Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Prenatal Care in the Paso del Norte Border Region

Journal of Perinatology volume 24, pages 62–71 (2004)Cite this article

Abstract

OBJECTIVES: The impact of a Medicaid-managed care system on access to prenatal care was investigated.

STUDY DESIGN: Postpartum interviews and medical chart abstractions were conducted among 493 Hispanic women who reside on the El Paso Texas/Juarez Mexico border (the Paso del Norte region). Descriptive analysis identified barriers and facilitators to prenatal care. Logistic regression identified the impact of social and demographic characteristics on selected maternal and infant outcomes.

RESULTS: The factors reported by these women as barriers to timely entry and sustaining enrollment in prenatal care were related to the availability of social support networks and affiliation with the Mexican/Hispanic culture (acculturation). Having Medicaid-managed care or other insurance was associated with receiving more adequate levels of prenatal care. Women who crossed the border to seek perinatal services were more likely to have infants who received higher levels of neonatal care (odds ratio 0.500; 95% CI [0.264, 0.946]).

CONCLUSIONS: The promotion of preconceptional, prenatal, and family planning services is strongly recommended as a strategic, regional, public health intervention.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Gonen JS . Medicaid managed care: the challenge of providing care to low-income women. Women's Health Issues 1999;9(2, Suppl 1):57S–67S.

    Article  CAS  Google Scholar 

  2. Balcazar H, Hartner J, Cole G . The effects of prenatal care utilization and maternal risk factors on pregnancy outcome between Mexican Americans and non-Hispanic whites. J Nat Med Assoc 1993;85(3):195–202.

    CAS  Google Scholar 

  3. Fiscella K . Does prenatal care improve birth outcomes? A critical review. Obstet Gynecol 1995;85(3):468–479.

    Article  CAS  Google Scholar 

  4. Sherraden MS, Barrera RE . Prenatal care experiences and birth weight among Mexican immigrant women. J Med Systems 1996;20(5):329–350.

    Article  CAS  Google Scholar 

  5. Simpson L, Korenbrot C, Greene J . Outcomes of enhanced prenatal services for Medicaid-eligible women in public and private settings. Public Health Rep 1997;112(2):122–132.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Baldwin L, Larson C, Connell F, et al. The effect of expanding Medicaid prenatal services on birth outcomes. Am J Public Health 1998;88:1623–1629.

    Article  CAS  Google Scholar 

  7. Homan R, Korenbrot C . Explaining variation in birth outcomes of Medicaid -eligible women with variation in the adequacy of prenatal support services. Med Care 1998;26(2):190–201.

    Article  Google Scholar 

  8. York R, Grant C, Gibeaur A, et al. A review of problems of universal access to prenatal care. Nurs Clin North America 1996;31(2):279–293.

    CAS  Google Scholar 

  9. Culpepper L, Jack B . Prenatal visits — it's not the number; it's the content. Birth 1996;23(4):236–238.

    Article  CAS  Google Scholar 

  10. Goss GL, Lee K, Koshar J, et al. More does not mean better: Prenatal visits and pregnancy outcome in the Hispanic population. Public Health Nurs 1997;14(3):183–188.

    Article  CAS  Google Scholar 

  11. Villar J, Bergsjo P . Scientific basis for the content of routine antenatal care. I. Philosophy, recent studies and power to eliminate or alleviate adverse maternal outcomes. Acta Obstet Gynecol Scand 1997;76(1):1–14.

    Article  CAS  Google Scholar 

  12. Misra D, Guyer B . Benefits and limitations of prenatal care. From counting visits to measuring content. JAMA 1998;279(20):1661–1662.

    Article  CAS  Google Scholar 

  13. Carroli G, Rooney C, Villar J . How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatr Perinat Epidemiol 2001;15(Suppl 1):1–42.

    Article  Google Scholar 

  14. Albrecht S, Miller M . Hispanic subgroup differences in prenatal care. Soc Biol 1996;43(1–2):38–58.

    CAS  PubMed  Google Scholar 

  15. Byrd T, Mullen P, Selwyn B, et al. Initiation of prenatal care by low-income Hispanic women in Houston. Public Health Rep 1996;111(6):536–540.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Tossounian S, Schoendorf K, Kiely J . Racial differences in perceived barriers to prenatal care. Matern Child Health J 1997;1(4):229–236.

