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May 19, 1993

Health Care Access and Birth Outcome-Reply

Author Affiliations

Harvard Medical School Boston, Mass

JAMA. 1993;269(19):2507. doi:10.1001/jama.1993.03500190048029

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In Reply.  —We agree with Dr Ferguson that public policy to improve the birth outcomes of disadvantaged women should address limited access to affordable family planning services. Unfortunately, our data set cannot address the role of "unintended" pregnancy in our findings.Dr Rodney questions whether the decline of family physicians with training in obstetrics may contribute to our findings. We unfortunately cannot address the role of the family physician in providing access to prenatal care for disadvantaged women in Massachusetts.Both of these letters suggest that factors beyond health coverage may affect access to prenatal care and birth outcomes. Although we believe that health coverage is a necessary first step toward improving access to prenatal care, our study suggests that health coverage alone may not be sufficient to ensure improved access and birth outcomes. We believe that policymakers should consider broader interventions to improve access to prenatal care and birth