6. The antenatal investment hypothesis
Current evidence on antenatal interventions, while
limited, would therefore suggest that the returns to
investing in this period are high, yet an explicit test of
this hypothesis is lacking. By amending Fig. 2a to
incorporate the antenatal period from conception to birth
Fig. 2b presents a graphical illustration of the antenatal
investment hypothesis. The hypothesis can be displayed as
two downward sloping investment curves representing
the rate of return to investment starting in the antenatal
period (upper curve), and the postnatal period (lower
curve). If the hypothesis is correct, the return in both cases
is greatest for earlier rather than later investment. This
hypothesis also indicates that the return on the antenatal
investment will be higher than the postnatal investment,
both initially and in the long-term, and may increase the
rate of return on investment at every subsequent period.
As the Nurse–Family Partnership had a greater impact on
young women having their first child, the hypothesis may
be further extended to investigate whether supporting
women at the beginning of their reproductive life leads the
benefits of the intervention to be carried over to
subsequent births.
An explicit study which tests the antenatal investment
hypothesis and models the impact of intervening at
different stages of the child’s and mother’s life is needed.Current knowledge in this area is based on a small number
of predominantly US studies, and it cannot be assumed
that the effectiveness of a US-style intervention can be
replicated across European settings given the differences
in social welfare systems and cultural contexts. For
example, social welfare spending in Ireland is half that
of Sweden (OECD, 2007). An optimal study design would
incorporate a series of randomised interventions with
programmes starting at difference ages. A longitudinal
study would reveal the impact of the timing.