The 130th Annual Meeting of APHA

Abstract #45061

Arden S. Handler, DrPH¹, Deborah Rosenberg, PhD², E Kathleen Adams, PhD³, Meagan Zimbeck, BA¹, and Kristin Rankin². (1) Community Health Sciences, University of Illinois School of Public Health, 1603 West Taylor, Chicago, IL 60612, 312-996-5954, handler@uic.edu, (2) Epidemiology & Biostatistics, SPH, University of Illinois, 1603 W. Taylor, Chgo, IL 60612, (3) Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA 30322

The implementation on August 22, 1996 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) was one of the most far-reaching policy changes in the past decade. While its major aim was to reduce welfare caseloads, it is likely that the PRWORA has had an impact on the financing of prenatal care and prenatal care utilization (pnc). This pre-post comparison of sampled birth cohorts uses Pregnancy Risk Assessment Monitoring System (PRAMS) data from 9 states (Alaska, Florida, Georgia, Maine, New York State, Oklahoma, S. Carolina, Washington and West Virginia) for the years 1994-1999 to examine the effect of the PRWORA on the insurance coverage and pnc utilization of women on public aid. In this dataset in 1994, 88% of pregnant women who reported that they had received public assistance as a source of income also reported that they had Medicaid insurance coverage for prenatal care; in 1999 this figure dropped to 80%, although in both years it is likely that all of these women were eligible for Medicaid coverage during pregnancy. In 1994, 68% of pregnant women receiving any public assistance initiated prenatal care in the first trimester; this figure was unchanged in 1999 despite progress at the national level for the general population for this indicator. After several decades of policy efforts to improve access to and utilization of pnc, it is essential that the effect of welfare reform on women's initiation and use of prenatal care be monitored so that negative effects can be counteracted.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Identify the changes in the insurance status of pregnant women who are recipients of public aid since the implementation of welfare reform.
• Identify the changes in prenatal care utilization of pregnant women who are recipients of public aid since the implementation of welfare reform.
• Discuss how welfare reform has had an effect on women's health and health care utilization beyond its effect on the reduction of welfare caseloads.

Keywords: Welfare Reform, Prenatal Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.