Prenatal care programs have proven effective in improving birth outcomes and preventing low birthweight. Yet over one-fourth of all pregnant women in the United States do not begin prenatal care in the first 3 months of pregnancy, and for some groups--such as black teenagers--participation in prenatal care is declining. To find out why, the authors studied 30 prenatal care programs and analyzed surveys of mothers who did not seek prenatal care. This new book reports their findings and offers specific recommendations for improving the nation's maternity system and increasing the use of prenatal care programs.

Contents

• COMMITTEE TO STUDY OUTREACH FOR PRENATAL CARE
• Acknowledgments
• Summary
• Introduction
• Chapter 1. Who Obtains Insufficient Prenatal Care?
  • Terminology and Measures
  • Current Patterns of Use
  • Relationships Among Demographic Risk Factors
  • Geographic Pockets of Need
  • Trends in the Use of Prenatal Care
  • Summary
  • References and Notes
• Chapter 2. Barriers to the Use of Prenatal Care
  • Financial Barriers
  • Inadequate System Capacity
  • Organization, Practices, and Atmosphere of Prenatal Services
  • Cultural and Personal Barriers
  • Summary
  • References and Notes
• Chapter 3. Women's Perceptions of Barriers to Care
  • Selection and Synthesis of Studies
  • Provider Perspectives
  • Multivariate Analysis
  • Summary
  • References
• Chapter 4. Improving the Use of Prenatal Care: Program Experience
  • Selection and Classification of Programs
  • The Programs Studied
  • Observations on Program Effectiveness
  • Program Design and Management
  • Common Difficulties in Program Implementation and Maintenance
  • Program Evaluation
  • Summary
  • References and Notes
• Chapter 5. Conclusions and Recommendations
  • Revising the Nation's Maternity Care System: A Long-Term Goal
  • Developing a Comprehensive, Multifacted Program: a Short-Term Goal
  • Financial Barriers
  • Inadequate System Capacity
  • Institutional Organization, Practices, and Atmosphere
  • Public Information and Education
  • The Role of Outreach: a General Framework
  • Casefinding
  • Social Support
  • Management and Evaluation
  • Research
  • A Note to Funders
  • Summary
  • References and Notes
• Appendix A Summaries of the 31 Programs Studied
• Appendix B Prenatal Care Outreach: An International Perspective
• Appendix C The Medical Malpractice Crisis and Poor Women

This project has been supported by the Ford Foundation, the Carnegie Corporation of New York, the March of Dimes Birth Defects Foundation, the Rockefeller Foundation, and the Division of Maternal and Child Health within the U.S. Department of Health and Human Services (SPRANS Grant No. MCJ-113852-02-HRSA).

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to the procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Instititute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.