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Index Adolescents, see Teenagers Aid to Families with Dependent Children, S. 58, 61~2 Alabama barriers to prenatal care use in, 73-74 free prenatal care, 63 prenatal care use in, 42 American Academy of Pediatrics, 26, 139 American College of Obstetricians and Gynecologists, 8, 26, 27, 67, 102, 139, 145, 167 American Indian women, prenatal care use, 3, 33, 35-36 Arizona barriers to prenatal care use in, 110 prenatal care use in, 42, 105 Arkansas Medicaid enrollment of pregnant women, 71 prenatal care use in, 42 Asian/Pacific Islander women cultural barriers to prenatal care, 76 prenatal care use, 33 961-BABY Telephone Information and Referral Service (Detroit, Michigan), 122, 194-195 245 Barriers to prenatal care attitudes about pregnancy, 7, 9, 76-77, 81, 94-96, 99, 101, 107, 109-111 child care, 6, 70, 73, 74, 81, 94-96, 99, 102-103, 108, 109, 112 communication problems between client and providers, 7 coordination deficiencies among prenatal services, 6-7, 7~76, 77, 81 cultural, 7, 70, 73, 75-76, 78, 81, 103 depression, denial and concealment, 8, 80, 81, 100, 101 elimination of, see Programs for improving prenatal care use; Recommendations; Strategies for improving prenatal care fear, 7, 8, 33, 78-79, 81, 94-97, 99, 101-103, 182 financial, 4-6, 8-10, 12, 21, 50, 54-63, 81, 82, 89, 92, 93, 95-97, 99-102, 107-113, 118, 157-158, 161, 172, 194; see also Health insurance (private); Medicaid inadequate information on services, 7, 76, 81, 110, 161 inhospitable institutional practices, 7, 8, 9, 70, 73-75, 81-82, 93-97, 99, 101, 103, 125, 157, 161, 184, 195

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246 knowledge of pregnancy, 93, 95, 96, 99 language, 7, 73, 76, 81, 182 life-style, 7, 77, 79-80, 100 limited provider availability, 8, 50, 94-96, 99, 119 missed menstrual period waiting time, 75 negative valuation of prenatal care, 77, 81, 93, 95-97, 994103, 10~110, 112, 113, 147 personal, 7, 9, 77-78, 147 providers' perspectives on, 8, 102-103, 113 ranking of, 95-96, 99 research recommendations, 157-158, 161 service hours of providers, 6, 8 stress, 80, 81, 97 studies of women's perceptions of, 89-102 system capacity inadequacies, 6, 9, 10, 12, 50, 63-69, 81~2, 157, 161 transportation problems, 6, 8, 45, 70, 73-74, 81, 93, 95_97, 99, 101-103, 108, 109-111, 113 women's perceptions of, 7 - , 9, 88-102 Better Babies Project (District of Black women Columbia), 122, 127, 18~191 payment means of, 60 perceptions of high~risk behavior, 78 prenatal care use, 3, 4, 17, 3~33, 35-40, 47, 49-51, 58, 167, 181 risk factors for insufficient prenatal care. 4,31,35-40,51, 107, 109, 111 sources of care used by, 64, 176 teenagers, 17, 34 California availability of obstetrical care in, 69 barriers to prenatal care use in, 98-99, 170 charges for clinic visits in, 63 clinic availability in, 67 demand for prenatal clinics in, 66 Medi-Cal and prenatal care use, 58-S9, 78-79, 170 Obstetrical Access Pilot Project, 119, 17~171 physician acceptance of Medi-Cal patients in, 67, 170 INDEX physician/patient ratios, 67 prenatal care use in, 42 Casefinding for adolescents, 196, 204 baby showers, 121, 169, 20~201 961-BABY Telephone Information and Referral Service (Detroit, Michigan), 122, 169, 194-195 Better Babies Project (District of Columbia), 122, 127, 188-191 cash/service incentives to pregnant women, 11, 121, 126, 169, 190, 20~201 Central Harlem Outreach Program, 122, 126, 185-186 CHOICE hotline, 122, 195-197 Community Health Advocacy Program (New York City), 122, 187-188 cost-effectiveness, 1~11, 186 cross-program