igh rates of infant mortality and morbidity persist in North Carolina despite efforts at the state and federal level to improve women's physical health and access to prenatal care in order to promote healthy birth outcomes. While infant mortality and low birth weight rates have declined over the past decade, more focused attention to women's behavioral health, specifically mental illness and substance use disorders, is needed to further close this gap. Women's mental health and substance use are often overlooked as determinants of both preconceptional health and pregnancy outcomes. This is regrettably shortsighted: addiction and mental illness not only pose risks to prenatal development and birth outcomes but also impair women's ability to be safe and sober mothers. Promoting positive birth outcomes requires that health care providers, policymakers, and communities in North Carolina collaborate to create a system of comprehensive care in order to support women's recovery from mental illness and substance abuse. PrevalenceThough overall rates of having any mental disorder are similar for men and women, the prevalence of specific disorders vary greatly by gender. According to the National Household Survey on Drug Use and Health, in 2007 the prevalence of serious mental illness (defined as a diagnosable mental, behavioral, or emotional disorder with substantial functional impairment) was higher in women, particularly those of reproductive age, than in men: 13.5% in women versus 10% in men for ages 18-25 and 10.1% versus 5.5% for ages 26-49.1 More women, 11.6% versus 7.7%, suffered mood disorders. 1 Substance use disorders are less common among women, with overall prevalence of substance use disorders of 5.7% among women as compared to 12.3% among men. 1Mental illness and substance use disorders are associated with significant morbidity, mortality, and disability. One in four individuals visiting a health care provider has at least one mental or behavioral disorder, yet these often go undiagnosed and untreated. 2 In the United States, only about one in four individuals who need substance abuse treatment receive it. 3 Failure to diagnose and treat has serious negative consequences. Mental illnesses are associated with increased risk of cardiovascular disease and diabetes and an increase of high-risk behaviors associated with substance abuse or HIV transmission. 2 Women who abuse substances are at increased risk for a variety of adverse health outcomes, including breast cancer, infertility, mental illness, unintentional injuries, suicide, and intimate partner violence. 4-9 This relationship between mental health, and substance use disorders, and risk behaviors is supported by data from the North Carolina Treatment Outcomes and Program Performance System (NC-TOPPS), a state reporting system that captures service and