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

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.