An Ounce of Prevention

Article excerpt

... is worth a pound of cure. Sometimes the simple truth of such a timeworn adage can be applied to new problems. For at-risk mothers and their children, prevention in the form of prenatal and postnatal intervention may be a key to improved long-term health and productivity.

How do you help generations of women and children who are mired in a cycle of poverty, teen pregnancy, single-parenthood, interrupted education, and other dysfunctions? Social scientists have been grappling with this question for years. The answers don't come easily.

Occasionally, however, a new strategy offers some hope. In the late 1970s and early 1980s, a study was conducted in Elmira, New York, to determine the effects of intensive prenatal and postnatal home visitation services for high-risk, first-time mothers and their children. Many of the mothers were unmarried teenagers, a particularly vulnerable group.

The early results were encouraging. Periodic evaluations conducted between birth and the children's fourth birthdays showed improved pregnancy outcomes and child care practices, reduced incidences of child abuse, and improved life course development for the mothers. The families also relied less on social services, resulting in reduced government expenditures.

"People were excited by the results and the model, but these intervention strategies aren't really a new idea," says human development and family studies professor John Eckenrode. "What we don't know is how they affect the lives of women and their children over the long term."

Eckenrode is one of the principal investigators in a five-year follow-up study that is examining the long-term effects of the prenatal and postnatal intervention program. He is attempting to see if the intervention strategies have continued to have positive effects on the lives of the mothers and children in the initial study. Working with him are Family Life Development Center research associate and project director Jane Levine Powers; University of Colorado professor David Olds, the principal investigator in the first project and a human development and family studies graduate; University of Rochester investigators Robert Cole and Harriet Kitzman; human development and family studies senior research associate Charles Henderson; and John Shannon of Comprehensive Interdisciplinary Developmental Services in Elmira.

The initial study randomly divided the women into four groups. The women in the first, the control group, assumed responsibility for seeking prenatal care themselves and received no additional services. The women in the second group were provided with free transportation to their medical appointments and other prenatal services.

"Back in the mid-seventies, it was thought that lack of transportation was a barrier to low-income women who needed prenatal care," explains Eckenrode. "But providing them with transportation didn't make a difference or affect the outcomes because the women in the control group used prenatal care. So those two groups are usually combined when outcomes are considered."

The strategy primarily responsible for the improved outcomes appears to be in-home nurse visits. These were provided to the women in the third group, who received prenatal home visits, and to the women in the fourth group, who received both prenatal home visits and two years of postnatal home visits.

"These home visits focused on health-related issues, such as smoking and diet," Eckenrode says. "During the prenatal visits, the women were encouraged to get to all their medical appointments, and they were educated about the birth and delivery process. Efforts were made to mobilize support from the women's mothers, husbands, or boyfriends and get them to participate in the labor and delivery process."

Postnatal visits focused on the health and development of the child and on mother-child interaction. The home visits included discussions about life course issues for the women, such as planning for the future. …