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Bernard Guyer, MD, MPH
The Johns Hopkins University School of Hygiene and Public Health Baltimore, Md

JAMA. 1991;265(8):975.

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In Reply. —

Dr Jameson raises an important issue but reaches the wrong conclusion. "Policymakers in government, public health, and medicine" recognize that maternal behavior influences birth outcome.¹ In fact, the recent report of the Expert Panel on the Content of Prenatal Care² outlines a comprehensive program directed at identifying and addressing these risk factors. The interventions can only be applied, however, if women who are poor have the same access to health care as their middle-class contemporaries. The Medicaid eligibility expansions were intended by Congress to assure such access. Blaming the women who engage in these high-risk behaviors and preventing them from accessing services can hardly be expected to improve their outcomes.

I agree with Dr Moore's diagnosis that the fragmented and overly complex nature of our health care system contributes to the adverse perinatal outcomes among low-income women. He provides a brief description of an innovative . . . [Full Text PDF of this Article]

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