PRENATAL-CARE NEEDS ASSESSMENT COMPARING SERVICE USE AND OUTCOMES IN FRESNO, CA

The authors performed a prenatal care needs assessment for Fresno Coun ty, CA, using data from a sample of 11,878 birth certificates for the county for 1989. Birth records, patterns of prenatal care utilization, and low birth weight outcomes in the county were compared with those in a random sample of 11,826 certificates derived from births in the r emainder of the State. Bivariate techniques were used in calculating c are utitization rates. Multivariate logistic regression analysis was u sed in associating rates of prenatal care visits and gestational month of initiation of prenatal care with low weight birth outcomes. County women entered prenatal care as early as women in the remainder of the State, but did not return as often for prenatal care visits. Their ra te of return for followup visits was 29.9 percent, compared with 24.8 percent for women in all other counties (P < 0.001). County women with the lowest rates of visits had 1.4 to 1.9 times the risk of having a low weight birth than other county women with higher rates of visits, and a significantly higher risk than for women of all other counties. An intensive visit schedule for high-risk care was provided 28.9 perce nt of county women, compared with 33.0 percent of women in all other c ounties (P < 0.001). County women who received a high-risk intensive v isit schedule were 2.5 times more likely to have a low weight birth th an county women who did not receive the schedule. For all other women in the State, the comparable risk was 2.1 times. Improvements in the n umber and content of prenatal care visits were shown to have a high li kelihood of substantially improving birth weight outcomes for pregnanc ies among Fresno County women.