The impact of a maternal and child health care program on the quality of prenatal care: an analysis by risk group.

A typical maternal and child health care program was implemented in an American Indian reservation community, and its impact on the effectiveness of prenatal care was assessed. Evaluation included examination from both the provider perspective (care provided to program users) and the population perspective (care received by a sample of all prenatal patients in the community), as well as examination of outcomes of prenatal care. The study cohorts were sorted into relatively high and average risk as a function of age, gravidity, and history of abortion or miscarriage. The study results suggest that such a program will improve the quality of prenatal care, although the program has a greater impact on the average risk group. Standard methods of assessing program effectiveness, which examine the care provided by the program as opposed to the care received by the community, will not detect this phenomenon.