Association for Public Policy Analysis & Management

Background: The number of babies born in the United States to undocumented mothers rose from 2.7 million in 2003 to 4 million in 2008. Most women whose immigration status is in question or who lack official immigration documentation from the US Citizenship and Immigration Services do not have access to health insurance or health care including prenatal care. As a result, infants born to undocumented women are often low birth weight, premature, and suffer from abnormal conditions that cost the US health care system millions of dollars. Nebraska presents an interesting case where a state granted Medicaid access to undocumented pregnant women from 1996 to 2010 and then discontinued access from 2010 to 2012. However, little is known about the maternal health of these undocumented women in Nebraska.

 

Objective: To compare maternal health of undocumented women with and without access to Medicaid in Nebraska from 2007 to 2011.

 

Methods: The comparative study data were from the 2007 to 2011 public birth certificate records from Nebraska. There were 8,170 women who met the study eligibility criteria of having no social security number, residing in Nebraska, and giving birth during 2007 to 2011. Women were included if they were 18 years or older. Outliers (e.g., BMI under 14) and missing observations were excluded from the sample. The final sample was 6,262 undocumented women. Groups of maternal health measures were created for demographics, prenatal, pregnancy, and delivery characteristics. Descriptive statistics including means, frequencies, and standard deviations were calculated on the study variables. Analyses were stratified by Medicaid access and comparisons were conducted using X² for binary variables and Student t-test for binary and continuous variables.

 

Results: In the study, 4,249 women had access to Medicaid and 2,013 had no access to Medicaid. Undocumented women were generally Hispanic (73.32%) without a high school level education (68.77%). Prenatally, they had normal weight (46.65), few smoked (0.94%) or had infections (1.84%). Most pregnancies included normal weight gain (54.74%). Some women delivered infants prematurely (7.70%) with complications (6.42%); while 7.75% died during child birth or gave birth to an infant with an abnormal health condition (7.46%). Women without access to Medicaid were more often self pay (63.34% vs. 4.71%), were obese prior to pregnancy (19.37% vs. 17.37%), and had inadequate prenatal care (10.28% vs. 6.94%) than women with access to Medicaid. Those who lacked access to Medicaid, however, delivered fewer infants with abnormal conditions (6.26% vs. 8.03%) than women with Medicaid. 

 

Conclusions: This study has important clinical and regulatory implications. Undocumented women who are prenatally obese and lack access to prenatal care may be at increased risk for poor maternal outcomes. Future policy research is needed to examine the impact of the Nebraska policy on maternal outcomes.