Changes in the mother’s life course.
Increase families’ economic self-sufficiency and reduce government costs at the same time.
While working with their nurse home visitor, many of the young women in the Nurse-Family Partnership program set goals for themselves for the very first time. The nurses call it “finding your heart’s desire” and know that goal setting is the first step toward accomplishment. Others look at this transformation and simply call it success.
One of the Nurse-Family Partnership program’s three stated goals is economic self-sufficiency for the family. The program’s two other goals are better pregnancy outcomes and healthy child development — foundations that help the family be prepared to succeed economically.
Research shows that Nurse-Family Partnership does, indeed, improve maternal life course. Nurses help the mother to feel empowered to make sound choices about her education, workplace participation, partner relationships, and the timing of subsequent pregnancies that enable her to financially take better care of herself and her child. That, in turn, brings down spending on social and other government program costs.
Among the improvements in low-income, unmarried mothers’ economic self-sufficiency that have been observed in at least two of the three randomized, controlled trials of the program are:
Reduction in use of welfare and other government assistance
Greater employment for the mothers
Increase in father presence and partner stability
Fewer closely-spaced subsequent pregnancies
Low-income parents often need welfare assistance during their early years of caring for their children, but long-term reliance on government support can interfere with families’ self-sufficiency. In the Elmira trial, nurse-visited low-income, unmarried women used government assistance for fewer months than did women in the control group.1
In the Memphis trial, by child age 12, there was a $12,300 difference between the nurse-visited and control groups in the cost of cash assistance, food stamps, and Medicaid that exceeded the cost of the program, after discounting and adjusting costs to the same year.2
The program impact on use of welfare did not hold in the Denver trial, which began just before federal welfare reform was passed and just as the U.S. economy moved into a period of rapid growth in the late 1990s. Nurse-visited women in the Denver trial did, however, improve their economic self-sufficiency to a greater extent than did women in the control group.3
Families’ economic resources are predictive of a wide range of indicators of child and family well-being. Nurse-visited low-income, unmarried women in the Elmira trial worked 82% more than their control-group counterparts through child age four;4 those in the Memphis trial were twice as likely to be employed at child age two,5 and in Denver, there were similar effects for nurse-visited women over time.3
Marriage and stable partner relationships contribute to better child and family functioning.6,7 Women in the Elmira trial who had been unmarried and from low socio-economic households at registration were more than twice as likely to be married 15 years following the birth of the first child than their control-group counterparts.8 In the Memphis trial, nurse-visited women were 60-70% more likely to be cohabiting with a partner or the child’s father at child age five,9 and at child ages six and nine, nurse-visited women had more stable partner relationships than did women in the control group.10,11
Closely spaced pregnancies make it harder for women to complete their educations and to make career advances.12-14 In all three trials, nurse-visited women had longer intervals between the births of first and second children, due to better pregnancy planning. In the Elmira trial, nurse-visited mothers who were unmarried and from low-income households at registration, compared to control-group counterparts, had a 12 ½ month greater interval between birth of the first and second child by the time the first child was four years of age4; in the Memphis and Denver trials, the corresponding increases in inter-birth intervals were 3.7 and 4.1 months.9,10
1. Olds D, Eckenrode J, Henderson C, Kitzman H, Powers, J, Cole R, Sidora K, Morris P, Pettitt L, Luckey D. Long-term effects of home visitation on maternal life course and child abuse and neglect: a 15-year follow-up of a randomized trial. JAMA 1997: 278(8):637-643.
2. Olds DL, Kitzman H, Cole R, Hanks C, Sidora-Arcoleo K, Anson E, Luckey DW, Knudtson MD, Henderson CR, Bondy J, Stevenson A. Enduring effects of prenatal and infancy home visiting by nurses on maternal life-course and government spending: Age-12 follow-up of a randomized trial. Arch Pediatr Adolesc Med 2010: 164(5):419-424.
3. Olds DL. Impact of the Nurse-Family Partnership on Neighborhood Context, Government Expenditures, and Children's School Functioning. Final report, grant 2005-MU-MU-0001. U.S. Department of Justice 2009.
4. Olds D, Henderson C, Tatelbaum R, Chamberlin R. Improving the life-course development of socially disadvantaged mothers: a randomized trial of nurse home visitation. Am J Public Health 1988: 78(11):1436-1445. #13
5. Kitzman H, Olds DL, Henderson CR Jr., Hanks C, Cole R, Tatelbaum R, McConnochie KM, Sidora K, Luckey DW, Shaver D, Engelhardt K, James D, Barnard K. Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing: a randomized controlled trial. JAMA 1997; 278(8):644-652.
6. McLanahan S, Osborne C. Partnership Instability and Child Well-Being. Journal of Marriage and Family 2007:69(4):1065-1083.
7. Amato P. The impact of family formation change on the cognitive, social, and emotional well-being of the next generation. Future of Children 2005:15:75-96.
8. Pettitt L. Marriage, Fathers, Partners, and the Nurse Family Partnership. Pennsylvania Nurse-Family Partnership State Conference, April 5-7, 2004. Hershey, PA.
9. Kitzman H, Olds DL, Sidora K, Henderson CR Jr., Hanks C, Cole R, Luckey DW, Bondy J, Cole K, Glazner J. Enduring effects of nurse home visitation on maternal life course: a 3-year follow-up of a randomized trial. JAMA 2000: 283(15):1983-1989. #14
10. Olds D, Kitzman H, Cole R, Robinson J, Sidora K, Luckey D, Henderson C, Hanks C, Bondy J, Holmberg J. Effects of nurse home visiting on maternal life-course and child development: age-six follow-up of a randomized trial. Pediatrics 2004: 114(6):1550-1559.
11. Olds DL, Kitzman H, Hanks C, Cole R, Anson E, Sidora-Arcoleo K, Luckey DW, Henderson CR Jr., Holmberg J, Tutt RA, Stevenson AJ, Bondy J. Effects of nurse home visiting on maternal and child functioning: age-9 follow-up of a randomized trial. Pediatrics 2007: 120(4):e832-845.
12. Conde-Agudelo A, Rosas-Bermudez A, Kafury-Goeta AC. Birth spacing and risk of adverse perinatal outcomes: a meta-analysis. JAMA 2006: 295(15):1809-1823.
13. Zuravin SJ. Fertility patterns: their relationship to child physical abuse and child neglect. J Marriage and Family 1988: 50(4):983-993.
14. Furstenberg FF, Brooks-Gunn J, Morgan SP. Adolescent mothers in later life. Human Development in cultural and historical contexts. Cambridge University Press, New York, NY 1987.