The primary objective of this research is to determine whether, within a population of Medicaid births, there is an association between poor birth outcomes and source of prenatal care. A corollary objective is to determine if adequate prenatal care is obtained differentially by Medicaid recipients at public versus private prenatal care sites. While the exact mechanism by which prenatal care acts to influence good birth outcomes is poorly understood, early and adequate prenatal care reduces the incidence of low birth weight and infant mortality. The Medicaid population is at high risk for poor birth outcomes and poor utilization of prenatal care. A further aim of this research is to compare whether demographic and reproductive risk factors among Medicaid prenatal care recipients vary between women who receive services at public versus private prenatal care sites. Because neither the distribution of public and private sties nor the prevalence of poor birth outcomes is distributed uniformly across geographic regions, the final analytic objective is to determine regional effects on birth outcomes which may be attributable to the joint distribution of provider sites and characteristics of the resident Medicaid population. Natality data from 1988 demonstrate a continuation in the decline of U.S. maternal and infant health status indicators concurrent with the 1986 Medicaid expansion expected to increase Medicaid enrollment and access to prenatal care. This study will analyze differences between the adequacy and content of prenatal care, utilization of health services, source of prenatal care, and low birthweight outcomes in a representative sample of Medicaid recipients using data from the 1988 National Maternal and Infant Health Survey, a nationally representative cross-sectional linked survey of vital records and maternal, provider, and hospital questionnaires. If differences in birth outcomes are found, it suggests there are differences in the characteristics of the population of women who receive prenatal care, or there are differences in the care provided to these women. Because the current proposal for national health care reform constitutes the greatest opportunity for social transformation since the Social Security Act of 1935 and the Great Society programs of the 1960s, research finding on the adequacy of parental care and low birthweight outcomes among the Medicaid population appear timely if not urgent in guiding health care reform for this high risk population.
