Abstract
OBJECTIVES: This study examined the income distribution of childbearing women in California and sought to identify income groups at increased risk of untimely prenatal care. METHODS: A 1994/95 cross-sectional statewide survey of 10,132 postpartum women was used. RESULTS: Sixty-five percent of all childbearing women had low income (0%-200% of the federal poverty level), and 46% were poor (0%-100% of the federal poverty level). Thirty-five percent of women with private prenatal coverage had low income. Most low-income women with Medi-Cal (California's Medicaid) or private coverage received their prenatal care at private-sector sites. Compared with women with incomes over 400% of the poverty level, both poor and near-poor women were at significantly elevated risk of untimely care after adjustment for insurance, education, age, parity, marital status, and ethnicity (adjusted odds ratios = 5.32 and 3.09, respectively). CONCLUSIONS: This study's results indicate that low-income women are the mainstream maternity population, not a "special needs" subgroup; even among privately insured childbearing women, a substantial proportion have low income. Efforts to increase timely prenatal care initiation cannot focus solely on women with Medicaid, the uninsured, women in absolute poverty, or those who receive care at public-sector sites.
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Selected References
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- Blane D. Social determinants of health--socioeconomic status, social class, and ethnicity. Am J Public Health. 1995 Jul;85(7):903–905. doi: 10.2105/ajph.85.7.903. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Egbuonu L., Starfield Child health and social status. Pediatrics. 1982 May;69(5):550–557. [PubMed] [Google Scholar]
- Forrest J. D., Singh S. Timing of prenatal care in the United States: how accurate are our measurements? Health Serv Res. 1987 Jun;22(2):235–253. [PMC free article] [PubMed] [Google Scholar]
- Gornick M. E., Eggers P. W., Reilly T. W., Mentnech R. M., Fitterman L. K., Kucken L. E., Vladeck B. C. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med. 1996 Sep 12;335(11):791–799. doi: 10.1056/NEJM199609123351106. [DOI] [PubMed] [Google Scholar]
- Guralnik J. M., Land K. C., Blazer D., Fillenbaum G. G., Branch L. G. Educational status and active life expectancy among older blacks and whites. N Engl J Med. 1993 Jul 8;329(2):110–116. doi: 10.1056/NEJM199307083290208. [DOI] [PubMed] [Google Scholar]
- Haan M., Kaplan G. A., Camacho T. Poverty and health. Prospective evidence from the Alameda County Study. Am J Epidemiol. 1987 Jun;125(6):989–998. doi: 10.1093/oxfordjournals.aje.a114637. [DOI] [PubMed] [Google Scholar]
- Hahn R. A., Eaker E., Barker N. D., Teutsch S. M., Sosniak W., Krieger N. Poverty and death in the United States--1973 and 1991. Epidemiology. 1995 Sep;6(5):490–497. [PubMed] [Google Scholar]
- Harvey S. M., Faber K. S. Obstacles to prenatal care following implementation of a community-based program to reduce financial barriers. Fam Plann Perspect. 1993 Jan-Feb;25(1):32–36. [PubMed] [Google Scholar]
- Melnikow J., Alemagno S. Adequacy of prenatal care among inner-city women. J Fam Pract. 1993 Dec;37(6):575–582. [PubMed] [Google Scholar]
- Montgomery L. E., Kiely J. L., Pappas G. The effects of poverty, race, and family structure on US children's health: data from the NHIS, 1978 through 1980 and 1989 through 1991. Am J Public Health. 1996 Oct;86(10):1401–1405. doi: 10.2105/ajph.86.10.1401. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pappas G., Queen S., Hadden W., Fisher G. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med. 1993 Jul 8;329(2):103–109. doi: 10.1056/NEJM199307083290207. [DOI] [PubMed] [Google Scholar]
- Singh S., Torres A., Forrest J. D. The need for prenatal care in the United States: evidence from the 1980 National Natality Survey. Fam Plann Perspect. 1985 May-Jun;17(3):118–124. [PubMed] [Google Scholar]
- Sorlie P. D., Backlund E., Keller J. B. US mortality by economic, demographic, and social characteristics: the National Longitudinal Mortality Study. Am J Public Health. 1995 Jul;85(7):949–956. doi: 10.2105/ajph.85.7.949. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Torres A., Kenney A. M. Expanding Medicaid coverage for pregnant women: estimates of the impact and cost. Fam Plann Perspect. 1989 Jan-Feb;21(1):19–24. [PubMed] [Google Scholar]
- Winkleby M. A., Jatulis D. E., Frank E., Fortmann S. P. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health. 1992 Jun;82(6):816–820. doi: 10.2105/ajph.82.6.816. [DOI] [PMC free article] [PubMed] [Google Scholar]
