Prenatal care and public policy: lessons for promoting women's health.

One of the most notable health-related legislative achievements of the 1980s was the expansion that transformed Medicaid from a medical assistance program for a relatively small group of the very poorest mothers meeting strict categorical criteria to a health program for low-income uninsured, pregnant women and their children, regardless of work status or family composition. Yet Medicaid coverage remains unavailable to millions of poor and uninsured women who are significantly less likely to obtain needed care without health insurance. Among the factors that help explain why Medicaid was not simultaneously expanded for uninsured women are our nation's longstanding reluctance to provide public assistance except to individuals deemed "deserving" based on the circumstances that led to their indigency. Another factor is the special value our culture places on pregnancy, which permits pregnant women who do not meet the definitions of the "deserving" to transcend those restrictions. Finally, while data served as an effective tool in the campaign for pregnant women's coverage, comparable data related to nonpregnant women are limited. Nonetheless, the lessons from the Medicaid expansion are helpful in efforts to improve women's access to care in general.