Health Insurance Status among Low-Wage, Female Workers of Child-Bearing Age in San Francisco

Pregnant Black and Latina women are 2-3 times more likely to enter prenatal care after the first-trimester than White or Asian women in San Francisco. We sought to understand this disparity by examining health insurance of women of childbearing age using data from the 2009 American Community Survey. The prevalence of health insurance (or coverage) was estimated by age, race/ethnicity, income, public assistance, neighborhood, and employment status. Approximately 25,500 women aged 19 to 44y did not have any health insurance or health coverage at the time of the survey; 26% of women 19-24y, 14% of women 25-34y, and 11% of women 35- 44y did not have health insurance. Black and Latina women of child-bearing age were 2-3 times more likely to be uninsured than White women. Most of the uninsured women 19-44y were working more than 20 hours/week (46%) or students (37%). The majority (57%) of the working, low-income, uninsured women were employed in 10 job codes (cooks, waitresses, home care aides, childcare workers, maids, personal appearance workers, retail sales, cashiers, bookkeeping clerks, and stock clerks). Racial disparities in preconception health care access mirror disparities in early prenatal care (and poor birth outcomes). The data suggest need for policy and program change to increase preventive health care access and utilization for young women, including students and those working in low-moderate wage jobs. Work is needed to pursue preventive healthcare services for women as a way to improve early access to prenatal care and birth outcomes.