Improving pregnancy outcomes: public versus private care for urban, low-income women

This study describes the characteristics of women who received maternity care from the Chicago Department of Health or from private practitioners in 1988 and the first half of 1989, and who delivered at the University of Illinois Hospital or Cook County Hospital. The risk of preterm low birthweight for the infants of these women was compared according to source of prenatal care. The likelihood of giving birth to a preterm, low-birthweight infant was significantly greater (odds ratio 3.1, 95% confidence interval 2.3-4.0) for women who received care only from private physicians (n = 530) compared with those who received care entirely from the Chicago Department of Health (n = 2465). This relationship remained after adjustment for race, age, parity, history of adverse pregnancy outcomes, smoking, and use of drugs during pregnancy. We examined alternative explanations for these findings, and concluded that although the role of urban public health departments in the direct delivery of maternity care services continues to be a source of controversy, these institutions remain an important provider of such care for low-income women.