Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Sign up for MCHalert eNewsletter

Evidence Tools
MCHbest. Adequate Insurance.

MCHbest Logo

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

Return to main MCHbest page >>

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 immigrant populations facing barriers to healthcare access.[1]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Advocacy (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

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. Here are sample ESMs to use as models 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?")

PROCESS MEASURES:

  • Number of outreach activities conducted to promote prenatal care access for immigrant women (measures education and awareness efforts)
  • Number of partnerships established with community organizations serving immigrant populations (assesses collaboration networks)

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

PROCESS MEASURES:

  • Percent of healthcare providers trained on prenatal care services available through expanded programs (measures workforce preparation)
  • Percent of eligible women who receive information about prenatal care services in their preferred language (assesses accessibility of outreach)

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

PROCESS MEASURES:

  • Number of simplified enrollment procedures developed for prenatal care programs (facilitates easier access to services)
  • Number of clinics offering extended or flexible hours for prenatal appointments (increases service availability)

OUTCOME MEASURES:

  • Number of immigrant women who initiate prenatal care in the first trimester (demonstrates impact on early care access)
  • Number of immigrant women who complete the recommended schedule of prenatal visits (captures utilization of services)

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

PROCESS MEASURES:

  • Percent of pregnant immigrant women who receive prenatal care services (measures the reach and potential for population-level impact)
  • Percent of healthcare facilities offering prenatal care services that accept expanded coverage options (evaluates system capacity)

OUTCOME MEASURES:

  • Percent reduction in pregnancy complications among women enrolled in expanded prenatal care programs (captures impact on maternal health outcomes)
  • Percent improvement in infant birth weights among participants in expanded prenatal care programs (reflects impact on infant health outcomes)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

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

References

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.