title: The policy implications of better structure and process on birth outcomes in Jamaica.
abstract: BACKGROUND
  We investigated if better structural and process elements of prenatal care relate to higher birth weights in the Jamaican population.
  
  
  METHODS
  We used data from two surveys: (1) a national sample of randomly selected households; and (2) a concurrent facility survey of the public health clinics in Jamaica. In the household survey, all women aged 14-50, who had a pregnancy lasting 7 months during the previous 5 years (n = 913) were interviewed. From the household survey, we gathered information on the maternal, clinical and socioeconomic risk factors and on the newborns birth weight (the outcome measure). The facility survey collected data from all public primary care clinics in the country (n = 366). This gave us information on the quality of care (structure and process measures) provided in the clinics.
  
  
  RESULTS
  Prenatal care in Jamaica, while generally available, provides care to many women who are at particular risk because of parity, age and poverty. Structural measures of the facilities show that clinics are in general disrepair, have only 70% of the basic equipment and are insufficiently stocked with supplies or medication. Many facilities had poor process of care, as measured by assessing the clinical examination and counseling. The average birth weight was 3232 g and 9.8% weighed < 2500 g. The relationships between birth weight and the quality of care were estimated using multiple regression. The biologic and socioeconomic risk factors related to birth weight in the expected direction. None of the structural quality measures were statistically significant. Among the process measures, women who had access to a more complete examination, had infants that weighed an average of 128 g more at birth.
  
  
  CONCLUSIONS
  Better quality of care, provided by a more thorough clinical evaluation, has a more powerful effect on birth weight in the population than upgraded facilities or equipment. In developed or developing countries, where resources are limited, policy should focus on education and training to improve birth outcomes.
authors.affiliation: RAND, Santa Monica, CA 90407-2138, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Peabody
authors.forename: P J
authors.initials: PJ
authors.lastname: Gertler
authors.forename: A
authors.initials: A
authors.lastname: Leibowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D003151:Community Health Centers / Q000592:standards*; D003906:Developing Countries; D005260:Female; D019538:Health Care Surveys; D006291:Health Policy; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D007563:Jamaica; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011295:Prenatal Care / Q000592:standards*; D012959:Socioeconomic Factors