A Hawaii Case Study on Interconception Care for Women on Quest/Medicaid

Background:

Quest/Medicaid is a crucial source of health coverage for low-income pregnant women and their infants. Previous research suggests that two months of interconception care is an inadequate amount of time for post-delivery care, which may contribute to adverse health outcomes.

Study Purpose:

To determine if women on Quest/Medicaid have more adverse outcomes compared to women with other health insurance.

Methods:

Data from the Hawaii Pregnancy, Risk, Assessment, and Monitoring System, a population-based surveillance system of self-reported information on maternal behaviors and experiences before, during and after the birth of a live infant were analyzed for 2004-2006. Women on Quest/Medicaid were compared to those with other health insurance for differences in risk factors and other health outcomes.

Findings:

Women on Quest/Medicaid were: 3 times less likely to access prenatal care in the first trimester (p<0.001); 1.5 times more likely to have an unintended pregnancy (p<0.001); 3 times more likely to smoke during last trimester (p<0.001); 3-4 times more likely to use illicit drugs during pregnancy (p<0.001); 2 times more likely to suffer post-partum depression (p<0.001); 10% more likely to have a low-birthweight (p=0.008) or premature infant (p=0.002); and 2 times less likely to have post-partum examinations (p<0.001) or to initiate breastfeeding (p<0.001) than women with other health insurance.

Implications:

Women on Quest/Medicaid are at increased risk for adverse perinatal health outcomes. This analysis has increased public policy discussion on this important MCH issue. Bills to extend interconception care for women on Quest/Medicaid have been introduced in the 2008 Hawaii State Legislature.