referrals, 11, 15, 116, 121, 127, 151-154, 169, 189 definition, 2, 19, 135 evaluation of programs, 125-126 free pregnancy testing/prenatal care advocacy program (Tulsa, Oklahoma), 122, 197-199 hotlines, 11, 15, 116, 12~122, 126-127, 151, 155, 169, 192-197 Maternity and Infant Outreach Project (Hartford, Connecticut), 122, 191-192 methods, 9, 1~11, 15, 22, 120~122, 126, 151-154 need for, 13, 126, 161 Pregnancy Healthline (New York City), 122, 192-194 programs, 12~122, 185-201 public information efforts, 121, 152 recommendations on, 15, 133, 151-154 staging, 11, 120, 126, 128, 130, 152-155, 186, 188 target populations, 15, 152 value, 11, 121-122, 151, 157, 159, 195, 196 Central Harlem Outreach Program, 122, 126, 159, 185-186 Child Survival Project, Columbia- Presbyterian Medical Center (New York City), 120, 125, 182-184 Clinics capacity inadequacies in, 5, 6, 8, 59, 63

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INDEX charges for services, 63 demand for prenatal services at, 6,65, 66,176 enlargement of, 10, 119, 124 foreign, 220-221 free, 63 funding of, 129,144 hospital, 65 hours of operation, 74,81,195 language barriers at, 76 liability insurance, 69 negative attributes of, 76,81 procedural reforms, 14,179 public health, 66,70,75 satellite, 177-178,179 school-based, 144,153 State Health Agency, 65 value of, 64-65 waiting times, 6,8,59,64,66,74,75, 81,101,103 see also Prenatal services Colorado barriers to prenatal care use in, 95, 111 prenatal care use in, 42,90,106 Community Health Advocacy Program (New York City), 122, 187-188 Community Health Centers inadequacies in, 6,64 liability insurance, 69 value of, 65 Concern for Health Options: Information, Care and Education (CHOICE) (Philadelphia, Pennsylvania), 122,195-197 Connecticut barriers to prenatal care in, 101 Maternity and Infant Outreach Project (Hartford), 122,191-192 pregnancy testing and prenatal visits in, 71 prenatal care use in, 42,44,48,91 Consolidated Omnibus Budget Reconciliation Act of 1985,61 Deficit Reduction Act of 1984,61 Delivery services barriers to receipt of, 20-21 funding for, 21 importance, 20 District of Columbia 247 barriers to prenatal care use in, 74,79 Better Babies Project, 122,188-191 institutional reforms in, 74-75 liability insurance Costs, 69 prenatal care use in, 42,44,47,49 Employee Retirement Income Security Act, 143 Europe (Western) infant mortality, 18 low birthweight rates, 18 maternity systems, 2,18; see also International perspectives on prenatal care Evaluation of prenatal care from birth certificate data, 28,29,166 data sources on use, 27-28,166 definition of visits, 27 Kessner index for, 29,90,91,180,181 methodological problems, 59~0, 102, 117-118,121-122,157 multivariate analysis/predictors of use, 8-9,12,39,77-78,103-112 qualitative measures, 29,34,90-91 quantitative measures, 27-29,90-91, 178 recommendations, 157,158-159,162 studies of women's perceptions of barriers, 89-107 time-of-onset measure of use, 28-29, 90,91 Fair Labor Standards Act, 143 Family planning services, 77,140, 148-149,153-154,161,192 Florida availability of obstetrical care in, 69 barriers to prenatal care use in, 96, 98-99 Medicaid enrollment of pregnant women, 71 prenatal care use in, 42,49,91,106 Grannies Program (Bibb County, Georgia), 123,127,206-207 Health care financing, see Medicaid Health insurance (private) characteristics of women with, 60 cost-sharing by patient, 56,58,143 eligibility for coverage, 56-57

