The purpose of this study was to examine whether there are racial disparities in birth and neonatal outcomes among military personnel in California, a population for whom financial barriers to health care services is minimal. Data were drawn from the Maternal and Child Health Data Base of University of California at Santa Barbara (1981-1995). Data were classified as related to military personnel and their dependents if the facility of care was one of twenty-two Army, Navy, and Air Force hospitals, while data regarding all other hospitals were classified as civilian. White and black racial groups were defined based on medical records and birth/death certificates; black racial group included those with Spanish surnames.

Both military and civilian blacks were less likely to receive prenatal care (black-white RR=0.79 for military and 0.51 for civilian). Over the nine month period, there were changes in this racial pattern: in the first month of pregnancy, a higher percentage of blacks than whites received prenatal care, but, by the second month, 1.5% more whites in military care and almost 15% more whites in civilian care received care. Differences reduced after the third month, with a higher proportion of whites than blacks receiving care every month following the first. Low birth weight births were also more common among blacks than whites, with the difference being higher among civilians than military personnel/families. Blacks had higher fetal and neonatal mortality rates, and there was no difference in the patterns for civilian versus military personnel/families.

The finding of smaller disparities in receipt of prenatal care among military personnel/families than among civilians indicated that better financial coverage of health services was associated with improved utilization of prenatal care. However, even with the reduction in financial barriers, black women received less care and, in turn, had poorer pregnancy outcomes with regard to birth weight and fetal/neonatal mortality rates. The authors conclude that, "expansions in insurance coverage may require concurrent improvements in associated systems of outreach and service delivery. The full promise of financial coverage may depend on a renewed commitment to the infrastructure of community services to ensure comprehensive access to all forms of health care." It is important to note that potential confounders were not measured or tested in this analysis, particularly health conditions, substance use, education, and stress.