Initiatives to expand prenatal care brought documented reductions in infant mortality during the early 1980s. However, subsequent interventions proved less effective. Moreover, the incidence of low birth weight has not been significantly affected by policy, with the incidence of low birth weight essentially the same today as it was in 1970. Pregnancy-related substance abuse treatment encounters similar difficulties. Rigorous evaluations of prenatal smoking cessation programs typically find quit rates of 25 percent or less.
Programs targeted for poor women achieve even worse results.
Interventions for illegal drug use, while providing important benefits, yield equally limited results. In light of such findings, we hypothesize that pregnancy-triggered policies face inherent limitations. The most generous entitlement or the most effective substance abuse treatment is only helpful once a woman becomes pregnant, knows it, and receives effective care. We therefore hypothesize that substance abuse policies that reach the entire population will have a larger impact on infant health than will narrowly targeted interventions that occur during pregnancy. Broad policies have the further advantage that they foster general improvement in population health, including the health of women both before and after pregnancy, for the growing numbers of women who do not bear children, and for men.