Pregnancy is not a condition to be “managed”

(written by lawrence krubner, however indented passages are often quotes). You can contact lawrence at:, or follow me on Twitter.

Amy Romano is writing an in-depth series of blog posts on health care in the USA. I wish I was a bit more optimistic about the chance of reform in the USA, but certainly it helps to be aware of the programs that are known to work in various countries. Regarding the Nurse-Family Partnership programs she writes:

These included reconnecting personal health to relationships, and impacting the whole person, not just the “disease.” These are the crux of Nurse-Family Partnership (NFP), the first of four evidence-based models I will examine in the “Care Models That Work” segment of this series.

NFP is a voluntary home visiting program for low-income, first-time moms. A public health nurse is paired with each woman and visits her regularly during pregnancy and until the child’s second birthday. Visits include some standardized assessments and interventions, but are largely woman-directed. What matters to the woman is what the woman and the nurse will work on together, whether that’s improving her diet or accessing job training for her return to work after childbirth. The model was developed in the 1970’s and refined and studied throughout the 80’s and 90’s, and has been replicated broadly since 1996. NFP programs are now established in 558 counties, enrolling over 30,000 women and families at any given time. The program is also being replicated internationally, including in the UK, Canada, and the Netherlands.

…The program acknowledges that pregnancy is not a condition to be “managed,” but rather a powerful inflection point in the life course of a woman and a family. I began to get a sense of NFP’s long view when I followed links to a study earlier this year reporting reduced maternal and child death with NFP.

As someone who routinely analyzes maternity research, my frame of reference was our vital statistics concepts of mortality: infant mortality is death within the first year; maternal death occurs during or within 42 days of pregnancy. To be sure, these are important public health measures, but if you look at it from the family’s perspective, the death of a mother or child is devastating no matter when it happens, and it has ripple effects through a family and community. So the NFP researchers looked at death at any time during the child’s upbringing, and the findings are remarkable. In a 20-year follow-up from one of the original NFP randomized controlled trials, they found:

* 1.6% of children in the control group (without nurse home visiting) died of preventable causes like SIDS, homicide, or accidental injury while none of the nurse-visited children died.

* Mothers were three times more likely to die of any cause and seven times more likely to die of homicide, suicide, accidental injury, or drug overdose if they did not receive nurse home visitation.

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