Low birthweight (<2500 g) and preterm birth (<37 weeks gestation) are key indicators of newborn health. Both are associated with an increased risk of death in the first year of life as well as chronic conditions during the life course. Therefore, reducing poor birth outcomes is a global public health priority and requires strategies to improve access to health services during pregnancy.

Previously, the existing evidence on this topic was limited to the United States and specific vulnerable subgroups such as low-income individuals or immigrants. Adina Epure and her team assessed the effect of a Swiss health policy that expanded coverage of healthcare costs during pregnancy on newborn health outcomes. For this they performed a nationwide study and included nearly all live births (about 509.000 children) in Switzerland between 2011 and 2019. The scientists implemented a quasi-experimental design that imitated a randomized experiment. They assessed the effect on birthweight, gestational age, and neonatal death of a 2014 Swiss policy expansion, which provided full coverage of mother participation to healthcare costs from 13 weeks of gestation through 8 weeks postpartum.

The results of the study showed that the policy expansion had a positive effect on newborn health at a population level, notably with respect to reducing the risk of low and very low birthweight births. For example, the predicted proportion of low birthweight births decreased by 0,81%. However, the risk of preterm births and neonatal deaths was not reduced in the population at risk of poverty. 

This investigation showed that expanding coverage of healthcare costs during pregnancy had a positive effect on the health of babies born in Switzerland. But the policy did not reduce socioeconomic health inequalities. Therefore, strategies targeting both financial and non-financial barriers could be considered in the future to reduce socio-economic inequalities and to maximize maternal and child health.

Effect of covering perinatal health-care costs on neonatal outcomes in Switzerland: a quasi-experimental population-based study. Adina Mihaela Epure, Emilie Courtin, Philippe Wanner, Arnaud Chiolero, Stéphane Cullati, Cristian Carmeli. Lancet Public Health. 2023 Mar;8(3):e194-e2024