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248 employer subsidization trends, 56-57 group, 56 outreach program coverage, 19 percentage/number of women covered by, 55, 56 and prenatal care use, 4, 19, 55-56, 59, 61, 63, 81, 92, 101, 108-110 recommended reforms in, 143 risk factors for insufficient prenatal care, 39, 57 scope and depth of coverage, 50, 55-57, 101, 143 waiting periods, 56, 57, 143 see also Uninsured women Healthy Mothers, Healthy Babies Coalition, 168 Healthy Start Program (Massachusetts), 119, 165-167 Hispanic women cultural barriers to prenatal care, 76 prenatal care use, 3, 4, 32, 36, 38, 40, 51 risk factors for insufficient prenatal care, 4, 32-33, 36, 38, 40, 111 sources of care used by, 64 Homeless women, barriers to prenatal care, 7, 79-80, 82, 194 Hospitalization barriers to admission, 20-21 see also Delivery services Illegal immigrants, fears and prenatal Illinois care use, 78-79, 182, 188 barriers to prenatal care use in, 95 prenatal care use in, 42, 90 Improved Child Health Project (Mississippi), 120, 181-182 Improved Pregnancy Outcome Project (North Carolina), 120, 181 Indiana, prenatal care use in, 42, 49 Infant Health Improvement Projects, 168 Infant mortality and prenatal care use, 18 programs to reduce, 88, 165-169, 171-172, 179, 180 Insurance, see Health insurance (private) International perspectives on prenatal care continuity of care, 225 countries studied, 211-213 INDEX data adequacy on, 213-214 demographic considerations, 214-216 health care financing, 218-219 home deliveries, 224 home visiting, 222-223 hospital deliveries, 223 incentives to participate in prenatal care, 223 income considerations, 217-218 maternity-related benefits, 225-226 maternity-related services, 219-225 number of prenatal visits, 221 public clinics, 22~221 teenage childbearing, 216-217 Japan, maternity system, 2, 18; see also International perspectives on prenatal care Low birthweight and prenatal care use, 18, 171 prevention programs, 176-178 in Western Europe, 18 Maine barriers to prenatal care use in, 110 prenatal care use in, 42, 49, 106 Massachusetts barriers to prenatal care in, 9S, 101, 108 Healthy Start Program, 119, 124, 165-167 prenatal care use in, 39, 42, 49, 90, 104 Maternal and Child Health Services Block Grant, 70, 119, 141, 143, 176 Maternal mortality focus of efforts to lower, 27 and prenatal care, 18 Maternity and Infant Care projects, 64, 119, 120, 168, 179-181 Maternity and Infant Outreach Project (Hartford, Connecticut), 122, 191-192 Maternity care systems access problems, 13, 161 capacity inadequacies, 63-68 context for improving, 21 continuity of, 225 deficiencies, 12, 45

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INDEX definition, 20 design strategies, 137-138 financing of services, 139, 165 foreign, 18, 219-225 home deliveries, 224 home visiting, 222-223 hospital deliveries, 224 in Japan, 18 long-term reform goals, 136-140, 161 national standards needed for, 140 reform recommendations, 13-14, 136-142, 161 short-term reform goals, 140-142 underfinancing of, 232-233 in Western Europe, 18 see also Clinics Maternity costs, 54 Medicaid application procedures, 71-73, 183 barriers to prenatal care, 58-62, 67, 70, 72-73, 81, 183 case management, 155 characteristics of recipients, 60, 64 claims processing, 67 confidentiality concerns, 78 eligibility, 5, 50, 58, 61-62, 70, 72-73, 125, 136, 142, 145-146, 165 enrollment process, 5, 6, 59, 81, 145-146, 183 enrollment rates, 71 fines for enrollment errors, 72 information dissemination on, 146 and minority access to prenatal care, 58 notification of eligibility, 73 percentage of women covered by, 55 physician acceptance of, 5, 6, 59, 64, 67-68, 81, 170 preeligibility funding through