All ETDs from UAB

Advisory Committee Chair

Martha S Wingate

Advisory Committee Members

E Michael Foster

Janet Bronstein

Milton Kotelchuck

Bisakha Sen

Document Type

Dissertation

Date of Award

2012

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

In 2002 the State Children's Health Insurance Program (SCHIP) "unborn child ruling" was established to provide prenatal care (PNC) to low income women otherwise without health insurance. The majority of foreign-born (FB) Latinas otherwise ineligible for PNC should have benefited most from the ruling. In late 2003 six states incorporated the UCR into their state plan amendments, providing a natural experiment for policy analysis. This study used cross-sectional pooled natality data from 2000-2007 to estimate the effect of the UCR on prenatal care utilization (PNCU) and birth outcomes. A differences-in-differences econometrics model was employed using policy enacting and non-enacting states, an high eligibility treatement and low eligibility control populations. Findings support the UCR in increasing PNCU scores especially for vulnerable Latinas. Significant increases in PNCU and declines in large for gestational age (LGA) infants were associated with comprehensive state-funded PNC programs for Latinas. Comprehensive state reform initiatives that provide PNC to ineligible Latinas appear to narrow the persistent disparities in PNCU and may improve birth outcomes.

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