Health and insurance status of pregnant low-income women with chronic illness

As preconception and interconception care gain attention as strategies for improving pregnancy outcomes, it is important to understand the role of chronic illness prior to pregnancy, particularly among low-income women. A postpartum survey of 130 African-American low-income women in two high-risk Chicago communities asked about health and insurance status before and during pregnancy.

The mean age of respondents was 25.4 years, almost 60% had a high school education or less, and the average number of previous live births was 1.9. During pregnancy, 42.3% received TANF, 80.8% used WIC and food stamps, and 59.2% reported total household income under $1000/month.

Medicaid coverage prior to pregnancy was reported by 76% of the participants, private insurance by 11.5%, and 11.5% were uninsured. Ninety-three percent of the women reported Medicaid payment for delivery.

Participants reported 11 chronic illnesses, including lung problems/asthma (20.8%), migraines (16.9%), and obesity/overweight (10.8%). Among women with pre-pregnancy chronic illness, 85.2% had pre-pregnancy Medicaid, 11.5% had private insurance, and 3.3% were uninsured. Among women without chronic illness, 70.8% had pre-pregnancy Medicaid, 9.2% had private insurance, and 20% were uninsured. The prevalence of pre-pregnancy Medicaid coverage among participants is likely due to Illinois' generous Medicaid policies, including its Illinois Healthy Women program, and/or the high prevalence of TANF assistance among this group.

The pervasiveness of chronic illness prior to pregnancy among this population underscores the significance of pre-pregnancy health insurance for low-income women. In order for women with chronic illness to enter pregnancy healthy and obtain needed care, pre-pregnancy insurance is critical.