In 1998, California voters approved Proposition 10, the Children and Families First Act, which placed an additional tax on cigarette sales; monies generated will be used to improve early childhood development for birth to five. In terms of early childhood development, the starting point is not birth but long before; care of women of reproductive age prior to conception and prenatal care are the cornerstone to a healthy start for children. This report makes the case for Proposition 10 investment in preconceptional and prenatal care. Following a brief introduction, the report defines preconceptional and prenatal care and reviews the literature on the impact of such care on early childhood development, noting that care can avert major maternal and infant morbidity and mortality, as well as promote healthy behaviors and reduce risk-taking behaviors. The report next presents an assessment of the need for preconceptional and prenatal care. This section profiles use of such care in California, highlights some risk behaviors and exposures that could be addressed by such care, and reports on pregnancy outcomes in California that may have an impact on early childhood development. The report then addresses service system capacity, describing major programs that fund or provide preconceptional and/or prenatal care, and family planning. Gaps and barriers to access for such care are also discussed. The report then explores the fragmentation of service delivery, between family planning and other reproductive health services, between reproductive and non-reproductive health services, and between reproductive health care and children's health care. The report concludes with recommendations to Proposition 10 commissioners for addressing needs, gaps and barriers for preconceptional and prenatal care, including promoting outreach, enhancing service capacity, providing psychosocial support at different levels, enhancing service coordination and system integration, and funding evaluation and research. The report's appendix provides a partial list of organizations and Web sites for perinatal programs in California. (Contains 141 references.) (HTH)