    Article  CAS  Google Scholar 

  17. Mikhail B . Perceived impediments to prenatal care among low-income women. West J Nurs Res 1999;21(3):335–355.

    Article  CAS  Google Scholar 

  18. Zambrana R, Scrimshaw S, Collins N, et al. Prenatal health behaviors and psychosocial risk factors in pregnant women of Mexican origin: the role of acculturation. Am J Public Health 1997;87(6):1022–1026.

    Article  CAS  Google Scholar 

  19. Healthy People 2010. National Health Promotion and Disease Prevention Objectives. US Department of Health and Human Services. Public Health Service, Washington, DC; 2000.

  20. Frisbie WP, Echevarria S, Hummer RA . Prenatal care utilization among non-Hispanic Whites, African Americans, and Mexican-Americans. Matern Child Health J 2001;5(1):21–33.

    Article  CAS  Google Scholar 

  21. Drinkard C, Shatin D, Luo D, et al. Healthy Pregnancy Program in a national managed care organization: evaluation of satisfaction and health behavior outcomes. Am J Managed Care 2001;7(4):377–386.

    Article  CAS  Google Scholar 

  22. Griffin J, Hogan J, Buechner J, et al. The effect of a Medicaid managed care program on the adequacy of prenatal care utilization in Rhode Island. Am J Public Health 1999;89:497–501.

    Article  CAS  Google Scholar 

  23. Raube K, Merrell K . Medicaid managed care in Chicago: changes in utilization. J Health Care Poor Underserved 2000;11(2):195–211.

    Article  CAS  Google Scholar 

  24. Oleske D, Linn E, Nachman K, et al. Effect of Medicaid managed care on pregnancy complications. Obstet Gynecol 2000;95(1):6–13.

    CAS  PubMed  Google Scholar 

  25. Cooper W, Hickson G, Mitchel E, et al. Comparison of perinatal outcomes among TennCare managed care organizations. Pediatrics 1999;104(3):525–529.

    Article  CAS  Google Scholar 

  26. Gazmararian J, Arrington T, Bailey C, et al. Prenatal care for low-income women enrolled in a managed-care organization. Obstet Gynecol 1999;94(2):177–184.

    CAS  PubMed  Google Scholar 

  27. Cokkinides V . Health insurance coverage-enrollment and adequacy of prenatal care utilization. J Health Care Poor Underserved 2001;12(4):460–473.

    Article  Google Scholar 

  28. Howell E . The impact of the Medicaid expansions for pregnant women: a synthesis of the evidence. Med Care Res Rev 2001;58(1):3–28.

    Article  CAS  Google Scholar 

  29. Dubay L, Joyce T, Kaestner R, et al. Changes in prenatal care timing and low birth weight by race and socioeconomic status: implications for the Medicaid expansions for pregnant women. Health Services Res 2001;36(2):399–403.

    Google Scholar 

  30. March of Dimes. Perinatal Profiles: Statistics for Monitoring State Maternal and Infant Health, New York: White Plains; 1998.

  31. Kessner DM, Singer J, Kalk CE, et al. Infant death. An analysis by maternal risk and health care. In: Kessner DM, editor. Contrasts in Health Status. Vol. 1. Washington, DC: Institute of Medicine and National Academy of Sciences; 1973.

    Google Scholar 

  32. Texas State Department of Health. Texas health data: Birth data, Accessed on-line June 2002 @ http://soupfin.tdh.state.tx.us/birthdoc.htm.

  33. Khan A, Bhardwaj A . Access to health care: a conceptual framework and its relevance to health care planning. Eval Health Professions 1994;17(1):60–76.

    Article  CAS  Google Scholar 

  34. Texas State Department of Health. Population data. Accessed on-line June 2002 @ http://soupfin.tdh.state.tx.us/people.htm.

  35. Fullerton J, Nelson C, Shannon R . Development of a survey research instrument for a study of Hispanic, border-dwelling pregnant women: pragmatic strategies and approaches. Hispanic Health Care Int 2002;1(3):128–134.

    Google Scholar 

  36. Timmins C . The impact of language barriers on the health care of Latinos in the United States: a review of the literature and guidelines for practice. J Midwif Womens Health 2002;47:80–96.

