Building Prenatal Care Capacity: A Community Report

Over the past 15 years, the Council on Healthy Mothers and Babies (COHMAB) has worked to improve prenatal care access in Franklin County, Ohio. Efforts have included studying the amount of time a woman must wait to obtain an initial prenatal care appointment at the public OB clinics and determining barriers to accessing prenatal care. A major barrier is the lack of awareness among women with Medicaid or no insurance on how to access prenatal care. To address this access barrier, the COHMAB created a centralized scheduling program for initial prenatal care appointments called Pregnancy Care Connection. Beyond providing access to prenatal care, Pregnancy Care Connection’s goal is to reduce the wait time for initial prenatal care appointments.

Despite the fact that Pregnancy Care Connection has had an impact on prenatal care access, the wait time for appointments continues to increase. This rise in waiting time is attributed to the decline in capacity for prenatal care appointments. Between 2003 and 2004, there was a 31% decrease in available prenatal care appointments. This decline was attributed to hospital-based clinics reducing the number of patient appointments due to the cap in resident work requirements; clinics experiencing an increase in the number of immigrant pregnant patients requiring longer appointments to address language and cultural barriers; and broader, overarching concerns regarding medical malpractice and liability issues for OB/GYNs resulting in fewer OB providers and future residents. This decline is the reason the Council on Healthy Mothers and Babies began to hold roundtables with physicians, OB clinic nurses, social workers, and key community leaders to address the issue of prenatal care capacity.

The purpose of the roundtables was to heighten awareness and devise solutions to curb the declining prenatal care capacity in Franklin County. The participants of the roundtables identified four areas to concentrate efforts to positively impact capacity: (1) raise public awareness on the importance of prenatal care and access to care; (2) impact the State of Ohio’s budget to increase Medicaid coverage, ensure Medicaid reimbursement for interpretive services, and increase the Child and Family Health Services budget line item for local health departments and community organizations to provide health care and enabling services; (3) understand and address the specific needs of pregnant immigrant and refugee women; and, (4) advocate and obtain a waiver for family planning services to extend Medicaid coverage to more women.

While these valid and noble efforts have some impact on capacity, most of them tend to have a greater impact on access. Thus, more women may attempt to access prenatal care, but capacity is not increasing at the same rate to meet such a demand. The prenatal care capacity crisis must be addressed by community, state, and national leaders who can increase availability of prenatal care for uninsured and Medicaid eligible women. These actions will require increased funding for clinics along with increased number of OB/GYNs to provide public prenatal care.