May 19, 1993

Health Care Access and Birth Outcome

Author Affiliations

University of Tennessee Memphis

JAMA. 1993;269(19):2507. doi:10.1001/jama.1993.03500190048028

To the Editor.  —Haas et al1 demonstrated that extending insurance coverage to poor uninsured pregnant women did not increase access or improve birth outcomes. One of the factors worth considering in this problem is the near disappearance of the family physician with training in obstetrics.Massachusetts is a particularly tragic example, where a majority of the medical schools have chosen to exclude family practice as a possible solution. Even the Tennessee study was based at a school that continues to exclude family practice.2 Academic family medicine bears some of this responsibility. It did not create adequate expectations for women's health care as a core curriculum in family practice and it failed to measure outcomes of training programs. The strategic error has been perceived by the American Academy of Family Physicians, which established a Task Force on Obstetrics in 1989.The investigations of this task force have uncovered myriad