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Use of Prenatal Care by Hispanic Women After Welfare Reform

From the ¹Departments of Pediatrics and Epidemiology and Biostatistics, University of California, San Francisco, California; ²Department of Medicine, University of California, San Francisco, California; ³New York Academy of Medicine, New York, New York; ⁴Department of Obstetrics and Gynecology, University of Miami, Coral Gables, Florida; ⁵Department of Obstetrics and Gynecology, Washington Hospital Center, Washington, DC; ⁶SUNY Downstate Medical Center, Brooklyn, New York; and the ⁷Departments of Obstetrics and Gynecology at SUNY Downstate and Maimonides Medical Center, Brooklyn, New York.

OBJECTIVE: The 1996 Personal Responsibility Work Opportunity Reconciliation Act (PRWORA, "welfare reform") changed immigrants' eligibility for publicly funded services such as Medicaid. However, implementation of the PRWORA varied by state. Florida implemented the eligibility restrictions, while California and New York preserved eligibility. Our objective was to compare the effect of state of residence and immigration status on use of prenatal care among Hispanic women in the period following the enactment of PRWORA.

METHODS: In 1999–2001, we interviewed 3,242 postpartum Hispanic women in California, Florida, and New York. The dependent variable was use of prenatal care, dichotomized as adequate (initiated during the first trimester and 6 visits, referent) or inadequate (initiated during the first trimester and < 6 prenatal visits or initiated after the first trimester). The primary independent variables were state of residence and maternal immigration status (U.S.-born citizens in New York, reference group).

RESULTS: Thirteen percent of women were U.S.-born citizens, 8% were foreign-born citizens, 15% were documented immigrants, and 64% were undocumented immigrants. In Florida, women in all immigration subgroups were 2–4 times more likely to make inadequate use of prenatal care than U.S.-born citizens in New York. Documented immigrant women in New York were 90% more likely to make inadequate use of prenatal care than U.S.-born citizens in New York.

CONCLUSION: Among Hispanic women in California, Florida, and New York, the state of residence, a measure of PRWORA policy changes, was associated with use of prenatal care.

LEVEL OF EVIDENCE: II-2

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				K. P. Derose, J. J. Escarce, and N. Lurie Immigrants And Health Care: Sources Of Vulnerability Health Aff., September 1, 2007; 26(5): 1258 - 1268. [Abstract] [Full Text] [PDF]