Introduction

The conference that formed the basis for this book was motivated in large part by recurrent questions in the literature regarding the value of prenatal care. Research has examined whether efforts to improve the access of pregnant women to timely prenatal care have been a successful means of improving birth outcomes. Although some reports have enthusiastically supported the accomplishments of prenatal care (IOM, 1985); others have stressed the equivocal nature of the empirical evidence, and their conclusions have been more guarded (Alexander and Korenbrot, 1995; Kogan et al., 1998; Fiscella, 1995).

Some of the more pointed commentaries on the value of prenatal care have occurred in the context of articles addressing cost-effectiveness. Several influential reports and studies have concluded that prenatal care is a cost-effective intervention based on its impact on specific adverse outcomes of pregnancy, namely low birth weight and prematurity. These studies have calculated the monetary savings resulting from the use of prenatal care (IOM, 1985; Gorsky and Colby, 1989; Korenbrot, 1984; Schramm, 1992), figures readily cited in policy debates. However, other authors have sharply contested these conclusions regarding cost-effectiveness (Huntington and Connell, 1994).

Here, we examine some of the issues relevant to assessing the value of prenatal care that have been highlighted in this book. The premise of this book, as described in the Introduction, is that the arguments for and the critiques of the effectiveness and cost-effectiveness of prenatal care are based on a very narrow conceptualization of both prenatal care and the relevant outcomes.