We study the introduction of a noninvasive prenatal screening—cell-free DNA (cfDNA) screening—which is used to target a more costly invasive test that elevates miscarriage risk. Using Swedish administrative data, we document that coverage of cfDNA substantially increases cfDNA screening and reduces invasive testing. We develop and estimate a stylized model of prenatal choices and find that narrow targeting of cfDNA coverage can improve outcomes and reduce costs, while broader coverage also improves outcomes but with increased costs. These findings point to the potential gains from well-designed targeting of screening but at the same time highlight the importance of the targeting design.

We use linked administrative data on the universe of California births to provide novel evidence on economic inequality in infant and maternal health. Infants and mothers at the top of the income distribution have worse birth and morbidity outcomes than their lowest-income counterparts, but are nevertheless the least likely to die in the year following birth. Racial disparities swamp these income disparities, with no racial convergence in health outcomes as income rises. A comparison with Sweden shows that infant and maternal health is worse in California at virtually all income levels.