Demand for Prenatal Care for Poor Strains Localities

Demand is also high at an obstetric clinic for low-income patients at Potomac Hospital in Woodbridge, health-care professionals said. In addition, the Greater Prince William Area Community Health Center, which serves uninsured and low-income patients, does not offer prenatal care. But it has considered doing so since 2003. In a needs assessment that year, prenatal care ranked second after care for such chronic conditions as diabetes, hypertension and high cholesterol, Corey R. Riley, the center's executive director, said.

"We knew it would be a challenge" to add prenatal care, Riley said. But, he said, "the costs of obstetrics coverage have gone through the roof" since he first heard an estimate four years ago.

The Loudoun and Prince William community health centers plan to apply for a federal grant that would cover their malpractice insurance costs for prenatal care. But Dever said that competition for the grants is high and that Northern Virginia's wealth might prove a hindrance.

This month, the Loudoun Health Department received a $54,000 grant from the Kaiser Permanente health organization that Goodfriend said he intends to use as seed money for the health-care community to forge a solution.

Elsewhere in the Washington region, experts said, women sometimes move or fake residency to obtain care because eligibility for most charity programs is based on income and proof of residency within a jurisdiction.

"We don't ask, but when we try to contact them, it's not uncommon to find they are not where they say they're from," said Fred E. Mecklenburg, chairman of the Department of Obstetrics and Gynecology at Inova Fairfax Hospital, which runs a large clinic for low-income pregnant women.

Many low-income or uninsured women also face language barriers or other problems, including domestic abuse, that require complex solutions, health-care workers say. Illegal immigrants sometimes skip care to avoid notice.

"Some will say: 'It's prenatal care. What's the big deal?' The big deal is even those five minutes with a doctor is an opportunity to see the size of baby, that it's growing correctly," said Maria Gomez, president of Mary's Center for Maternal and Child Care, a center in the District that provided 1,092 women with prenatal care last year.

The Mary's Center is expanding to Long Branch in November in partnership with Washington Adventist Hospital, which has been "overwhelmed" with demand for prenatal care since it expanded its services to indigent people in July 2006, said Lydia Parris, the hospital's communications director.

"The most important thing is for a future mother to come in early to take care of problems sooner rather than later," Gomez said.