    Article  Google Scholar 

  37. Weech-Maldonado R, Morales L, Elliott M, et al. Race/ethnicity, language and patients' assessments of care in Medicaid managed care. Health Services Res 2003;38(3):789–807.

    Article  Google Scholar 

  38. Wallman K, Evinger S, Schechter S . Measuring our nations's diversity: developing a common language for data on race/ethnicity. Am J Public Health 2000;90(11):1704–1708.

    Article  CAS  Google Scholar 

  39. Zambrana R, Carter-Pokras O . Health data issues for Hispanics: implications for public health research. J Health Care Poor Underserved 2001;12(1):20–21.

    Article  CAS  Google Scholar 

  40. Rogers R, Gilson G, Miller A, et al. Active management of labor: does it make a difference? Am J Obstet Gynecol 1997;177:599–605.

    Article  CAS  Google Scholar 

  41. Prendiville WJ, Elbourne D, McDonald S . Active versus expectant management of the third stage of labour (Cochrane Review). In: The Cochrane Library, Issue 2. Oxford: Update Software; 1999.

    Google Scholar 

  42. Amaya M, Pingitore N . The border basket study. Retrieved 10/3/01 from: http://borderbaseket.utep.edu/sources.

  43. Amaya M, Pngitore N . Prevention of childhood toxic lead exposure in a U.S.–Mexico border community. Project #EH 97. Retrieved 10/3/01 from: http://www.scerp.org.

  44. Tabet SR, Wiese WH . Medications obtained in Mexico by patients in southern New Mexico. South Med J 1990;83(3):271–273.

    Article  CAS  Google Scholar 

  45. Casner PR, Guerra LG . Purchasing prescription medication in Mexico without a prescription. The experience at the border. West J Med 1992;156(5):512–516.

    CAS  PubMed  PubMed Central  Google Scholar 

  46. Kotelchuck M . An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. Am J Public Health 1994;84(9):1414–1420.

    Article  CAS  Google Scholar 

  47. Kotelchuck M . The Adequacy of Prenatal Care Utilization Index: its US distribution and association with low birthweight. Am J Public Health 1994;84(9):1486–1489.

    Article  CAS  Google Scholar 

  48. Norbeck JS, Anderson NJ . Life stress, social support, and anxiety in mid-and late-pregnancy among low income women. Res Nurs Health 1989;12:281–287.

    Article  CAS  Google Scholar 

  49. Schaffer M, Lia-Hoagberg B . Effects of social support on prenatal care and health behaviors of low-income women. J Obstet Gynecol Neonat Nursing 1996;26:433–440.

    Article  Google Scholar 

  50. Hodnett ED . Continuity of caregivers for care during pregnancy and childbirth (Cochrane Review). In: The Cochrane Library, Issue 2. Oxford: Update Software; 1999.

    Google Scholar 

  51. Thompson WW . Cross-border health care utilization and practices of Mexican-Americans in the Lower Rio Grande Valley. Border Health J 1993;9(2):1–9.

    Google Scholar 

  52. Macias E, Morales L . Crossing the border for health care. J Health Care Poor Underserved 2001;12(1):77–87.

    Article  CAS  Google Scholar 

  53. Parchman M, Byrd T . Access to and use of ambulatory health care by a vulnerable Mexican American population on the US-Mexico border. J Health Care Poor Underserved 2001;12(4):404–414.

    Article  CAS  Google Scholar 

  54. Cobas JA, Balcazar H, Benin MB, et al. Acculturation and low-birthweight infants among Latino women: a reanalysis of HHANES data with structural equation models. Am J Public Health 1996;86:394–396.

    Article  CAS  Google Scholar 

  55. Koshar JH, Lee KA, Goss G, et al. The Hispanic teen mother's origin of birth, use of prenatal care and maternal and neonatal complications. J Ped Nursing 1998;13(3):151–157.

    Article  CAS  Google Scholar 

  56. Heilemann M, Lee K, Stinson J, et al. Acculturation and perinatal health outcomes among rural women of Mexican descent. Res Nurs Health 2000;23:118–125.

    Article  CAS  Google Scholar 

  57. Jones ME, Kubelka S, Bond ML . Acculturation status, birth outcomes, and family planning compliance among Hispanic teens. J School Nursing 2001;17(2):83–89.

