It’s a scenario repeated thousands of times in the past 30 years: A young, poor, pregnant woman agrees to have a nurse visit her in her home.
The nurse talks about good nutrition, giving up cigarettes and preparing for childbirth.
After the baby is born and for two more years, the nurse visits once or twice a month to help the young mother cope with the daily demands of a growing child.
This maternal home-visit service is on its way to becoming a massive federal program, thanks to President Obama and his administration’s push for health care reform.
But, as with any grass-roots approach that burgeons into a federal program, criticisms emerge. Concerns with this home-visit program range from its likely $1 billion price tag to the idea of Uncle Sam doing “in-home family planning” in poor neighborhoods.
As a candidate, Mr. Obama touted the Nurse-Family Partnership (NFP), founded in the late 1970s by psychologist David Olds.
“This program saves money,” Mr. Obama said in 2007. “It raises healthy babies and creates better parents. It reduced childhood injuries and unintended pregnancies, increased father involvement and women’s employment, reduced use of welfare and food stamps, and increased children’s school readiness. And it produced more than $28,000 in net savings for every high-risk family enrolled in the program.
“I will expand the Nurse-Family Partnership to provide at-home nurse visits for up to 570,000 first-time mothers each year,” Mr. Obama promised. “We can do this. Our God is big enough for that.”
The Obama administration kept its word. Its first budget called for a home-visitation program for new mothers costing $8.6 billion over 10 years. The home-visit program is now embedded in health care reform, costing $750 million over five years in the House bill and $1.5 billion in the Senate bill. The bills are being merged.
The Denver-based NFP has many supporters, including nine major foundations. Twenty-eight states use NFP, with almost 20,000 families enrolled.
However, the home visit program is viewed with suspicion in some quarters.
The House Republican Conference initially derided the House provision for its “billions for babysitters,” but seems to have backed off that claim, reportedly because of some Republicans’ support for NFP.
Other critics are animated by the specter of a “nanny state” and displacement of parental rights.
The program could increase “matriarchal dominance” in poor neighborhoods already awash with absent-father homes, said Gordon E. Finley, a psychology professor at Florida International University who writes on gender roles.
Most nurses are women, he said, so it would mean more women advising women, without necessarily considering the fathers. And because nursing is a female-dominated sector, the program means more jobs for women, but not men.
The program may bring “biases of the medical community into the home,” said E. Christian Brugger, an ethicist and senior fellow at Culture of Life Foundation. The medical community, for instance, has a bias against large families - women in maternity wards who have delivered a second child are “routinely asked” whether they want to be sterilized, he said.
The House bill also stipulates that home-visiting professionals will, when appropriate, “provide referrals to other programs serving children and families.”
“Given the pro-abortion biases of the administration pushing this reform and of like-minded members of the health care industry, it is highly likely that such referrals will routinely include … Planned Parenthood and other abortion-providing institutions,” Mr. Brugger said. “This is a serious concern to all who oppose the federal government getting involved in the counseling, referring or funding of abortions.”
The House bill’s goal of home visits “increasing birth intervals between pregnancies” alarms James Harden, president and chief executive of CompassCare Pregnancy Services in Rochester, N.Y.
“‘Increasing birth intervals’ is a very loaded phrase, and where it goes in the future, no one can know,” Mr. Harden said. “What is the birth interval? Is it two years between children? Three years between children? Five years between two children? From my perspective, [increasing] birth intervals relates to a backdoor approach to population control.”
NFP spokesman Julian Kesner strongly disputed such an idea.
There has been “no documented situation” in which a nurse has told a mother to get pregnant or not to get pregnant, he said.
Mothers in one NFP study site did have longer birth intervals (average 28 months) between first and second children, compared with other mothers, but “that’s a byproduct of trying to teach the moms some personal responsibility. … The vast majority of these pregnancies are unplanned.”
The program is entirely voluntary, Mr. Kesner added, and when it comes to future pregnancies, the nurses’ goal is to get the women to “think it out better, plan for the future.”
Meanwhile, a new cautionary note about the NFP appeared last week in a study in the Archives of Pediatrics & Adolescent Medicine, a publication affiliated with the Journal of the American Medical Association.
The study looked at the 19-year-old children of New York mothers who received home visits from nurses when the children were born.
The daughters of the nurse-visited mothers were less likely to have been in trouble with the law than daughters of mothers who did not get the visits, said Cornell University researcher John Eckenrode and his colleagues. This means NFP “has the potential to produce lasting changes” for girls in reducing crime, they wrote.
However, the nurse-visit program had no effect on the women’s sons. Mr. Olds, NFP founder and professor of pediatrics at the University of Colorado in Denver, called the gender disparity disappointing.
Still, there is great enthusiasm for the NFP and home-visit programs among politicians, academics, child-welfare advocates and the mothers.
“They always say babies don’t come with instruction manuals,” a Pennsylvania mother named Andrea told NFP, “but if there was one, the Nurse-Family Partnership program would be it.”