Project Summary
The project team examined the causal effect of access to prenatal care for immigrant women on maternal and infant health outcomes and state economic impacts. The team compared undocumented and recently arrived immigrant families before and after the staggered implementation of Oregon’s Citizen Alien Waived Emergent Medical (CAWEM) Plus program, which provides access to prenatal Medicaid services for undocumented women.
Research Questions/Aims
- What is the impact of providing preventive healthcare services to undocumented and recently arrived immigrants? What are the effects on maternal and infant health outcomes? What are the economic implications for the state?
Actionability
- Inform state-level policy and access to prenatal services for immigrant families, by providing information on the health impacts, if any, of such services on both immigrant mothers and their citizen children.
Results
After expansion of prenatal care access to prenatal care in Oregon, the number of prenatal care visits increased by 7.2, receipt of adequate prenatal care increased by 28%, diabetes screenings increased by 61%, and fetal ultrasonograms increased by 74%. This expanded access was also associated with increases in the number of well-child visits and rates of recommended screenings and vaccines and reductions in infant mortality and rates of extremely low birth weight.
Outcomes
Service utilization; costs; detection of maternal anemia, gestational diabetes, and hypertensive disorders of pregnancy; incidence of undiagnosed breech presentation at the onset of labor; complications from diabetes, fetal macrosomia or shoulder dystocia; children's rates of preterm birth; neonatal intensive care unit admission; respiratory distress and undiagnosed anomalies of children.
Methodology
Difference-in-differences approach to estimate the average treatment effect on the treated, and extended to incorporate fixed effects regression with unit and time-period fixed effects and including any appropriate time-varying covariates as controls.
