At one level, the results of a clinical trial that studied low-income families in Memphis for more than 20 years delivered about what was expected.
“I don’t think it was a surprise to anyone that some of the families living in our impoverished areas, the young moms, were not prepared for parenthood and rarely understood how best to care for their (young children),” said Meri Armour, president and CEO of Le Bonheur Children’s Hospital.
But the study also found that the Nurse-Family Partnership reduces preventable death among both low-income mothers and their firstborn children in economically depressed urban neighborhoods.
In the Nurse-Family Partnership program, a low-income woman having her first baby is paired with a nurse who provides home visits throughout her pregnancy and until the child’s second birthday.
“All of the deaths of children from preventable causes were in the control group,” said David Olds, professor of pediatrics at the University of Colorado and lead investigator on the study.
Beginning in 1990, the trial enrolled low-income, primarily African-American mothers living in Memphis neighborhoods and assessed maternal and child mortality for more than two decades (until 2011). Children in the control group not receiving nurse-home visits had a mortality rate of 1.6 percent for preventable causes – including sudden infant death syndrome, unintentional injuries and homicide.
The numbers were even more significant for mothers in the program. Mothers in the control group who did not receive nurse-home visits were nearly three times more likely to die than were nurse-visited mothers; they were eight times more like to die from external causes – those tied to maternal behaviors and environmental conditions, including unintentional injuries, suicide, drug overdose and homicide.
Olds said the trial showed the consequences for young mothers living in tough situations where they are “just trying to survive.”
Noting that many of the young mothers were dealing with multiple challenges – from being unemployed to having a substance abuse problem – Armour said, “Having a child doesn’t reduce stress.”
Earlier follow-up studies of the Memphis trial found that nurse-visited mothers had better prenatal health and behavior; reduced rates of closely spaced subsequent pregnancies; decreased use of welfare, Medicaid and food stamps; fewer behavioral issues due to substance abuse; and fewer parenting attitudes that predispose them to abuse their children.
Earlier follow-ups of the nurse-visited children showed they were less likely to be hospitalized with injuries through age 2; less likely to have behavioral problems at the point of entering school; and less likely at age 12 to have symptoms of depression, anxiety or substance use.
Over the last 37 years there have been a series of randomized clinical trials of the NFP program; currently, it is in 43 states and is being implemented in six other countries.
Le Bonheur’s Nurse-Family Partnership was launched in 2010 and through March 2014 reported a rise in children being up to date on their immunizations and in workforce participation by moms. Those 18 and older were employed at a rate of 39.3 percent when starting the program and were at 69.8 percent after 24 months.
Armour says they’ve been funding the program through health department grants, hospital resources and philanthropy dollars – “sort of piecing it together financially.”
She says the study demonstrates not only the value of education but also the long-term economic impact of intervening early by the reduced health care costs for both mother and child going forward.
“We like to lay blame (as a society) sometimes,” Armour said, “but people just don’t know what they don’t know.”