Nurse Visits to Low-income Mothers Improves Outcomes

Published on in CHOP News

November 1, 2010 — Home visits by nurses to low-income first-time mothers in the two years following the birth of a first child helps reduce rapid second pregnancies, which can be an important public health outcome because of the beneficial effects spacing can have on a child’s well-being, according to a new study by PolicyLab at The Children’s Hospital of Philadelphia.

While the program improved outcomes universally following statewide implementation in Pennsylvania in the past decade, the effects were particularly strong in rural locations and with young mothers, the researchers found. The study, published online today in Archives of Pediatrics and Adolescent Medicine, reviewed 3,844 clients in 17 urban and six rural areas in Pennsylvania between 2000 and 2007.

Second pregnancy rate lower in rural areas with nurse visits

“The continued effectiveness of the program following implementation was encouraging, but particularly striking were the strong effects among young rural mothers,” said study leader David Rubin, MD, MSCE, a pediatric researcher at Children’s Hospital. “Once programs are established, there was a two-fold reduction in second pregnancies in the rural areas compared with urban locations.”

How the study was conducted

The study looked at families paired with nurses who receive extra training through the national, non-profit organization Nurse-Family Partnership (NFP). The nurses make home visits to low-income mothers during their first pregnancy, and for two years after, as a way to improve the child’s health and development, as well as strengthen the parents’ economic self-sufficiency.

NFP serves more than 22,000 families in 32 states each year. Past studies have shown NFP’s volunteer recipients benefit in many ways including lower dependence on government assistance programs such as welfare, improved perinatal outcomes and reduced antisocial behavior in children.

Study results

The study showed no immediate effects during the program’s initial years in 2000 through 2003. However clients whose first infants were born after 2003 had fewer second pregnancies, especially among mothers younger than 18. In the rural areas there was a two-fold reduction in second pregnancies compared with urban locations.

“The impact of these programs in rural areas has not been well-studied, so evidence of their effectiveness can be particularly helpful as programs look to expand their reach to smaller communities throughout the country,” Dr. Rubin said.

Study authors

Other study authors include Amanda L.R. O’Reilly, MPH; Xianqun Luan, MS; Dingwei Dai, MSc, PhD; A. Russell Localio, PhD; and Cindy W. Christian, MD, of Children’s Hospital and the University of Pennsylvania School of Medicine. This project was supported by a grant from the Department of Public Welfare, Commonwealth of Pennsylvania.

More information

“Variation in Pregnancy Outcomes Following Statewide Implementation of a Prenatal Home Visitation Program,” Archives of Pediatrics and Adolescent Medicine, Published online November 1, 2010. doi:10.1001/archpediatrics.2010.221.