Changes in births to foreign-born women after welfare and immigration policy reforms in California.

OBJECTIVES: To determine whether passage of welfare and immigration policies was followed in California by changes in births to foreign-born women in California with respect to total numbers, payer sources, prenatal care use, or health outcomes. METHODS: Comparison of births to foreign-born and US-born women from 1990 to 1997 using adjusted odds ratios generated with multivariate logistic regression. RESULTS: Policies passed in 1994 and 1996 were followed by decreases in adjusted odds of births to foreign-born women with prenatal Medicaid coverage, without a corresponding increase in uninsured foreign-born women. There was no decline in the use of prenatal care by foreign-born women, and no worsening of birth outcomes after passage of the reforms. Foreign-born women, however, remained more likely to have inadequate prenatal care than US-born women, and the improvement in outcomes that occurred for US-born women from 1994 to 1997 did not occur for foreign-born women. CONCLUSIONS: In spite of the fact that pregnant immigrant women remained eligible for Medicaid after passage of welfare and immigration policies in California, the volume of births to foreign-born women using Medicaid declined. The lack of a corresponding increase in births to uninsured foreign-born women appears to have prevented deterioration in the use of prenatal care or birth outcomes.