Association for Public Policy Analysis & Management

Persistent disparities in infant health across racial and socioeconomic groups have motivated a major policy focus in the U.S. on improving birth outcomes. However, little evidence exists on whether policy interventions explicitly designed to improve fetal health can generate long-lasting benefits. In this paper, we evaluate whether there are improvements in the short- and long-term outcomes of individuals who benefited from a publicly-funded prenatal intervention while in utero. Created in 1984, the Comprehensive Perinatal Services Program is a landmark program designed to address poor infant health outcomes among high-risk populations in the state of California. The program provides “enhanced” services to low-income pregnant women receiving routine obstetrical care under Medicaid and include comprehensive risk assessments and targeted support services. To identify the effects of this intervention, we use a difference-in-differences design that takes advantage of variation in exposure to the program due to its staggered implementation across counties. For our analyses, we rely on a novel dataset that links birth certificate data for individuals born in California to federal survey and administrative data held by the U.S. Census Bureau. These data contain information on health at birth and later life outcomes, including mortality, disability, educational attainment, labor force participation, income, and participation in public programs. This is the first evaluation of the long-term effects of an enhanced prenatal care program under Medicaid, despite their widespread use as a policy tool to promote infant health. The majority of states have similar enhanced prenatal care programs and their potential impact is large: not only do state Medicaid programs cover nearly half of all births, but these programs target low-income women who are at higher risk of poor birth outcomes. This research will provide timely, relevant knowledge that will help policymakers at all levels accurately assess the benefits of this type of public health intervention.