state programs, 165, 168 prenatal care financing with, 5 and prenatal care use, 58, 61, 63, 81, 107-108, 110, 111 presumptive eligibility, 73, 146 recommended changes, 142, 144, 14~146 reforms, 58, 61-62, 73, 119, 136 reimbursement, 67-68, 144, 145, 166, 170 separation from welfare, 61-62, 139 state variation in, 73 transportation cost coverage, 74 249 Medical malpractice insurance crisis award size and, 230-231 causes of cost increases in, 229-233 for clinics and health centers, 69 contingency fees for lawyers and, 231 costs, 68, 69 effect on prenatal care availability, 50, 68~9, 23~239 grants to underwrite premiums, 168 locality rule, 230 medical advances and, 230 national standards in, 140 physician/obstetrician response to increases, 23~239 profit motive of insurance companies and, 232 public funding, 145 recommended approaches to resolving, 144, 145 state responses, 239-240 substandard physicians and, 231 underfinancing of maternity care and, 232-233 Medicare Catastrophic Coverage Act of 1988, 61 Michigan baby showers, casefinding through, 122, 169, 200-201 961-BABY Telephone Information and Referral Service (Detroit), 122, 169, 194-195 barriers to prenatal care use in, 108 Healthy Mothers, Healthy Babies Coalition, 168 Maternity and Infant Care Projects, 168 prenatal care use in, 42, 104 Prenatal-Postpartum Care Program, 119, 167-169 Migrant and Rural Health Centers, 64, 65, 70 Minorities access to prenatal care, 14, 58 programs that improve use of prenatal care, 166 see also American Indian women; Asian/Pacific Islander women; Black women; Hispanic women Mississippi Improved Child Health Project, 120, 181-182

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250 Medicaid enrollments of pregnant women, 71 physician/patient ratios, 67 prenatal care use in, 42 National Center for Health Statistics, 45, 58 National Health Interview Survey, 60 61 National Health Service Corps, 144 National Medical Care Utilization and Expenditures Survey, 64 National Natality Survey, 34, 38 National Survey of Family Growth, 38, 59, 64 New Mexico Perinatal Program (Lea County), 88, 119, 171-174 prenatal care use in, 42 New York City barriers to prenatal care use in, 76, 79-80, 96, 97-100, 109 Central Harlem Outreach Program, 122, 126, 159, 18~186 Child Survival Project, Columbia-Presbyterian Medical Center, 120, 125, 182-184 Community Health Advocacy Program, 122, 187-188 delayed care among Medicaid recipients, 59 demand for prenatal services in, 66 physician/patient ratios, 67 Pregnancy Healthline, 122, 192-194 prenatal care use in, 91, 105 New York State availability of obstetrical care in, 69 Prenatal and Infancy Home Visiting Program (Elmira), 123, 20~206 Prenatal Care Assistance Program, 119, 174-176 prenatal care use in, 42 Prevention of Low Birthweight Program (Onondaga County), 119, 17~178 North Carolina barriers to prenatal care use in, 96, 98-99, 109 Improved Pregnancy Outcome Project, 120, 181 Maternity and Infant Care Project, 179-181 INDEX Medicaid enrollments of pregnant women, 71 prenatal care use in, 42, 44, 46, 91, 104 Obstetrical Access Pilot Project (California), 119, 17~171 Ohio barriers to prenatal care use in, 95 Maternity and Infant Care Project, 120, 179-181 prenatal care use in, 42, 90 Oklahoma barriers to prenatal care use in, 95, 108-109 free pregnancy testing/prenatal care advocacy program (Tulsa), 122, 197-199 prenatal care use in, 42, 90, 104, 105 Omnibus Budget Reconciliation Acts of 1986 and 1987, 61 Oregon availability of obstetrical care in, 69 prenatal care use in, 42, 49 Outreach programs and access to maternity