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Objectives: Stress due to experiences of racism could contribute to African-American women's adverse birth outcomes, but systematic efforts to measure relevant experiences among childbearing women have been limited. We explored the racism experiences of childbearing African-American women to inform subsequent development of improved measures for birth outcomes research. Methods: Six focus groups were conducted with a total of 40 socioeconomically diverse African-American women of childbearing age in four northern California cities. Results: Women reported experiencing racism (1) throughout the lifecourse, with childhood experiences seeming particularly salient and to have especially enduring effects (2) directly and vicariously, particularly in relation to their children; (3) in interpersonal, institutional, and internalized forms; (4) across different life domains; (5) with active and passive responses; and (6) with pervasive vigilance, anticipating threats to themselves and their children. Conclusions: This exploratory study's findings support the need for measures reflecting the complexity of childbearing African-American women's racism experiences. In addition to discrete, interpersonal experiences across multiple domains and active/passive responses, which have been measured, birth outcomes research should also measure women's childhood experiences and their potentially enduring impact, perceptions of institutionalized racism and internalized negative stereotypes, vicarious experiences related to their children, vigilance in anticipating future racism events, as well as the pervasiveness and chronicity of racism exposure, all of which could be sources of ongoing stress with potentially serious implications for birth outcomes. Measures of racism addressing these issues should be developed and formally tested. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine trends in prenatal insurance coverage and utilization of care in California over two decades in the context of expansions in Medi-Cal (California's Medicaid) and other public efforts to increase prenatal care utilization. METHODS: Retrospective univariate and bivariate analysis of prenatal care coverage and utilization data from 10,192,165 California birth certificates, 1980-99; descriptive analysis of California poverty and unemployment data from the U.S. Census Bureau Current Population Survey; review of public health and social policy literature. RESULTS: The proportion of mothers with Medi-Cal coverage for prenatal care increased from 28.2 to 47.5% between 1989 and 1994, and the proportion uninsured throughout pregnancy decreased from 13.2 to 3.2%. Since the mid-1990s, fewer than 3% of women have had no insurance coverage for prenatal care. Between 1989 and 1999, the proportion of women with first trimester initiation of prenatal care increased from 72.6 to 83.6%, reversing the previous decade's trend, and the proportion of women with adequate numbers of visits rose from 70.7 to 83.1%. Improvements in utilization measures were greater among disadvantaged social groups. Improvements in California during the 1990s coincided with a multifaceted public health effort to increase both prenatal care coverage and utilization, and do not appear to be explained by changes in the economy, maternal characteristics, the overall organization/delivery of health care, or other social policies. CONCLUSIONS: While this ecologic study cannot produce definitive conclusions regarding causality, these results suggest an important victory for public health in California. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe the characteristics and risk factors of women with only third-trimester (late) or no prenatal care. METHODS: A statewide postpartum survey was conducted that included 6364 low-income women delivering in California hospitals in 1994 and 1995. RESULTS: The following factors appeared most important, considering both prevalence and association with late or no care: poverty, being uninsured, multiparity, being unmarried, and unplanned pregnancy. Forty-two percent of women with no care were uninsured, and uninsured women were at dramatically increased risk of no care. Over 40% of uninsured women with no care had applied for Medi-Cal prenatally but did not receive it. Risks did not vary by ethnicity except that African American women were at lower risk of late care than women of European background. Child care problems were not significantly associated with either late or no care, and transportation problems (not asked of women with no care) were not significantly related to late care. CONCLUSIONS: Lack of insurance appeared to be a significant barrier for the 40% of women with no care who unsuccessfully applied for Medi-Cal prenatally, indicating a need to address barriers to Medi-Cal enrollment. However, lack of financial access is unlikely to completely explain the dramatic risks associated with being uninsured. In addition to eliminating barriers to prenatal coverage, policies to reduce late/no care should focus on pre-pregnancy factors (e.g., planned pregnancy and poverty reduction) rather than on logistical barriers during pregnancy. [ABSTRACT FROM AUTHOR]