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Expanding Prenatal Care to Unauthorized Immigrant Women and the Effects on Infant Health

Swartz, Jonas J. MD, MPH; Hainmueller, Jens PhD, MPA; Lawrence, Duncan PhD, MA; Rodriguez, Maria I. MD, MPH

doi: 10.1097/AOG.0000000000002275
Contents: Original Research
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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 (−1.01/1,000, CI −1.42 to −0.60) and rates of extremely low birth weight (less than 1,000 g) (−1.33/1,000, CI −2.44 to −0.21).

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.

Prenatal care expansion programs increase health service utilization and improve health outcomes for unauthorized immigrants and their U.S. citizen children.

Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; and the Department of Political Science, the Immigration Policy Laboratory, and the Graduate School of Business, Stanford University, Stanford, California.

Corresponding author: Maria I. Rodriguez, MD, MPH, Oregon Health and Science University, Department of Obstetrics and Gynecology, 3181 SW Sam Jackson Park Road, Mail Code UHN50, Portland, OR 97239; email:

Supported by a grant from the Robert Wood Johnson Foundation for Jens Hainmueller and Maria I. Rodriguez, grant 73792. Maria I. Rodriguez is a Women's Reproductive Health Research fellow; grant 1K12HD085809.

Financial Disclosure Dr. Rodriguez received grants from the National Institute of Health, personal fees from the World Health Organization, personal fees from Teva, personal fees from the Society of Family Planning Research Fund, and personal fees from Lupin, outside the submitted work. The other authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.