The Short- and Long-Term Effects of a Large-Scale Prenatal Care Intervention

Little evidence exists on whether policy interventions explicitly designed to improve fetal health in the U.S. 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 publicly-funded prenatal intervention while in utero. We examine the effects of a set of landmark policies in the state of California to expand access to medical and support services to low-income pregnant women in the late 1980s and early 1990s. During this period, California expanded eligibility for prenatal Medicaid coverage to undocumented immigrants and to women with family incomes well above federally mandated eligibility levels. To identify the effects of expanded access to publicly-funded prenatal care, we use variation in exposure to the two different expansions across counties and population groups. Our analyses use state hospital discharge data to examine changes in insurance coverage for delivery and pregnancy outcomes. We also use a novel dataset that links birth certificate data for individuals born in California to federal survey and administrative data to examine short- and long-term outcomes for the children who benefited from these interventions while in utero. 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.