What do women in Medicaid say about enhanced prenatal care? Findings from the national Strong Start evaluation

Birth. 2019 Jun;46(2):244-252. doi: 10.1111/birt.12431. Epub 2019 May 13.


Background: Medicaid pays for approximately half of United States births, yet little research has explored Medicaid beneficiaries' perspectives on their maternity care. Typical maternity care in the United States has been criticized as too medically focused while insufficiently addressing psychosocial risks and patient education. Enhanced care strives for a more holistic approach.

Methods: The perspectives of participants in the Strong Start for Mothers and Newborns II initiative, which provided enhanced prenatal care to women covered by Medicaid or the Children's Health Insurance Program (CHIP) during pregnancy through Birth Centers, Group Prenatal Care, and Maternity Care Homes, are evaluated. Strong Start intended to improve care quality and birth outcomes while lowering costs. We analyzed data from 133 focus groups with 951 pregnant or postpartum women who participated in Strong Start from 2013 to 2017.

Results: The majority of focus group participants said that Strong Start's enhanced care offered numerous important benefits over typical maternity care, including considerably more focus on women's psychosocial risk factors and need for education. They praised increased support; nutrition, breastfeeding, and family planning education; community referrals; longer time with practitioners; and involvement of partners in their care. Maternity Care Home participants, however, occasionally voiced concerns over lack of practitioner continuity and short clinical appointments, whereas Group Prenatal Care participants sometimes said they could not attend visits because of lack of childcare.

Conclusions: Medicaid and CHIP beneficiaries reported positive experiences with Strong Start care. If more Medicaid practitioners could adopt aspects of the prenatal care approaches that women praised most, it is likely that women's risk factors could be more effectively addressed and their overall care experiences could be improved.

Keywords: Medicaid; Strong Start; enhanced care; prenatal care.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Birthing Centers
  • Centers for Medicare and Medicaid Services, U.S.
  • Female
  • Focus Groups
  • Humans
  • Infant, Newborn
  • Maternal-Child Health Services / organization & administration
  • Medicaid*
  • Mothers
  • Patient Satisfaction / statistics & numerical data*
  • Postpartum Period
  • Pregnancy
  • Premature Birth / prevention & control*
  • Prenatal Care / methods*
  • Qualitative Research
  • Risk Factors
  • United States
  • Young Adult