Obstetrics and Gynecology
Volume 130, Issue 5, 2017, Pages 938-945

Expanding prenatal care to unauthorized immigrant women and the effects on infant health (Article)

Swartz J.J. , Hainmueller J. , Lawrence D. , Rodriguez M.I.*
  • a Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States, Department of Political Science, Immigration Policy Laboratory, Graduate School of Business, Stanford University, Stanford, CA, United States
  • b Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States, Department of Political Science, Immigration Policy Laboratory, Graduate School of Business, Stanford University, Stanford, CA, United States
  • c Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States, Department of Political Science, Immigration Policy Laboratory, Graduate School of Business, Stanford University, Stanford, CA, United States
  • d Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States, Department of Political Science, Immigration Policy Laboratory, Graduate School of Business, Stanford University, Stanford, CA, United States

Abstract

Objective: To measure the effect of access to prenatal care on unauthorized and low-income, new legal permanent resident immigrant women and their offspring. Methods: We used a difference-in-differences design that leverages the staggered rollout of Emergency Medicaid Plus by county from 2008 to 2013 as a natural experiment to estimate the effect on health service utilization for women and health outcomes for their infants. Regular Medicaid pregnancies were used as an additional control in a triple difference design. Results: Our sample included pregnancies covered by Emergency Medicaid (35,182), Emergency Medicaid Plus (12,510), and Medicaid (166,054). After expansion of access to prenatal care, there was an increase in prenatal visits (7.2 more visits, 95% CI 6.45-7.96), receipt of adequate prenatal care (28% increased rate, CI 26-31), rates of diabetes screening (61% increased rate, CI 56-66), and fetal ultrasonograms (74% increased rate, CI 72-76). Maternal access to prenatal care was also associated with an increased number of well child visits (0.24 more visits, CI 0.07-0.41), increased rates of recommended screenings and vaccines (0.04 increased probability, CI 0.002-0.074), and reduced infant mortality (21.01/1,000, CI 21.42 to 20.60) and rates of extremely low birth weight (less than 1,000 g) (21.33/1,000, CI 22.44 to 20.21). Conclusion: Our results provide evidence of increased utilization and improved health outcomes for unauthorized immigrants and their children who are U.S. citizens after introduction of prenatal care expansion in Oregon. This study contributes to the debate around reauthorization of the Children's Health Insurance Program in 2017. © 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Author Keywords

[No Keywords available]

Index Keywords

immigrant rhesus antibody progeny prenatal care lowest income group poverty human statistics and numerical data diabetes mellitus priority journal premature labor outpatient resident fetus echography Undocumented Immigrants United States Humans migrant undocumented immigrant Infant, Newborn Emigrants and Immigrants female Infant newborn pregnancy child health Glucose Tolerance Test Article extremely low birth weight health care utilization pregnancy outcome adult patient attitude Infant Mortality medicaid prenatal screening Patient Acceptance of Health Care ethnicity Infant Health first trimester pregnancy Oregon Health Services Accessibility child death health care delivery
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85032629904&doi=10.1097%2fAOG.0000000000002275&partnerID=40&md5=59185abc6b45879ee5895f2c6e01b11e
DOI: 10.1097/AOG.0000000000002275
ISSN: 00297844
Cited by: 11
Original Language: English