A systematic review and meta-analysis of racial disparities in prenatal care in California: How much? Does insurance matter?

This meta-analysis compares California to 13 states with regard to adequacy of prenatal care in the context of the major Medicaid expansion. It shows a reduction in prenatal care inadequacy after 1992, especially in California. It also shows persistent racial ethnic disparities. By examining how California differed from other states, this study provides not only benchmarks for attaining the Healthy People 2010 goal of 90% adequacy but also possible strategies for achieving this goal. Attaining the Healthy People 2010 objective for prenatal care for California as a whole will require further efforts to understand and address racial/ethnic and insurance-related inequalities.

Disparities in initiation and adherence to prenatal care: impact of insurance, race-ethnicity and nativity.

We used the intersectionality framework to examine impact of racial/ethnic, immigration, and insurance differences on the timing of initiation of prenatal care (PNC) and subsequent adherence. In this cross sectional study independent variables were women's race/ethnicity; nativity; age; education; and insurance. The dependent variables were late initiation and non-adherence to recommended number of PNC visits. We used multivariate analysis to evaluate the impact of the independent variables on late initiation and non-adherence. Analysis revealed that race/ethnicity/nativity (RE-N) was more consistently associated with late initiation and non-adherence for privately insured than publicly insured persons. While private insurance had a positive impact on initiation and adherence overall, its impact was greater for White women. Having private insurance coverage was most beneficial to White women. We contend that the intersectional approach provides promising avenues for expanding our knowledge of health disparities and of identifying new ways of going about eliminating the persistent and pervasive social inequalities and informing efforts to reduce them.

The experiences of migrant health nurses employed in seasonal satellite nurse-managed centers: a qualitative study.

This research study describes the unique experiences of nurses who are employed in migrant health seasonal satellite nurse-managed centers in the upper Midwest. Data were generated through semistructured interviews with 10 seasonal nurses. Phenomenology served as the research method. Four themes were identified including seeking seasonal employment, establishing migrant seasonal satellite nurse-managed centers, learning the culture of Hispanic migrant farmworkers, and referring Hispanic migrant farmworkers for medical care. During their seasonal employment, nurses learned to establish and operate satellite nurse-managed centers. Due to the migrant health nurses' daily contact with their clients, they were able to establish rapport that led to a trusting relationship. This enabled them to provide culturally sensitive and lifestyle appropriate care to the migrant farmworker population.