Association for Public Policy Analysis & Management

A primary goal of the U.S. health care reform (e.g., Medicaid expansion, Affordable Care Act) is to improve infant and maternal health by expanding insurance coverage for pregnancy-related care especially prenatal care, with the belief that receiving early and adequate prenatal care can substantially reduce adverse health outcomes for infants and mothers. However, the empirical evidence has been equivocal on whether prenatal care makes a difference in infant health. More importantly, surprisingly little is known on the effectiveness of prenatal care in enhancing the health and health behavior of the mother.

Does early care onset, having sufficient number of care visits, or integration of the two improve women’s health and health behavior during pregnancy? What are those enhanced prenatal outcomes (subtle measures such as gestational weight gain latently related to various maternal complications or acute conditions upon delivery, or both)? Furthermore, does adequate prenatal care have any beneficial effect on different aspects of maternal postnatal health and behavior? Answering these questions is important because, first, it generates efficiency gain on care utilization by uncovering the true productivity of timely and adequate prenatal care. Second, reducing maternal adverse health and behavior during pregnancy, childbirth and in the postpartum period has been a crucial objective of the Healthy People 2020. Third, it sheds new light on cost-benefit evaluation of the programs which facilitate access to prenatal care for pregnant women.

To address the research questions, we use a large panel dataset of mothers having multiple births to handle the unobservable mother heterogeneity correlated with prenatal care utilization. This dataset has rich information on prenatal care, maternal health and health behavior (several important measures in the data such as gestational weight gain and timing of smoking cessation have not been explored in the literature), and a diverse set of control variables. The baseline regression controlling for mother fixed effects shows late care onset and insufficient number of visits significantly increase the risks of inadequate gestational weight gain, prenatal smoking, premature rupture of membranes and precipitous labor. Mothers with delayed or inadequate care are also less likely to breastfeed the baby and more likely to be underweight and smoke in the postpartum period. The magnitude of the estimates ranges from 3 to 30 percent relative to the corresponding bases.

The benchmark results are robust in various sensitivity checks such as applying care measures integrating the timing of initiation and quantity, stratifying the full sample by state and number of births, controlling for birth outcomes, and using lagged dependent variable models. The findings of this study suggest promoting early and adequate prenatal care will benefit women of reproductive age in various dimensions of health and health behavior, not only during pregnancy but also after giving birth.