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Using data from the Puerto Rican Maternal and Infant Health Study, we investigate the implications of family income and insurance status for well-baby care among mainland Puerto Ricans. Given the socioeconomic disadvantage of Puerto Ricans, it is critical to understand the extent to which low income and lack of health insurance create barriers to well-baby care and result in low utilization. The analysis shows that the income-to-needs ratio is related to barriers to well-baby care, and a key intervening factor is insurance status. The odds of reporting any barriers to care are lowest among those with both adequate income and private health insurance. Access to insurance is also vital in achieving adequate well-baby care. Uninsured children receive inadequate care more often than children with public or private insurance, especially when their income is also low. Children with public insurance are as likely as children with private insurance to receive an adequate number of well-baby visits, despite the fact that their mothers report more barriers to care.

Recent public health initiatives in the USA identify the improvement of maternal and infant health outcomes among ethnic minorities as a national priority. Prenatal care is emphasized in these initiatives as a crucial intervention for reducing the risks of adverse outcomes. We investigate the barriers to prenatal care and the adequacy of prenatal care among mainland Puerto Ricans using data from a follow-back survey of a representative sample of mothers. The results show that barriers to prenatal care and the adequacy of prenatal care cannot be reduced solely to financial problems or problems associated with migration. Rather, attention to the social and the psychological circumstances surrounding the pregnancy (e.g. pregnancy wantedness) is required.

Using the Linked Birth and Death data set for 1990, the County-City Plus for 1993, and Summary Tape Files (STF) for 1990, a multilevel model is utilized to examine the influence of county and individual-level characteristics on low birthweight risk for white, black, Mexican, Cuban and Puerto Rican infants in the United States. Logistic regression results show that the racial and ethnic differences in low birthweight are not only the result of the individual-level characteristics of the mother, but also are a function of the characteristics of the county where the mother resides. Support for the contention that contextual factors work directly and indirectly to affect low birthweight risk was found. Separate racial/ethnic models indicate that the specific contextual variables that account for low birthweight risk vary across racial/ethnic groups.