Nurse Home Visitation

One aspect of the health care bill that hasn’t gotten much attention but that I think is pretty exciting is the federal funding of a large-scale nurse home visitation program. The basic idea of these programs is that you send nurses to visit first-time low-income mothers in their homes and give then advice about infant nutrition and related childcare concerns. Studies conducted thus far have found not only the hoped-for improvements in child health but also a dramatic decrease in the incidence of criminal behavior on the part of families that received the intervention. One can’t be sure that these results will hold up to larger-scale scrutiny, but it seems promising. And it also seems likely that the same factors that were leading to a reduced rate of criminal activity—better impulse control and whatnot—will also help people do better in school and the labor market more generally.

So I was a bit saddened to see this morning Jill Filipovic lambasting this idea as of a piece with Bart Stupak’s odious amendment as part of an insidious plot to coercively control the fertility of women of color. She quotes Dorothy Roberts and Gwendolyn Mink saying that “Under the program envisioned in the House bill, government-sponsored medical professionals are charged with exhorting fertility control among poor women, based on the mistaken premise that reproduction among the poor leads to crime, neglect, low educational attainment, and dependency.”

I appreciate where Roberts and Mink are coming from in terms of an unfortunate historical legacy of trying to control poor women’s reproductive capacities. At the same time, we also have an unfortunate historical legacy of underinvesting in poor women and their children. And I think this provision, if you read what it actually says and think about who the authors of the legislation are, is much more about counteracting the latter trend than re-enforcing the former.

I think Amanda Marcotte has the right take on this noting that concern about this provision makes some sense “in an atmosphere where legislators on a woman-controlling kick are writing bills like” Stupak’s. And as she says it would also make sense to do this on a universal rather than targeted basis since that “Post-childbirth advice about pregnancy spacing, healthy babies, and education aren’t something that only low-income women need.” That said, going universal costs more money and money is hard to find and I think there are clear reasons to believe that poor women are likely to have less access to helpful resources in this regard.

Stepping back, it’s worth looking at the big picture. The overwhelming majority of Stupak Amendment supporters are opponents of the overall health reform package. His amendment is like a regressive parasite clinging to the body of a progressive bill. The nurse home visitation program isn’t like that at all. It wasn’t foisted on an unwilling House leadership by a rogue Democrat acting in concert with a bloc vote from the GOP. One way you could tell that the Stupak Amendment was a big deal and pernicious is that all the pro-choice women in congress were loudly protesting it. But you don’t see Congressional Black Caucus members or Nancy Pelosi or the major civil rights organizations taking this negative line on nurse home visitation.

Long story short, this seems like a good idea. We know that children who grow up in disadvantaged households suffer from a disproportionate amount of problems in life. In the long-run, I’d like to see this solved by dramatically reducing the level of child poverty in America. But while we wait for that to happen, it’s worth looking at effective targeted interventions and nurse home visitation programs seem to fit the bill.