in North Carolina. Am J Public Health 1991;81(12):1625–9.Google Scholar
  6. 6.
    Public Health Service. Caring for Our Future: The Content of Care. A Report of the Public Health Service Expert Panel on the Content of Prenatal Care. U.S. Government Printing Office, Washington, D.C., 1989.Google Scholar
  7. 7.
    Mirvis DM, Chang CP, Hall CJ, Zaar GT, Applegate WB. TennCare—health system reform for Tennessee. J Am Med Assoc 1995;274:1235–41.Google Scholar
  8. 8.
    Medicaid HEDIS. National Committee for Quality Assurance. Washington, D.C., 1995.Google Scholar
  9. 9.
    Buescher PA, Smith C, Holliday JL, Levine RH. Sources of prenatal care and infant birthweight: The case of a North Carolina county. Am J Obstet Gynecol 1987;156(1):204–10.Google Scholar
  10. 10.
    Handler A, Rosenberg D. Improving pregnancy outcomes: Public versus private care for urban, low-income women. Birth 1992;19(3):123–30.Google Scholar
  11. 11.
    Buescher PA, Ward NI. A comparison of low birthweight among Medicaid patients of public health departments and other providers of prenatal care in North Carolina and Kentucky. Public Health Rep 1994;107(1):54–9.Google Scholar
  12. 12.
    Kogan MD, Kotelchuck M, Alexander GR, Johnson W. Racial disparities in reported prenatal care advice from health care providers. Am J Public Health 1994;84(1):82–8.Google Scholar
  13. 13.
    Kogan MD, Alexander GR, Kotelchuck M, Nagey DA, Jack BW. Comparing maternal reports on the content of prenatal care to recommended national guidelines. Public Health Rep 1994;109(5):637–46.Google Scholar
  14. 14.
    Sanderson M, Placek PJ, Keppel KG. The 1988 National Maternal and Infant Health Survey: Design, content and data availability. Birth 1991;18(1):26–32.Google Scholar
  15. 15.
    Survey Data Analysis, Version 6.33. Research Triangle Park, NC: Research Triangle Institute, 1993.Google Scholar
  16. 16.
    Arizona Medicaid. Competition among managed care plans lowers program costs. GAO/HEHS-96-2, 1995.Google Scholar
  17. 17.
    Kogan MD, Alexander GR, Kotelchuck M, Nagey DA. Relation of the content of prenatal care to risk of low birth-weight. J Am Med Assoc 1994;271(17):1340–5.Google Scholar
  18. 18.
    Strobino DM, Chase GA, Kim YJ. The impact of the Mississippi Improved Child Health Project on prenatal care and low birthweight. Am J Public Health 1984;76(3):274–8.Google Scholar
  19. 19.
    Kotch JB, Whitten D. The effect of a WIC program on children's clinic activity in a local health department. Med Care 1982;5:691–8.Google Scholar
  20. 20.
    Kotelchuck M, Schwartz JB, Anderka MT, Finison KS. WIC participation and pregnancy outcomes: Massachusetts Statewide Evaluation Project. Am J Public Health 1984;74:1086–92.Google Scholar
  21. 21.
    Devany B, Bilheimer L, Schore J. Medicaid costs and birth outcomes: The effects of prenatal WIC participation and the use of prenatal care. J Policy Analysis Management 1992;11(4):573–92.Google Scholar
  22. 22.
    Freda MC, Andersen HF, Damus K, Merkatz IR. What pregnant women want to know: A comparison of client and provider perceptions. J Obstet Gynecol Neonatal Nurs 1993;22(3):237–44.Google Scholar
  23. 23.
    Meis PJ, Ernest JM, Moore ML, et al. Regional program for prevention of premature birth in northwest North Carolina. Am J Obstet Gynecol 1987;157:550–6.Google Scholar
  24. 24.
    Casey R, Rieckhoff M, Beebe SA, Pinto-Martin J. Obstetric and perinatal events: The accuracy of maternal reports. Clin Pediatr (Phila) 1992;31(4):200–4.Google Scholar
  25. 25.
    Britt H, Harris M, Driver B, et al. Reasons for encounter and diagnosed health problems: Convergence between doctors and patients. Fam Pract 1992;9:191–4.Google Scholar

Copyright information

© Plenum Publishing Corporation 1997

Authors and Affiliations

  • Milton Kotelchuck
    • 1
  • Michael D. Kogan
    • 2
  • Greg R. Alexander
    • 3
  • Brian W. Jack
    • 4
  1. 1.Department of Maternal and Child HealthUniversity of North CarolinaChapel Hill
  2. 2.Centers for Disease Control and PreventionNational Center for Health StatisticsHyattsville
  3. 3.Department of Maternal and Child HealthUniversity of Alabama at BirminghamBirmingham
  4. 4.Department of Family MedicineBrown UniversityProvidence

Personalised recommendations