Public policy and programs have the potential to reduce the rate of preterm birth and ensure healthy outcomes for infants who were born preterm through the provision of guidance on how to formulate effective public policies to reduce the rate of preterm birth. The provision of guidance can be difficult, however, because, as documented throughout this report, a great deal of uncertainty regarding the mechanisms through which preterm birth occurs still exists and relatively little evidence regarding effective interventions is available. The provision of guidance on how to improve the outcomes for children who were born preterm is somewhat less problematic, however, as the evidence on the positive effects of social and other policies on the health of children is stronger. Effective policy recommendations, however, will require more research to identify effective clinical interventions; to determine the role of the quality, financing, and organization of the health care delivery system on outcomes; and to identify the role of social policies on the health of mothers and children.

The lack of data that can be used to inform policies has been reported elsewhere. In 2001, the Advisory Committee on Infant Mortality published a report that reviewed the current literature and concluded that the findings from the literature justified “considerable investment in research programs, and policies focused on the goal of decreasing the incidence of preterm delivery, and thus of low birth weight and infant mortality” (ACIM, 2001, p. 15). The Committee on Infant Mortality called for research efforts in areas of disparities, smoking prevention and cessation, promotion of health education and healthy behaviors, and understanding the causes of preterm labor and premature rupture of membranes. It also recommended investigation of the health care delivery system and its effects on birth outcomes.

The remainder of this section discusses selected policy options for the financing of health care, the organization and quality of care, and other social policies and their possible roles in reducing the rate of preterm birth and ensuring healthy outcomes for infants.

Policy makers have focused on the expansion of access to prenatal care since the 1980s in an effort to improve birth outcomes in general, including a reduction in the rate of preterm birth. These efforts have primarily been achieved through an expansion of Medicaid eligibility for pregnant women at the state level. States have the option of extending eligibility to those with incomes greater than 133 percent of the federal poverty level, and the majority of states do so. A direct link between increased insurance