discretion. using prenatal diagnostic tests may enforce the importance of following doctor's orders. medical staff should aim to establish effective lines of communication with health care providers to ensure an increase awareness of women's health while establishing trust with their patients. if patients cannot be matched with healthcare providers culturally, then they should at least be able to visit a physician who is trained specifically to deal with cultural differences. this awareness and sensitivity can come in many forms, such as a familiarity with a foreign language, an understanding of how a specific ethnicity views mothers, or knowing how family networks play into the mothers’ decision-making process. all of these options have the potential to improve doctor-patient relationships, and the establishment of such relationships can be implemented in medical training in the us both in medical school settings and on-site training programs. it has been suggested that physicians and other health care providers screen their patients for both abuse and sexually transmitted diseases to ensure their overall well being. they should also aid them in getting the proper treatment, health, social and legal services if a problem exists. increase insurance the lack of adequate health insurance, specifically health insurance in the united states, can contribute to the limitations and underutilization experienced by women. hessolhas two studies demonstrating that insurance status is a strong determinant of the utilization of prenatal care; as eligibility of health insurance increased, the use of prenatal care increased and ethnic differences decreased. although, while private health insurance is one method to which women can access or afford prenatal care, private health insurance has not always proven to necessarily be helpful or reassuring. sesia et al. found no significant differences suggesting that a mandatory managed care program for prenatal care improved nor impeded access to prenatal care services. a study done on women utilizing prenatal care services found that resources provided by an hmo program, such as prenatal education classes, recommendations for diet, exercise, weight gain, and rest, pregnancy books, and magazines subscriptions, were not viewed by women as being helpful. community outreach programs community outreach programs would train members of the minority population in basic health education; then these community health workers would help to facilitate connections between expectant mothers and local healthcare establishments. the community health workers could even continue their relationship throughout the duration of the pregnancy, serving as a patient liaison during the various tests, appointments, and conversations. communities of low-income should employ community residents to encourage and support the utilization of health care services. those with outreach contact were more likely to serve disadvantaged populations such as those reported with obstetric risks, younger than 19 years old, and less likely to have a significant partner. targeting this population through community outreach programs that take on community projects can have a positive effect of rates of women accessing and utilizing prenatal care services available. suggestions of supporting teen health centers have been made to provide health care services. resources from this study strongly suggests that prenatal care delivered in a community-base setting is a more efficient and cheaper method for providing positive health outcomes; however, the missions of community-based care program are different. in relation to teenagers or adolescent medicine, a focused community program may lead to an increase in contraceptive use and a decrease in the rate of subsequent pregnancies.