The impact of extended maternity services on prenatal care use among Medicaid women.
The goals of this study were to examine the use of maternity support services (MSS) and maternity case management (MCM) by Medicaid-eligible low-income pregnant women in Washington state, and to determine whether receipt of the services was associated with improved prenatal care use. We obtained data from linked birth certificates and Medicaid eligibility and claims files for women delivering between August 1989 and December 1991. Unconditional logistic regression was used to assess the programs' effects independent of other variables associated with prenatal care adequacy. The percentage of women receiving MSS and MCM was highest among women with demographic risks for adverse birth outcomes. Women receiving prenatal care from health departments or community clinics were more likely to receive MSS and MCM than those seen by private physicians or midwives. After adjustment for multiple confounding factors, we found that recipients of MSS, but not MCM, were significantly less likely than other women to receive an inadequate number of prenatal visits. Our findings suggest that public policies that pay for support services to low-income pregnant women can improve the use of prenatal care.
Farrow
D C
DC
Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle 98195, USA.
Baldwin
L M
LM
Cawthon
M L
ML
Connell
F A
FA
D019090:Case Management; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000458:organization & administration*; D017057:Medically Uninsured / Q000706:statistics & numerical data; D011203:Poverty; D011295:Prenatal Care / Q000191:economics / Q000706:statistics & numerical data*; D012947:Social Work; D014481:United States; D014861:Washington