preventing disability; however, assessing or evaluating their cost implications was not part of the charge to this committee.

RECOMMENDATION 16: Provide comprehensive health services to all mothers and children

Preventing disability will require access by all Americans to quality health care. An immediate step that could be taken would be to ensure the availability of comprehensive medical services to all children up to the age of 18 and to their mothers who are within 200 percent of the poverty level; in addition, every pregnant woman should be assured access to prenatal care. When provided, these services should include continuous, comprehensive preventive and acute health services for every child who has, or is at risk of developing, a developmental disability. In certain circumstances—for example, providing prenatal care for the prevention of low birthweight—the economic consequences have been shown to be favorable, but they need to be explored further in other areas of health care delivery.

Research on prenatal care has demonstrated that comprehensive obstetric care for pregnant women, beginning in the first trimester, reduces the risk of infant mortality and morbidity, including congenital and developmental disability. Researchers also have documented that women who have the greatest risk of complications during pregnancy—teenagers and women who are poor—are also the least likely to obtain comprehensive prenatal care. Furthermore, in its 1985 report, Preventing Low Birthweight , the IOM showed conclusively that, for each dollar spent on providing prenatal care to low-income, poorly educated women, total expenditures for direct medical care of their low-birthweight infants were reduced by more than $3 during the first year of life.

RECOMMENDATION 17: Provide effective family planning and prenatal services

Educational efforts should be undertaken to provide women in high-risk groups with the opportunity to learn the importance of family planning services and prenatal care. Access to prenatal diagnosis and associated services, including pregnancy termination, currently varies according to socioeconomic status. The committee respects the diversity of viewpoints relative to those services but believes they should be available to all pregnant women for their individual consideration as part of accessible, affordable quality care.

Even among privately or publicly insured people with disabilities, access to needed services is often a problem. Coverage may be limited by an



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