Changes in births to foreign-born women after welfare and immigration policy reforms in California.

OBJECTIVES

To determine whether passage of welfare and immigration policies was followed in California by changes in births to foreign-born women in California with respect to total numbers, payer sources, prenatal care use, or health outcomes.

METHODS

Comparison of births to foreign-born and US-born women from 1990 to 1997 using adjusted odds ratios generated with multivariate logistic regression.

RESULTS

Policies passed in 1994 and 1996 were followed by decreases in adjusted odds of births to foreign-born women with prenatal Medicaid coverage, without a corresponding increase in uninsured foreign-born women. There was no decline in the use of prenatal care by foreign-born women, and no worsening of birth outcomes after passage of the reforms. Foreign-born women, however, remained more likely to have inadequate prenatal care than US-born women, and the improvement in outcomes that occurred for US-born women from 1994 to 1997 did not occur for foreign-born women.

CONCLUSIONS

In spite of the fact that pregnant immigrant women remained eligible for Medicaid after passage of welfare and immigration policies in California, the volume of births to foreign-born women using Medicaid declined. The lack of a corresponding increase in births to uninsured foreign-born women appears to have prevented deterioration in the use of prenatal care or birth outcomes.