This report addresses the current status of birth outcomes (low birth weight), risk factors for poor birth outcomes, service utilization patterns for Maternity Support Services, and future directions to maximize impact of enhanced prenatal services on birth outcomes. The First Steps Program has served low-income pregnant women in Washington State for more than 15 years, since August 1989. By the end of 2004, nearly 350,000 women had received services through this program, and Medicaid was funding 46% of all births to Washington residents. Gains in prenatal care access and birth outcomes (low birth weight and infant mortality) were clear during the first five years of the program
