Prenatal Home Visits Lead to Improved Child Health and Development Outcomes

Home visiting programs during pregnancy have been shown to measurably improve child health and development outcomes. One such program, the Memphis Nurse Family Partnership (NFP), sent registered nurses to the homes of primarily African-American, unmarried, low-income, first-time mothers. The visits began during pregnancy and lasted until the children turned two years old.

During pregnancy, nurses informed mothers of the dangers of smoking and drinking, and taught them about healthy diet options and prenatal care. After the babies were born, home visitors gave mothers instructions on how to encourage bonding with their child. Research has shown that forming strong bonds with caring adults is crucial in setting the foundation for a child’s healthy development. Finally, nurses guided parents in thinking through next steps for their futures regarding family planning, careers and education.

Research on the Memphis NFP and similar programs have used randomized control trials to demonstrate the efficacy of the programs. However, potential irregularities in the analysis of the trial data and questions about how the programs work motivated James Heckman and co-authors Maria Rosales, Rodrigo Pinto, Margaret Holland and Kevin Makino to reexamine the results of the 1990 randomized evaluation in Memphis.

While the Memphis NFP has been evaluated many times, this analysis employs two additional methods to test the validity of earlier findings. Overall, they find the program is effective, but not to the same degree as earlier findings. The new methods avoid two pitfalls—bias introduced by small sample sizes and problems associated with testing multiple hypotheses.

Benefits from the NFP began as early as pregnancy. Boys in the program had higher birth weights, a statistically significant treatment effect, which is important because low birth weights can lead to developmental issues that contribute to negative outcomes later in life. There were also significant effects on home environment. By the time children turned two years old, mothers experienced improved parental attitudes, increased self-esteem and reduced anxiety.

Positive effects persisted as children grew older. By age six, participants’ children demonstrated higher cognitive skills compared to children in the control group. Females displayed stronger early socio-emotional skills, including reduced aggression and increased empathy, while boys saw larger effect sizes on cognitive skills. At age 12, years after the intervention had ended, males continued to see statistically significant improvements in cognition, as well as math and reading achievement test scores. Heckman and colleagues noted that, according to some medical experts, boys are more vulnerable to their prenatal environments. Therefore, it is possible that the enhanced cognitive skill formation seen in boys resulted from healthier prenatal environments fostered by the NFP, ultimately resulting in stronger long-term effects for boys than for girls.

This research provides evidence that the support provided through the NFP created concrete, positive changes. As the researchers put it, “We show that parenting matters.” Two-generation approaches such as the NFP aim to address the needs of parents and children simultaneously. As a result, they may offer parenting skills to disadvantaged families, which can lead to better home environments for young children. Though these programs generally enjoy bipartisan support, concerns about budget shortfalls have led to programs such as the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) reauthorization to be stalled in Congress. While variation in program implementation and efficiency make it difficult to conclude whether the benefits of home visiting programs are consistently worth the costs, there is general consensus that these services are valuable to vulnerable communities and merit continued research.

Article source: Heckman, James J., Margaret L. Holland, Kevin K. Makino, Rodrigo Pinto, and Maria Rosales-Rueda. “An Analysis of the Memphis Nurse-Family Partnership Program” National Bureau of Economic Research No. w23610, (2017).

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