care services, 13, 126, 161 definition, 2, 19, 135 evaluation of, 116, 186 funding for, 19, 168 goals and content, 20, 12~123, 161 insurance coverage of, 19 international perspective, see International perspectives on prenatal care recommended role, 149-151 status as a health service, 19 value, 13, 19, 133 see also Casefinding; Social support services Pennsylvania Concern for Health Options: Information, Care and Education (Philadelphia), 122, 19~197 prenatal care use in, 42 Perinatal Program (Lea County, New Mexico), 88, 119, 171-174 Physicians, obstetricians, and other providers

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INDEX acceptance of Medicaid-enrolled pregnant women, S. 6,59,64, 67-68,81,168 advance payment requirements, S8, 172 attitudinal issues, 75,108,109 availability for low-income women, 6, 8,56,64,94-96,99,124-125, 165-166,169,173,238-239 casefinding role, 153 cessation of obstetrical practice, 233-234 charges for maternity services, 67-68 geographic distribution of, 66-67 grants to underwrite liability premiums, 168 malpractice insurance problems, 6,50, 68-69,229-241 nurse-practitioners and nurse-midwives, 68,76,125,131, 144,167,172-175,177,183 professional societies' role in overcoming care barriers, 144-145 rejection of high-risk women, 235-238 socioeconomic status and utilization of, 64 substandard physicians, 231 views on barriers to prenatal care, 8, 102-103 Pregnancy Discrimination Act of 1978, 56,57,143 Pregnancy Healthline (New York City), 122,192-194 Prenatal and Infancy Home Visiting Program (New York State), 123, 205-206 Prenatal care access to, 13 adequacy, 1, 29,41; see also Evaluation of prenatal care cost-effectiveness, 18,11,137 definition, 24 financial assistance programs, 164-169; see also Medicaid geographic pockets of need, 41-45 major risk factors for nonuse, 17 pregnancy testing and, 71,81,121, 127,153, 154, 197-199 schedule of recommended visits, 27, 28 251 value, 2,8,17-18,23-24,26,27,137 Prenatal Care Assistance Program (New York State), 119, 174-176 Prenatal care use age and, 3,5,9,17,30-31,34,37-41, 50,60,64,81,101-102,108-111, 178 barriers to, see Barriers to prenatal care birth certificate data on, 28,29 birth order (parity) and, 3,9,36-37, 50,81,108-112,153 birthplace of pregnant woman and, 33-34 connection to health care system and, 71 current patterns, 29-39 delayed (second trimester), 1, 28,29, 101 drug abuse and, 79,100,109,130 early (first trimester), 1, 3,5,17,28, 29,32-33,38,39,47,49,58-60, 101,158-159,169,175,178,180, 185 educational attainment and, 3,5,9, 31,33,34-37,39-41,50,56,59, 60,81,108,109,111,112 emotional support network and, 80, 81,100,108,109 episodic, 34 geographic correlates, 4,9,12,39-49, 51,60,81,110,111 health insurance and, 19, 50,55-59, 81,92,101,108-111 income and, 4,9,31,33,38-40,44, 50,56,60,108-109,111 and infant mortality rates, 18 international comparisons, 2,18 late (third trimester), 1-2,3,17,28, 29,31-33,36,38-48,50,77-78, 89-97,101,169,175,176,178 and low birthweight, 18 Kessner index of, 29,90,91,104 marital status and, 3-4,5,9,31, 37-41,50,57,60,81,108,110, 111,112 and maternal mortality rates, 18 measures of, 28,90-91,104-106 minority status and, 3,17,30-41,49, 50,60,64,81,107,109,111 multivariate analysis/predictors of, 8-9, 12,39,77-78,103-112

