Medicaid and prenatal care: necessary but not sufficient

Article Abstract:

Medicaid, along with subsequent changes in the program to increase coverage of prenatal care for low-income women, is part of a national policy directed at lowering infant mortality to seven deaths per 1,000 live births by the end of the century. The article by Piper and others in the November 7, 1990 issue of The Journal of the American Medical Association, points out a number of policy issues. Infant mortality was seen as a problem of access to health care, so the solution was to increase access by removing financial barriers for poor pregnant women. However, this alone is not enough to achieve the desired decrease in infant mortality. First, the population at highest risk is already covered under Medicaid. Adverse outcomes are also due to the demographics of this population, and the complexity and delays of applying for Medicaid. Second, each incremental expansion of coverage includes a population at lower risk than the one before; therefore infant deaths among Medicaid recipients will decline because of the inclusion criteria, not because of the Medicaid program. Third, insurance alone cannot ensure better outcomes. Several studies have verified that low-income women in clinic settings do better than those with private physicians. The reason for this is that clinics provide case management, including nutrition counseling, psychological and social resources, and social and emotional support which may lead to healthier behaviors. Fourth, a new maternity system should include adequate health insurance, services reflecting the recommendations of the Public Health Service Expert Panel on the Content of Prenatal Care, comprehensive health and support services, recognition of the effects of poverty and lack of education, child care and job opportunities to reduce poor outcomes of all kinds. Finally, waiting for individual states to provide research results is a poor way to evaluate a national program. A single national system of data collection should be mandated through the Health Care Financing Administration and the Maternal and Child Health Bureau. (Consumer Summary produced by Reliance Medical Information, Inc.)

United States, Evaluation, Finance, Health insurance, Medicaid, editorial

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Classification and analysis of fetal deaths in Massachusetts

Article Abstract:

Autopsy reports were obtained for 61 percent of the 574 fetal deaths that occured in Massachusetts in 1982 and compared to the cause-of-death information. The underlying cause of death from the fetal death record differed from the autopsy report in 55 percent of the cases. The study found that fetal morthality was higher among blacks, unmarried and older mothers. Multiple fetuses suffered unusually high rates of fetal death. Causes of death include congenital anomalies, infection and asphyxia. Many stillbirths remain unexplained, and research is needed to identify reasons in order to reduce the number of fetal deaths currently ascribed to unknown causes.

Analysis, Causes of, Massachusetts, Death, Identification and classification, Perinatal death, Fetal death, Vital statistics

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Benefits and limitations of prenatal care: from counting visits to measuring content

Article Abstract:

Data collected on prenatal care needs to begin focusing on the content of the care rather than simply on how many times a woman gets prenatal care. A 1998 study found that two new data collection methods show that the use of prenatal care has risen steadily since 1981. However, this has not been associated with a corresponding decrease in premature births or low birth weight. These pregnancy outcomes are more common in black and low-income women, who may be less likely to receive regular prenatal care. An prenatal care may not make up for poor health of the mother and social inequities.

Editorial, Usage, Demographic aspects, Maternal health services

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