Nurse Visitation Can Reduce Social Problems

Research indicates that a carefully designed program of nurse visitation to low- income non-married women during pregnancy and after childbirth can have significant effects in reducing problem behaviors over the long-term.

In an article published in the Journal of the American Medical Association (JAMA), researchers examined the effects of a nurse home visitation program for low-income, non-married women conducted in Elmira, New York between 1978 and 1980. Although the visitation program was limited to the first two years after the birth of the mother's first child, in many cases it substantially altered the life course of the mother and produced positive results still apparent 15 years later.

In the Elmira visitation program, low-income, non-married pregnant women received home visits by nurses during their first pregnancy and for two years after the child's birth. The average age of the women in the program, at the time of pregnancy, was 18. About three-quarters of the women were white and one-quarter were black.

The nurse visitation occurred on roughly a monthly basis and focused on providing skills in three areas. First, the program sought to improve the mother's health-related behaviors during pregnancy and the early years after the child's birth. Second, it sought to improve the care provided by the mother to the child. Third, it sought to improve the decision-making and long-term life planning of the mother, with particular focus on planning future child-bearing, increasing educational attainment, and raising workforce participation.

The women receiving the nurse visits were compared to a randomly selected control group of similar non-married pregnant women in Elmira who did not receive nurse visits. Despite the fact that the visitation program dealt with the women for just two years, it was shown to have long-term effects on a wide range of behaviors.

Researchers examined the women some 15 years after their entry into the visitation and control groups. During the subsequent 15 years, the non-married, low-income women who had received the nurse visits had about one-third fewer pregnancies and one-third fewer subsequent births when compared to women in the control group. The average time interval between the first and second births was increased from three to five years.

The visitation program also significantly reduced future welfare receipt. Over the 15-year study period, women who participated in nurse visitation received AFDC benefits one-third less than women in the control group. Food Stamp receipt was cut in half among women who received nurse visits.

Other behaviors also showed marked long-term improvements a result of the program. Substantiated charges of child abuse and neglect were cut nearly in half among women who received the nurse visits. Alcohol and substance abuse were reduced by nearly half, and criminal convictions were cut by between 70 and 80 percent.

Caution should be used in applying some of these findings to current conditions. Since the enactment of national welfare reform legislation in 1996, the rate of welfare dependence and the average length of time single mothers spend on AFDC have dropped greatly. (As a result of that legislation, AFDC has been renamed Temporary Assistance to Needy Families or TANF.) Consequently, it should not be assumed that an Elmira-style nurse visitation program, implemented today, would have the same effects in reducing welfare receipt as the original program did in the 1980s and early 1990s.

Nonetheless, the experiment does show that well-designed programs offering personal instruction and mentoring can significantly reduce future out-of-wedlock childbearing and a wide range of other problem behaviors.

Robert Rector is a policy analyst at The Heritage Foundation.

For more information ...

Welfare: Broadening the Reform. What do we know about the causes and effects of welfare dependency? How can we foster independence? (The Heritage Foundation, Issues 2000, 25pp.)

Request PolicyBot documents #9200501 and #9200502.