Introduction

In different ways and to differing extents, all the chapters in this book suggest that the effectiveness of prenatal care is dynamic. The changing demography of childbearing in the United States and the remarkable innovation that has occurred in the clinical management of pregnancy and the perinatal period are constantly reshaping the match (and relative mismatch) between needs and capability. Recognition of this dynamic character is important because it inherently condemns static programs and policies. Rather, it invites constant reconsideration of prenatal care's structure and content.

Among the more prominent and recurring insights to emerge recently is the relative isolation of prenatal care from other components of women's health care in the United States. The discussions in a number of chapters in this book provide ample evidence for this insight. In both the clinical and programmatic arenas, current systems of prenatal care could be enhanced if greater coordination across clinical disciplines and preventive programs could be developed. Important recommendations have been made in this regard, including both technical and administrative improvements.

The obstacles to making prenatal care a more integrated part of women's health are not due to technical and administrative considerations alone, however. They are also deeply rooted in questions of justice. Prenatal programs and policies are not derived exclusively from technical knowledge or clinical capability. They are also the product of our deep anxieties over the plight of children in the United States, coupled with a continued ambivalence over the social roles of women in American society.