• By Dartington SRU
  • Posted on Wednesday 18th March, 2009

Visiting helps young mothers carry the weight

Low birth weight can have damaging consequences for child health and development far beyond the early years. It also signals intractable difficulties against which only two programs have been able to demonstrate consistent preventive effects. One is Nurse Family Partnership, the other – less well known outside the US – is Healthy Families America, which has proved similarly valuable among high risk and hard-to-reach populations. As well as being at risk of developmental delays, low birth weight babies are more likely to be born to very young, poor and disadvantaged women and are twice as likely to experience maltreatment or to be placed in foster care.A New York implementation of the program (HFNY) which began in 2000 has been evaluated in a randomized controlled trial led by Eunju Lee at the Center for Human Services Research, University of New York at Albany.Over 230 high-risk pregnant teenagers and women were allocated to the intervention group; another 265 received information and referrals to other services, excluding home visiting.The low birth weight (LBW) threshold was reckoned below 2,500 grams. Mothers in the control group were twice as likely as the HFNY group to have LBW babies (9.8% vs. 5.1%). Mothers who enrolled early in HFNY had an even smaller chance of giving birth to a LBW baby. The program was particularly effective for Black and Hispanic women. Those who received HFNY were visited twice a week for an hour by advisers from their own communities who shared the women's cultural heritage and language.Visits addressed three issues particularly salient during high-risk pregnancy: effective problem-solving strategies, good social supports, and preparedness for motherhood. A strong preventive effect was identified, but the researchers could not say if the benefits were attributable to the program components themselves or to the simpler value of regular social support.Reviewing the results, Eunju Lee says current literature suggests that low-income mothers have better outcomes if they are given access to services and have their cases managed by a lead professional. Other research among Black women has shown that LBW is associated with social support and the characteristics of communities and neighborhoods, all of which are amenable to change. This leads her to suggest that “social and tangible support by a home visitor” may have resulted in a “healthier and less stressful pregnancy” that reduces the chances of LBW. This was particularly the case among ethnic minority women and the effect was even more powerful if introduced early.See: Lee E et al (2009) “Reducing Low Birth Weight Through Home Visitation: A Randomized Controlled Trial,” American Journal of Preventive Medicine, 36, (2), pp 154-160.

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