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252 none, 1-2, 3, 29, 31-33, 36, 3~45, 47, 48, 50, 97-100, 176, 178 pregnancy outcomes and, 26, 27 reasons given by women for insufficient use of, 89-102 socioeconomic status and, 18-19, 50, 57, 81, 97, 109, 111-112 strategies for improving, 9-12, 20, 21-22; see also Outreach programs; Programs for improving prenatal care use; Strategies for improving prenatal care use studies of, 10~106 time-of-onset measure of, 28-29, 34 trends, 17, 10, 4~51 U.S. Surgeon General's goals, 18 Prenatal-Postpartum Care Program (Michigan), 119, 167-169 Prenatal services evaluation of, 9-10, 23, 24; see also Evaluation of prenatal care federal programs, 70 funding, 70, 143 goals and content, 26-27 hospital outpatient departments, 64, 65 information dissemination on, 146, 147-148 links with other services, 65 local health departments, 65 66 nutritional supplementation and education, 70 in organized settings, 64~6 payment sources; see Medicaid public health departments, 64, 66 reforms needed in, 12-13, 14; see also Recommendations school-based, 64 see also Clinics; Community Health Centers; Maternity care systems Prevention of Low Birthweight Program (Onondaga County, New York), 119, 176-178 Programs for improving prenatal care use 961-BABY Telephone Information and Referral Service (Detroit, Michigan), 122, 169, 194-195 Better Babies Project (District of Columbia), 122, 127, 188-191 Central Harlem Outreach Program, 122, 126, 185-186 INDEX Child Survival Project, Columbia-Presbyterian Medical Center (New York City), 120, 182-184 CHOICE hotline, 122, 19~197 Community Health Advocacy Program (New York City), 122, 187-188 free pregnancy testing/prenatal care advocacy program (Tulsa, Oklahoma), 122, 197-199 Grannies Program (Georgia), 123, 127, 20~207 Healthy Start Program (Massachusetts), 119, 165~167 Improved Child Health Project (Mississippi), 120, 181-182 Improved Pregnancy Outcome Project (North Carolina), 120, 181 Maternity and Infant Care Projects (Ohio, North Carolina), 64, 119, 120, 179-181 Maternity and Infant Outreach Project (Hartford, Connecticut), 122, 191-192 Obstetrical Access Pilot Project (California), 119, 17~171 Perinatal Program (Lea County, New Mexico), 88, 119, 171-174 Pregnancy Healthline (New York City), 122, 192-194 Prenatal and Infancy Home Visiting Program (New York State), 123, 20~206 Prenatal Care Assistance Program (New York State), 119, 174-176 Prenatal-Postpartum Care Program (Michigan), 119, 167-169 Prevention of Low Birthweight Program (Onondaga County, New York), 119, 17~178 Resource Mothers Program (South Carolina), 123, 202-203 see also Casefinding; Outreach programs; Social support services; Strategies for improving prenatal care use Recommendations access to maternity services, 13, 14 design of maternity care system, 13-14 evaluation of programs, 16

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INDEX goals of programs for increasing prenatal care use, 14, 136-142 federal and state responsibilities, 14 funding, 159-161 institutional practices at care delivery site, 14, 145-147 outreach programs, IS, 149-155 planning and needs assessment, 15, 155-157 public information campaign, 14, 147-149 removal of financial barriers, 14, 15, 142-143 research, 16, 157-159 system capacity improvements, 143-145 Resource Mothers Program (South Carolina), 123, 202-203 Rhode Island, prenatal care use in, 42, 61 Risk factors for poor use of prenatal care, 81, 191 Social support services for adolescents, 123, 203-205 case management, 155 definition, 2, 19, 135 financing, 155 Grannies Program (Georgia), 123, 127, 206-207 home visiting, IS, 154, 173-174 need for, 13, 154 obstetric care provider role, 155 Prenatal and Infancy Home Visiting Program (New York State), 123, 205-206 programs, 122-123, 201-207 purpose, 9, 116 recommendations, 15, 133, 154-155, 161 Resource Mothers