The Challenge of Improving Birth Outcomes for Low-Income Women

By Jose Fernandez, PHD
July 6, 2022

Jose Manuel Fernandez is an Associate Professor and Chair of the Economics Department at the University of Louisville. His research focuses on illicit drug use, risky behaviors and children with disabilities. Jose is a member of the 2022 Tradeoffs Research Council.

Following the Supreme Court’s decision to allow states to ban abortion, experts fear the country’s existing maternal and infant mortality crisis could get even worse. Poor birth outcomes are most common among Black Americans — Black babies are twice as likely to be born early than white babies, a major risk factor for serious health issues including death.

One suggested way to improve birth outcomes (and reduce disparities) is to provide women with extra support from visiting nurses, who can give mothers care and advice that could improve their health through their pregnancy. While similar programs have shown little impact in improving health of older people and teenage parents, community-based home visiting programs have been shown to decrease the risk of infant death. But a new robust study has more discouraging findings.

A randomized control trial published yesterday in JAMA led by Harvard’s Margaret McConnell sorted 5,670 Medicaid-eligible first-time mothers in South Carolina into two groups. One group received an average of nine prenatal nurse home visits, usually lasting more than an hour, with about half the time spent discussing personal health and parenting. The other group got the usual level of prenatal care.

The researchers found no difference in rates of preterm birth, low birthweight, small for gestational age or perinatal death between the two groups. They also looked at 52 other measures of infant and maternal health including maternal and infant mortality, NICU usage and type of delivery — no differences across the board. Finally, they looked at outcomes specifically for Black participants and again found no impact.

It’s a frustrating finding for those of us eager to find ways to staunch our maternal and infant mortality crises. Similar to a 2020 randomized control trial on the famed “hot spotters” program, the researchers noted that poor outcomes may reflect social determinants of health, like poverty and racism, which visiting nurse programs are not designed to address. They also note that the study isn’t done — they intend to continue following these families to see if differences emerge later in the children’s lives.

For now, it’s another reminder of the outsized risk parents and babies face in America.

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