Prenatal Care Reaching Mothers, Reaching Infants (1988) / Chapter Skim
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Introduction
Introduction
Pages 17-25
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From page 17... ...
First, there is widespread agreement that prenatal care is an effective intervention, strongly and clearly associated with improved pregnancy outcomes. Because randomized clinical trials are precluded on ethical grounds, incontrovertible scientific proof of this effectiveness is not available; nevertheless, exhaus17
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From page 18... ...
Surgeon General has set a goal of reducing the proportion of women who obtain no prenatal care cluring the first 3 months of pregnancy to 10 percent by 1990, the U.S. Department of Health and Human Services recently acknowledged that, "based on progress to date, it appears unlikely that this objective will be met."~3 This country's limited progress in extending prenatal care is only part of a larger problem of poor access to health services for low-income and minority populations.
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From page 19... ...
To many millions of Americans, access to medical care remains uncertain or unobtainable, even though the United States spends more per capita for care than any other industrialized nations 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 develop recommendations for improving participation in prenatal care, particularly through "outreach." In keeping with conventional understanding, outreach was defined to include various ways of identifying pregnant women and linking them to prenatal care (casefinding)
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From page 20... ...
Despite the clear need for such a continuum of care, there is ample evidence that the ties between prenatal and delivery services are often tenuously In some areas of the country, for example, women may receive prenatal care at Community Health Centers or health department clinics but deliver in hospitals without their prenatal records available, simply because of inadequate systems for transferring records among providers.~9 Moreover, obtaining prenatal services floes not lead automatically to admission at a hospital of choice for labor and delivery, because many institutions require large preadmission deposits or create other barriers to admission. (For example, in Brownsville, Texas, about 40 percent of women deliver out of hospital*
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From page 21... ...
Women need good health care whether pregnant or not, and plans to improve maternity services should always be developed within this broader context. STUDY METHOD The Committee surveyed existing or recently completed prenatal care programs in order to understand the range of approaches currently being used to increase participation in care, and to determine if data were available to judge their effect.
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From page 22... ...
The objective of studying a given program was not merely to understand its approach to improving access, but also to determine which activities appeared effective, with what populations, and under what circumstances. The Committee posed the question: What is the evidence that the approach leads to earlier registration in prenatal care, to participation in care by women previously unserved, to improved continuation in care once begun, or any combination of these?
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From page 23... ...
Chapter 5 presents the Committee's conclusions and recommendations; these are directed toward those involved in national, state, and local health policy; those who provide maternity services; health services researchers; and leaders in the private sector, particularly those in foundations who fund maternity care programs and related research. Appendix A describes individually the 31 programs studied.
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From page 24... ...
The Pane! has proposed that the impact of prenatal care be assessed in terms of maternal, infant, and family health, including, for example, maternal and fetal mortality, the developmental progress of preterm infants, family functioning, planning for future pregnancies, child abuse and neglect, and maternal stress.22 While awaiting the Panel's report and further consideration of the content of prenatal care, the Committee has elected to use a broad definition of prenatal care in this volume.
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From page 25... ...
Hughes DC, and Johnson K Maternal and child health services for medically indigent children and pregnant women.
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