Maternal and Child Health Journal

, Volume 11, Issue 1, pp 11–17 | Cite as

Prenatal care initiation among very low-income women in the aftermath of welfare reform: does pre-pregnancy Medicaid coverage make a difference?

  • Deborah Rosenberg
  • Arden Handler
  • Kristin M. Rankin
  • Meagan Zimbeck
  • E. Kathleen Adams
Original Paper


Objectives: To examine pre-pregnancy Medicaid coverage and initiation of prenatal care among women likely eligible for Medicaid coverage regardless of pregnancy. Methods: The Pregnancy Risk Assessment Monitoring System (PRAMS) was used to identify very low-income women with Medicaid payment for delivery. We then compared prenatal care initiation among women with (Non-GAP) and without (Medicaid GAP) pre-pregnancy Medicaid coverage. Results: Rates of first trimester prenatal care were 47.3% for women in the Medicaid GAP, 70.0% for women who were not. The adjusted odds ratio for being in the Medicaid GAP and delayed prenatal care was 2.7 (95% CI 1.2, 6.2), although this varied by race/ethnicity and education. The relationship was strongest among White and Hispanic women with less than a high school education: OR=13.8, (95% CI 3.0, 62.7) and OR=19.0 (95% CI 2.4, 149.2), respectively. Conclusions: Pre-pregnancy Medicaid coverage appears to be associated with early initiation of prenatal care. Almost a decade after welfare reform, it is essential to preserve the Medicaid expansions for pregnant women, foster Medicaid family planning waivers, and promote access to primary care and early prenatal care, particularly for very low-income women.


Prenatal Care Welfare Reform Pregnancy Risk Assessment Monitoring System Medicaid Coverage Medicaid Expansion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This analysis was conducted with funding support from the Maternal and Child Health Bureau Research Program, Grant R40MC00209. The authors thank members of the PRAMS staff at the Centers for Disease Control and Prevention and the PRAMS staff from the eight states included in this analysis for permitting us to use the PRAMS data and for reviewing and providing feedback on the completed manuscript.


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Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Deborah Rosenberg
    • 1
  • Arden Handler
    • 2
  • Kristin M. Rankin
    • 3
  • Meagan Zimbeck
    • 4
  • E. Kathleen Adams
    • 5
  1. 1.Epidemiology and BiostatisticsSchool of Public Health, University of Illinois at ChicagoChicagoUSA
  2. 2.Community Health SciencesSchool of Public Health, University of Illinois at ChicagoChicagoUSA
  3. 3.Center for the Advancement of Distance EducationSchool of Public Health, University of Illinois at ChicagoChicagoUSA
  4. 4.Institut National de la Sante et de la Recherche Medicale (INSERM)ParisFrance
  5. 5.Emory School of Public HealthAtlantaUSA

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