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Preventing Low Birthweight Summary (1985) / Chapter Skim
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Ensuring Access to Prenatal Care
Pages 21-26

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From page 21...
... After reviewing numerous studies, the committee concluded that the major barriers to early receipt of prenatal care fall into the following six categories: · financial constraints such as inadequate insurance or lack of Meclicaid funds to purchase care; · limited availability of maternity care providers, particularly providers willing to serve socially disadvantaged or high-risk pregnant women; · insufficient prenatal services in some sites routinely used by high-risk populations, such as Community Health Centers, hospital outpatient clinics, and health departments; experiences, attitudes, and beliefs among women that make them disinclined to seek prenatal care; · poor or absent transportation and child care services; and · inadequate systems to recruit hard-to-reach women into care. Financial Constraints Numerous studies have shown that the availability of funds to cover the costs of prenatal care influences women's decisions about seeking such services.
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From page 22...
... For example, in California, extending an improved set of Medicaid prenatal benefits to selected low-income women between 1979 and 1982 was found to be cost-effective because it was associated with savings in the costs of caring for low-weight infants.16 Support of the Medicaid program should be part of a comprehensive effort to reduce the nation's incidence of low birthweight. Changes in the program, a topic of considerable controversy in both Congress and state governments, should be dedicated to enrolling more eligible women in the program and to providing them with early and regular, high-quality prenatal care.
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From page 23...
... Maternity programs designed to serve high-risk mothers should increase their use of these providers; and state laws should be supportive of nurse-midwifery practice and of collaborations between physicians and nurse-midwives/nurse practitioners. Insufficient Prenatal Care Services Closely related to the issue of financial barriers and poor provider availability is the evidence that in some communities there is an inadequate number of organized facilities, particularly publicly financed ones, providing prenatal care to pregnant women who are unable or unwilling to use the private care system.
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From page 24...
... To acIdress the unmet needs for prenatal care, health departments should be given increased resources. Every community is different, however, and in some it may be more appropriate to provide additional support to Community Health Centers, Maternity and infant Care Projects, hospital outpatient departments, or related settings.
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From page 25...
... A System of Accountability The committee believes that although many different factors contribute to the problem of inadequate access to prenatal care, an underlying cause is the nation's patchwork, nonsystematic approach to making prenatal services available. Although numerous programs have been developed in the past to extend prenatal care to more women, no institution bears responsibility for ensuring that such services are available to those who need them.
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From page 26...
... ~ To meet or exceed these goals, the committee believes that the federal government should take the following specific actions: · provide sufficient funds to state and local agencies to remove financial barriers to prenatal care (through channels such as the Maternal and Child Health Services Block Grants, Mecticaid, health departments, Community Health Centers, and related systems) ; provide prompt, high-quaTity technical consultation to the states on clinical, aclministrative, and organizational problems that can impede the extension of prenatal services; · define a model of prenatal services for use in public facilities providing maternity care; and fund demonstration and evaluation programs and Hart training and research in these areas.
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Key Terms

  • pregnant women
  • prenatal services
  • health departments
  • health centers
  • community health

  • nurse practitioners
  • care services
  • hospital outpatient
  • child care
  • financial barriers

  • low birthweight
  • maternity care
  • services available
  • medicaid coverage
  • outpatient departments

  • medicaid program
  • child health
  • publicly financed
  • outreach personnel
  • organized facilities

  • financial constraints
  • numerous studies
  • infant care
  • providing prenatal
  • seeking prenatal

  • increase access
  • care projects
  • obstetrical nurse
  • seek prenatal
  • public facilities


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