The influence of site of care on the content of prenatal care for low-income women.
OBJECTIVE
To assess whether site of prenatal care influences the content of prenatal care for low-income women.


METHODS
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.


METHODS
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.


METHODS
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.
Kotelchuck
M
M
Department of Maternal and Child Health, School of Public Health, University of North Carolina, Chapel Hill 27599-7400, USA. kotelchuck@unc.edu
Kogan
M D
MD
Alexander
G R
GR
Jack
B W
BW
D000293:Adolescent; D000328:Adult; D003153:Community Health Services / Q000458:organization & administration*; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D010358:Patient Participation; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data* / Q000639:trends; D011365:Professional Practice Location / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012494:Sampling Studies; D014481:United States