National Center for Health Statistics Uses AHRQ Study to Change Standard Certificate of Live Birth

June 2007

Findings from an AHRQ-funded study on the effects of income and insurance status on untimely prenatal care indirectly influenced changes to the National Center for Health Statistics (NCHS) U.S. Standard Certificate of Live Birth. Untimely prenatal care is defined as either no care at all or care that begins after the first trimester.

Research conducted by Paula Braveman, MD, MPH, Professor of Family and Community Medicine and Director of the Center on Social Disparities in Health at the University of California at San Francisco (UCSF), and Susan Egerter, PhD, also at UCSF, found that lack of timely third-party coverage is associated with significantly higher risks of untimely prenatal care, even after taking into account many relevant maternal characteristics. Their research also showed that increased risk of untimely care associated with lack of insurance coverage early in pregnancy is not confined to women in absolute poverty or to those lacking private insurance. Absolute poverty is defined as family income at or below the federal poverty line.

According to Braveman, "In addition to examining questions about insurance and income in relation to receipt of prenatal care, the study's survey data also were used to validate insurance information that the authors had been instrumental in having included in the California birth certificate several years earlier."

Interested in what California had done, the NCHS ultimately introduced a similar item in the U.S. Standard Certificate of Live Birth, which is recommended but not required for state use. "I believe that our paper demonstrating the validity of the information on insurance in the California birth certificate was what made staff at NCHS interested," says Braveman. While AHRQ provided the main funding for that validation effort, the Robert Wood Johnson Foundation also supported it.

The NCHS is the Nation's principal health statistics agency. It is part of the Centers for Disease Control and Prevention and provides statistical information to guide actions and health policies. The U.S. Standard Certificate of Live Birth is available at: [PDF file, 145 KB; ].

Impact Case Study Identifier: 
AHRQ Product(s): Research
Topics(s): Women's Health, Disparities
Geographic Location: National
Implementer: National Center for Health Statistics
Date: 06/01/2007

Braveman P, Pearl M, Egerter S, Marchi K, Williams R. Validity of insurance information on California birth certificates. American Journal of Public Health 1998; 88(5):813-6. (R01 HS07910)

Egerter S, Braveman P, Marchi K. Timing of insurance coverage and use of prenatal care among low-income women. American Journal of Public Health March 2002; 92(3):423-27. (R01 HS07910)

Page last reviewed October 2014