    Article  CAS  Google Scholar 

  58. Byrd TL, Balcazar H, Hummer R . Acculturation and breast-feeding intention and practice in Hispanic women on the US–Mexico border. Ethnicity Disease 2001;11(1):72–79.

    CAS  PubMed  Google Scholar 

  59. Deyo R, Diehl A, Hazuda H, et al. A simple language-based acculturation scale for Mexican Americans: Validation and application to health care research. Am J Public Health 1985;75(1):51–55.

    Article  CAS  Google Scholar 

  60. Nothnagle M, tenMarchi K, Egerter S, et al. Risk factors for late or no prenatal care following Medicaid expansions in California. Mat Child Health J 2000;4(4):251–259.

    Article  CAS  Google Scholar 

  61. Egeter S, Braveman P, Marchi K . Timing of insurance coverage and use of prenatal care among low-income women. Am J Public Health 2002;92(3):423–427.

    Article  Google Scholar 

  62. Currie J, Grogger J . Medicaid expansions and welfare contractions: offsetting effects on prenatal care and infant health? J Health Econom 2002;21(2):313–335.

    Article  Google Scholar 

  63. Peacock NR, Kelley MA, Carpenter C, et al. Pregnancy discovery and acceptance among low-income primiparous women: a multicultural exploration. Mat Child Health J 2001;5(2):109–118.

    Article  CAS  Google Scholar 

  64. Pagnini D, Reichman N . Psychosocial factors and the timing of prenatal care among women in New Jersey's HealthStart Program. Fam Plan Perspectives 2000;32(2):56–64.

    Article  CAS  Google Scholar 

  65. Hulsey TM . Association between early prenatal care and mother's intentions of and desire for pregnancy. J Obstet Gynecol Neonat Nurs 2001;30(3):275–282.

    Article  CAS  Google Scholar 

  66. Buekens P, Notzon F, Kotelchuck M, et al. Why do Mexican Americans give birth to few low-birth-weight infants? Am J Epidemiol 2000;152:347–351.

    Article  CAS  Google Scholar 

  67. Williams D . The “epidemiological paradox” of health indicators and the Texas–Mexico border. Texas J Rural Health 2002;20(2):42–60.

    Google Scholar 

  68. Morales L, Lara M, Kington R, Valdez R, Escarce J . Socioeconomic, cultural and behavioral factors affecting Hispanic health outcomes. J Health Care Poor Underserved 2002;13(4):477–503.

    Article  Google Scholar 

  69. Centers for Disease Control. Revisions of the U.S. standard certificates of live birth and death and the fetal death report, available on-line at: http://www.cdc.gov/nchs/cital_certs_rev.htm.

  70. Mustafa G, David RJ . Comparative accuracy of clinical estimate versus menstrual gestational age in computerized birth certificates. Public Health Rep 2001;116(1:15–21.

    Article  CAS  Google Scholar 

  71. Clark K, Fu C, Burnett C . Accuracy of birth certificate data regarding the amount, timing and adequacy of prenatal care using prenatal clinic medical records as referents. Am J Epidemiol 1997;145(1):68–71.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The project described was supported by a grant from the Paso del Norte Health Foundation through the Center for Border Health Research Initiative. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Paso del Norte Health Foundation or the Center for Border Health Research Initiative.

Author information

Authors and Affiliations

  1. School of Nursing, University of Texas, El Paso, TX, USA

    Judith T Fullerton PhD, CNM, FACNM & Carlene Nelson PhD, CNM

  2. Department of Mathematical Sciences, University of Texas, El Paso, TX, USA

    Julia Bader PhD

  3. Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center, USA

    Carlene Nelson PhD, CNM & Rachel Shannon MSN, CNM

Authors
  1. Judith T Fullerton PhD, CNM, FACNM
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlene Nelson PhD, CNM
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rachel Shannon MSN, CNM
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Julia Bader PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Statistical assistance was provided by University of Texas at El Paso Statistical Consulting Laboratory via NIH RCMI Grant 2G12-RR08124.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fullerton, J., Nelson, C., Shannon, R. et al. Prenatal Care in the Paso del Norte Border Region. J Perinatol 24, 62–71 (2004). https://doi.org/10.1038/sj.jp.7211028

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211028

This article is cited by

Search

Advanced search

Quick links