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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 15: Continuous and Adequate Insurance

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Strategy. Expansion of Access to Prenatal Care

Approach. Expand access to prenatal care to increase coverage and improve health outcomes for immigrant women and their infants.

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Overview. Research indicates that prenatal care is an important component of preventive health care with multigenerational consequences for women and their families. A structured expansion of Emergency Medicaid Plus can provide access to prenatal care for a vulnerable immigrant population.1

Evidence. Scientifically Rigorous. There is strong evidence that expansion of access to prenatal care for immigrant women can result in a significant increase in adequate prenatal care, well-child visits, and reduced incidence of infant mortality and extreme low birth weight. These strategies have been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Pregnant women and their infants.

Outcome. Increase in adequate insurance for children (increase in coverage and care for women and their infants). For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the “Intervention Results” for each study.

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Expand access to prenatal care to increase coverage and improve health outcomes for immigrant women and their infants,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of pregnant women covered by a prenatal care expansion.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of prenatal visits after rollout of the prenatal care expansion.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of pregnant women reporting improved knowledge and/or positive behavior changes as a result of prenatal visits.
  • Number of infants receiving well-child visits.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of women receiving adequate prenatal care.
  • Percent of infants receiving recommended health services (e.g., screenings and vaccines).

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4):

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


1 Swartz JJ, Hainmueller J, Lawrence D, Rodriguez MI. Expanding prenatal care to unauthorized immigrant women and the effects on infant health. Obstetrics and gynecology. 2017 Nov;130(5):938.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.