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Health Care Access and Birth Outcome

Bruce Ferguson, MD
JAMA. 1993;269(19):2506-2507. doi:10.1001/jama.1993.03500190048027.
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To the Editor.  —A recent article by Haas et al1 reported that expansion of Medicaid coverage to uninsured low-income pregnant women with incomes up to 185% of federal poverty level "was not associated with improvements in access to prenatal care or birth outcomes." This is not surprising; Schlesinger and Dronebusch said that "requiring the states to expand Medicaid eligibility... is likely to yield small improvements in access, [and] may well create counterproductive side effects. While financial barriers undoubtedly are important, we believe that the relative importance of other attitudes, motivations, and constraints on women's behavior during pregnancy has not been adequately assessed... Ambivalent feelings about pregnancy [have] had a large effect on access to care."2 Although some possible causes of the Massachusetts results were mentioned by Haas et al, ambivalent feelings about pregnancy or even "unwanted" pregnancy were not mentioned, although the high prevalence of ambivalent feelings about


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