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VOLUME 46 | NUMBER 4 | AUGUST 2011


Is Direct Access to Obstetricians/Gynecologists Effective at Improving Maternal Health Behaviors?

Keywords: Direct access; mandates; maternal and infant health; state policy; health outcomes; pregnancy; managed care

Objective. To examine the effects of state legislation mandating direct access to obstetricians and gynecologists (OB/GYNs) on maternal health behaviors and infant health outcomes.

Data Sources. 1992– 2002 Natality Detail File; 1994– 2002 Pregnancy Assessment and Monitoring Survey (PRAMS).

Study Design. Using variation in state policy over time, we use individual-level data from two sources to consider the effects of direct access legislation on prenatal care utilization, maternal health behaviors during pregnancy, and infant health outcomes.

Principal Findings. Our results suggest that there is little evidence that direct access laws are effective at improving prenatal care access or conferring benefits to mothers and infants. These results are consistent across two data sets, a variety of specifications, and specific subgroups of women who are most likely to be affected by direct access legislation.

Conclusion. We conclude that direct access to OB/GYNs is not related to improvements in maternal health behaviors or infant health outcomes. If policy makers are interested in reforms that improve maternal and infant health, we recommend a focus on alternative policies.

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