To the Editor.
—The article by Haas et al1 on the effect of health coverage for uninsured pregnant women on maternal health and the use of cesarean section has some significant flaws.By looking at the data differently, one can see that provision of coverage leads to higher rates of cesarean section. Cesarean section is generally performed not for issues of maternal health, but rather for issues of fetal health and well-being, and no data were presented to demonstrate the effect of cesarean section on fetal health. It is well known that there is a trade-off between cesarean section rate and maternal health risks. However, the purpose of most cesarean sections is to improve fetal outcome, and this study had no data to bear on this question whatsoever. One of the reasons to provide coverage for uninsured patients is to improve fetal outcomes, not just maternal health indexes.Likewise,
Waszak SJ. The Effect of Health Coverage on Use of Cesarean Section. JAMA. 1993;270(20):2434-2435. doi:10.1001/jama.1993.03510200040021