Program (South Carolina), 123, 202-203 value, 11, 127, 133 Socioeconomic status and prenatal care use, 18-19, 50, 57, 64, 81, 97, 109, 111-112 South Carolina barriers to prenatal care use in, 95, 101 prenatal care use in, 42, 49, 90, 104 Resource Mothers Program, 202-203 253 South Dakota, prenatal care use in, 42, 105, 110 Special Supplemental Food Program for Women, Infants, and Children, 11, 70-71, 81, 109, 121, 122, 127, 167, 176-177, 189, 199-200 Strategies for improving prenatal care use abortion issue in, 131 basis, 54 bureaucratic difficulties, 13~131 community-based, 19 components, 14, 23, 158-159 coordination with other health services, 12 costs, 159, 166 data sources on, 118, 163-164 design and management, 112, 127-128 education/public information about services, 12, 14, 141 effectiveness of, 123-127, 133, 167, 169, 171, 173-174, 178, 18~182, 185 evaluation of, 9-10, 11-12, 13, 15-16, 123-124, 132-133, 157, 162, 166-167, 171, 173-174, 178, 180-182 federal role, 14, 141 financial/community support for, 128, 129-130 funding, 128, 129-130, 160, 172-173 implementation and maintenance problems, 11-12, 128-132, 156, 160 institutional modifications, 6, 10, 12, 14, 120, 125, 141, 178-185, 204 long-term nature of, 156, 160 manpower, 10, 130, 131 outreach component, 19; see also Outreach programs perinatal system development (Tennessee), 120, 184-185 planning and needs assessment, 15, 131, 155-156 positive attributes of, 127-128 recommendations, 12-13, 14-16, 140-141, 155-157, 158-160 removal of financial barriers, 10, 12, 14, 118-119, 124, 133, 140-141, 164-169 state role, 14, 141-142 start-up time, 131

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254 system capacity increases, 12,14,119, 124-125,133,141,169-178 see also Casefinding; Outreach programs; Programs for improving prenatal care use; Social support services Teenagers adequacy of prenatal care, 34 barriers to prenatal care, 78,96 casefinding for, 153,204 . . . . Improving ~nst~tutiona arrangements for, 204 international perspectives on childbearing, 216-217 minorities, 31,34 pregnancy testing and prenatal care initiation, 71,153 prenatal care use, 3,17,31,38,51, 153 programs that improve prenatal care use by, 166 risk factors in insufficient prenatal care, 39 social support programs for, 123, 204-205 views on barriers to prenatal care, 8, 101-102 Tennessee perinatal system development in Shelby County, 184-185 prenatal care use in, 43,91 Texas availability of obstetrical care in, 69 barriers to prenatal care use in, 9S, 98, 111 Medicaid enrollments of pregnant women, 71 perinatal system development (Shelby INDEX County, Tennessee), 120, 184-185 prenatal care use in, 43,90,106 Uninsured women characteristics of, 57,60,62-63 financial assistance programs, 164-169; see also Medicaid number/percentage, 5-6,55,62 obstacles to obtaining prenatal care, 62-63,67 prenatal care use by, 61 U.S. Department of Health and Human Services Expert Panel on the Content of Prenatal Care, 26 Preventive Services Task Force, 26 U.S. Surgeon General, goals for prenatal care use, 18 Utah, prenatal care use in, 43,49 War on Poverty, 1S3 West Virginia barriers to prenatal care use in, 73 demand for prenatal care clinics, 66 prenatal care use in, 43 WIC, see Special Supplemental Food Program for Women, Infants, and Children Wisconsin barriers to prenatal care use in, 110 prenatal care use in, 43,106 Women's perceptions of barriers to care adolescents, 101, 102 open-ended questions, 9~92,98 self-administered checklists, 9~92, 95, 98 women with insufficient care, 89-97 women with no care, 97-100