In the Womb, Assuring a Future

Even before there’s a child to educate, nurses in a Texas program visit low-income, first-time mothers during their pregnancy, helping them become “super-great moms” and giving their kids a very early edge in school.

National Journal
Sophie Quinton
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Sophie Quinton
Dec. 6, 2013, midnight

Ger­ie Perez has a 15-year-old cli­ent who’s ex­pect­ing her first child. As the nurse su­per­visor for a Nurse-Fam­ily Part­ner­ship agency in South Texas, Perez over­sees a group of nurses who vis­it low-in­come, first-time moth­ers twice a month dur­ing their preg­nancy, weekly for the six weeks after they give birth, then at least monthly un­til the child turns 2. “Just with that little bit of sup­port, it really lifts them up, and they are su­per-great moms,” Perez says. 

The Nurse-Fam­ily Part­ner­ship pro­gram, act­ive in 43 states, ad­dresses dis­par­it­ies in health and edu­ca­tion be­fore chil­dren ar­rive in preschool. It has suc­ceeded in im­prov­ing the health of moth­ers and ba­bies and also in help­ing moth­ers achieve fin­an­cial self-suf­fi­ciency. “We start par­ent­ing edu­ca­tion be­fore the baby’s born,” says Nancy Bo­tiller, chief op­er­at­ing of­ficer at the non­profit’s Den­ver headquar­ters.

Wo­men who en­roll in the pro­gram are more likely to carry their ba­bies to term. In Texas, where 54 per­cent of moth­ers the or­gan­iz­a­tion served in 2012 were His­pan­ic and 26 per­cent were Afric­an-Amer­ic­an, only 10 per­cent of the ba­bies were born pre­ma­turely, and just 9 per­cent were un­der­weight.

Na­tion­ally, chil­dren whose moth­ers en­roll in a Nurse-Fam­ily Part­ner­ship are 67 per­cent less likely to dis­play be­ha­vi­or­al and in­tel­lec­tu­al prob­lems at age 6. These in­ter­ven­tions have also halved the re­por­ted in­cid­ents of child ab­use and neg­lect.

Moth­ers join vol­un­tar­ily, at no cost, be­fore their 28th week of preg­nancy. Most are un­mar­ried. Na­tion­ally, their av­er­age age is about 20. Twenty-sev­en per­cent de­scribe them­selves as Afric­an-Amer­ic­an, 31 per­cent as Lat­ina, and 42 per­cent as white.

Nurses cov­er a range of top­ics with ex­pect­ant moth­ers, from pren­at­al nu­tri­tion to breast- feed­ing and deal­ing with a stress­ful home. They may help moth­ers save money on hous­ing or es­cape do­mest­ic vi­ol­ence. Moth­ers are taught how to re­spond to their ba­bies to cre­ate a strong bond, how to man­age in­fant tan­trums, and how to read and talk to their chil­dren.

Nurses use a tech­nique called mo­tiv­a­tion­al in­ter­view­ing. Rather than just telling a moth­er she ought to change a be­ha­vi­or, nurses will ask ques­tions, listen, and provide in­form­a­tion un­til cli­ents re­cog­nize the changes they must make. Mo­tiv­a­tion­al in­ter­view­ing also helps moth­ers set goals — to re­frain from smoking ci­gar­ettes be­fore the next nurse’s vis­it, say. Even if the moth­er doesn’t meet the goal, the nurse will con­grat­u­late her for mak­ing pro­gress and will help her brain­storm ways to meet the goal the fol­low­ing month. This pos­it­ive re­in­force­ment works, Perez says.

The na­tion­al or­gan­iz­a­tion has its roots in the 1970s, when Dav­id Olds, a pro­fess­or of pe­di­at­rics at the Uni­versity of Col­or­ado, star­ted a series of ran­dom­ized con­trolled tri­als to see how nurses’ vis­its could bring about healthy births. In the 1990s, pub­lic-health de­part­ments, hos­pit­als, and non­profit or­gan­iz­a­tions began rep­lic­at­ing the mod­el in their com­munit­ies. The Nurse-Fam­ily Part­ner­ship Na­tion­al Ser­vice Of­fice, es­tab­lished as a na­tion­al non­profit in 2003, has served 182,000 fam­il­ies.

The pro­gram typ­ic­ally costs $4,500 per fam­ily per year, fin­anced mainly by state and fed­er­al gov­ern­ments, but of­ten with private money as well. A 2005 study by Rand found that these ser­vices save between $1.26 and $5.70 in gov­ern­ment out­lays for every dol­lar spent, be­cause fam­il­ies are less likely to re­quire so­cial ser­vices.

COR­REC­TION: An earli­er ver­sion of this story mis­stated Dav­id Olds’s cre­den­tials. He is a pro­fess­or of pe­di­at­rics and holds a doc­tor­ate.

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