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Summary
Pages 1-16

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From page 1...
... When vital statistics are analyzed to determine rates of adequate care rather than trimester of onset, a slightly different picture emerges. In 1985, only 68.2 percent of all women obtained adequate prenatal care, 23.9 percent had an intermediate level of care, and 7.9 percent of all pregnant women had inadequate care.*
From page 2...
... STUDY FOCUS Faced with evidence of prenatal care's value and cost-effectiveness, and with data revealing poor and declining use of this key service, in the summer of 1986 the Institute of Medicine convened an interdisciplinary committee, the Committee to Study Outreach for Prenatal Care, to study ways of drawing more women into prenatal care early in pregnancy and of sustaining their participation until delivery. The Committee was asked to focus particularly on outreach as a means for increasing the use of prenatal services.
From page 3...
... . Hispanic mothers are substantially less likely than non-Hispanic white mothers to begin prenatal care early and are three times as likely to obtain late or no care.
From page 4...
... Financial Barriers Women with private health insurance are more likely to obtain adequate prenatal care than uninsured or Medicaid-enrolled women, but many women do not have access to employer-based group coverage (the most common means of obtaining private insurance)
From page 5...
... Finally, women on Medicaid are characterized by numerous demographic factors associated with insufficient prenatal care, including being unmarried, having less education, being under 20, and being in fair or poor health. Given these attributes of the Mecticaid population, health insurance alone is unlikely to close the gap between their use of health services and that of more affluent women with private coverage.
From page 6...
... Inadequate System Capacity Numerous reports document inadequate numbers of, and long waiting times for appointments at, such facilities as Community Health Centers and health department clinics settings that have traditionally provided prenatal care to those unable or unwilling to use the private care system. Similarly, there appears to be a growing demand for prenatal services in clinics—a picture consistent with the increasing number of women of reproductive age without adequate private health insurance and the decreasing number of private providers caring for Medicaid-enrolled and other low-income women.
From page 7...
... Unfortunately, numerous reports detail alarming increases in the proportion of women, including pregnant women, who abuse heroin and cocaine and in the number of babies born with varying degrees of addiction. Having friends ancl family to offer emotional support and tangible assistance, and having well-developed skills in overcoming isolation, may minimize or eliminate barriers to prenatal care; lack of these assets, particularly when combined with poverty, may constitute a barrier to care in and of itself.
From page 8...
... To help fill this gap, the Committee synthesized the findings of numerous studies of women who had obtained insufficient prenatal services and who had been queried about factors they felt had caused their delay in entering care. Financial barriers—particularly inadequate or no insurance and limited personal funds were the most important obstacles reported in IS studies of women who received insufficient care.
From page 9...
... Except for race, all of the other demographic risk factors noted earlier were also found to predict insufficient care in many of the studies, along with unintended pregnancy and a low opinion of prenatal services. Despite the clear value of these studies in defining key risk factors and in defining target groups, there is need for more sophisticated understanding of the factors influencing use of this key health service.
From page 10...
... With regard to the first category removing financial barriers to care the Committee noted how few programs could be identified that take this direct approach to improving participation in prenatal care, despite the salience of financial obstacles. Most try to ease financial barriers by enlarging the clinic systems relied on by low-income pregnant women, rather than by enabling them to use provider systems already in place, including physicians in private practice.
From page 11...
... Close cooperation between prenatal services ant! pregnancy testing services, pediatric services' and WIC sites (that is, sites administering the Special Supplemental Food Program for Women, Infants, and Children)
From page 12...
... improve the policies and practices that shape prenatal services at the delivery site; and 4. increase public information and education about prenatal care.
From page 13...
... These outreach services, supplementing a well-designed, highly accessible system of prenatal services, can help draw the most hard-to-reach women into care. Unfortunately, though, outreach is often undertaken without first making certain that the basic maternity care system is accessible and responsive to women's needs.
From page 14...
... 3. We recommend that more immediate efforts to increase participation in prenatal care emphasize four goals: eliminating financial barriers to care, making certain that the capacity of the maternity care system is adequate, improving the policies and practices that shape prenatal services at the site where they are provided, and increasing public information about prenatal care.
From page 15...
... efforts to encourage current program participants to recruit additional participants from their friends, neighbors, and relatives; (~) strong referral ties between prenatal programs and a variety of other systems in which pregnant women at risk for insufficient care may be found: family planning clinics, schools, housing programs, WIC agencies, welfare and unemployment offices, churches and community service groups, shelters for the homeless, the police and corrections systems, substance-abuse programs and treatment centers, and other health and social service networks; and (e)
From page 16...
... and linking them to prenatal services?


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