Nichole Shackleford

Nichole Shackleford

Health Care Mgt.

1/17/02

To address the issues discussed in class this week I read an article entitled “Changes in Prenatal Care Timing and Low birth Weight by Race and Socioeconomic Status: Implications for the Medicaid Expansions for Pregnant Women” by Lisa Dubay, et al. this article deals with the fact that birth outcomes, when categorized by race and socioeconomic status, have dramatic differences. These differences have been blamed on the lack of prenatal care availability. In response to this accusation, Medicaid coverage was extended to poor and near-poor pregnant women through legislation between 1986 and 1990. It would appear that this would create a solution to the problem, but evidence has been inconsistent to say the least.

The authors conducted a study to attempt to determine whether this Medicaid coverage for prenatal care was beneficial to increase the access to care and to improve birth outcomes among the poor. To do so, the study had to be carefully constructed to account for external factors. The study compared “rates of delayed initiation of prenatal care and rates of low birth weight by race and socioeconomic status for the periods 1980-86 and 19986-93” (Dubay 373). The authors expected that if the extension of the Medicaid coverage was beneficial then there should be an improvement in the outcomes of the rates from 1986 to 1993.

Women’s socioeconomic status was determined by the use of marital status and their educational level. It was determined that all unmarried women with less than a high school educations were eligible for Medicaid in 1993; however, only a small percentage of married women who obtained more than a high school education would qualify for Medicaid.

The study found that delayed initiation of prenatal care decreased dramatically between 1986 and 1993 among all women who were considered to be of a low socioeconomic level, regardless of race. These changes were significant when compared to the changes in the time period from 1980 to 1986. Given these findings it would appear that the goal of the extended Medicaid coverage was accomplished. However, there were not any significant results that proved that this expansion had a strong impact on low birth weight.

Although the expansion showed improvements in the timing of prenatal care, there are still differences found between race and socioeconomic levels. “In fact, the African American/white rate ratio for low birth weight actually increased over the period of the Medicaid expansions” (Dubay 398). There still are problems that can be related to poverty, race, and women’s behavior, not to mention access to health care. It will take more than health care legislations to solve this problem.

Dubay, Lisa, et al. “Changes in Prenatal Care Timing and Low Birth Weight by Race and Socioeconomic Status: Implications for the Medicaid Expansions for Pregnant Women.” Health Services Research. Chicago: June 2001.