United States Maternal and Child Health Services. Part II: a comparison with Western Europe and strategies for change

Part I of this article showed that accessibility and quality of health care in the United States is determined by race, language, national origin, income level, education, age, and location of residence; that there is consistent correlation of low income with inaccessibility to perinatal care and poor pregnancy outcome; and that certain traditional American values are in part responsible. Despite many well-designed programs, the existing system of maternal-child health care delivery in the U.S. remains an overly complex, fragmented, and fundamentally flawed network fraught with financial and institutional obstacles to care. Major health indices, such as infant mortality rate and teenage pregnancy rate, attest to the fact that our system is failing.