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From page 245... ... , 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 Read the entire page →
From page 246... ... , 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) Read the entire page →
From page 247... ... , 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) Read the entire page →
From page 248... ... 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 Read the entire page →
From page 249... ... 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 Read the entire page →
From page 250... ... , 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) Read the entire page →
From page 251... ... , 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) Read the entire page →
From page 252... ... , 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) Read the entire page →
From page 253... ... , 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 Read the entire page →
From page 254... ... . 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) Read the entire page →

From page 245...

... , 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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From page 246...

... , 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)

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From page 247...

... , 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)

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From page 248...

... 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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From page 249...

... 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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From page 250...

... , 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)

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From page 251...

... , 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)

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From page 252...

... , 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)

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From page 253...

... , 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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From page 254...

... . 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)

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Index Pages 245-254

Index
Pages 245-254