Maternal and Infant Home Visiting Programs

There is sufficient evidence that maternal, infant, and early childhood home visiting programs improve social outcomes, particularly in enhancing parenting practices, strengthening parent-child relationships, and supporting positive child development.

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Study Characteristics and Contextual Tags

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Impact Assessment

The findings below synthesize the results of the studies on maternal, infant, and early childhood home-visiting programs across three domains of measurement:

  • Healthcare Cost, Utilization & Value: There is mixed evidence for the impacts of maternal, infant, and early childhood home visits on healthcare utilization. While some studies reported reductions in emergency department (ED) visits and reduced disparities in emergency medical care access, others showed increased emergency use post-implementation. This variability suggests that further research is needed to clarify the program’s impact across healthcare utilization outcomes in different contexts and populations.
  • Health: There is mixed evidence for the impacts of maternal, infant, and early childhood home visiting on health outcomes. While certain studies report positive effects, such as reductions in preterm birth, low birth weight, and improvements in maternal mental health, other studies show no significant differences in key outcomes like repeat unplanned pregnancy, low birth weight, and maternal stress. Some results varied by subgroups, benefiting specific demographics (e.g., female children or Black families). Further research is needed to clarify the variability in health outcomes across different populations and contexts.
  • Social: There is sufficient evidence that maternal, infant, and early childhood home visiting programs have positive social outcomes, particularly in enhancing parenting practices, improving parent-child relationships, reducing child maltreatment, and supporting child behavioral development and academic performance. This consistency in social benefits across studies suggests that home-visiting interventions can improve social and family dynamics. However, further long-term studies may solidify the understanding of sustained impact.
Background of the Need / Need Impact on Health
Maternal Health Care 

Maternal health encompasses a person’s health during pregnancy, birth, and postpartum[1]. Out of 3.7 million births in the United States (U.S.) in 2021[2], 41% were covered by Medicaid[3]. Medicaid covered over half of births among Black and Hispanic individuals[4]. Medicaid also covers a large portion of individuals who are under age 25[5]. 

Adequate prenatal and postpartum care is integral to maternal health. In 2022, 74.9% of individuals who are birthing received early and adequate prenatal care[6] while the percentage of birthing people receiving no prenatal care increased to 2.3% in 2023[7]. Postpartum visit rates vary from 24.9% to 96.5%[8]. In addition to varying postpartum visit rates, the content and quality of care provided vary widely based on insurance, rural versus urban setting, and race/ethnicity[9]. Additionally, between 12%-17% of the gender-diverse individuals assigned female at birth have been pregnant at least once[10],[11],.

Maternal Mortality and Morbidity

The U.S. has the highest rate of maternal mortality (death within 42 days from the end of pregnancy from any cause related to the pregnancy or its management[12]), when compared to other high-income countries[13]. In 2022, the maternal mortality rate was 22.3 deaths per 100,000 live births[14]. Between 2017-2019, 80% of pregnancy-related deaths were deemed preventable[15]. The maternal mortality rate for non-Hispanic Black women is 2.6 times the rate for non-Hispanic White women[16]. The top three causes of pregnancy-related deaths for Hispanic/Latino and White birthing people are mental health conditions, hemorrhage, and a tie between cardiac/coronary conditions and infection. For Black women, the top three causes of pregnancy-related deaths are cardiac/coronary conditions, cardiomyopathy, and thrombotic embolism[17]. Overall, mental health conditions are a leading underlying cause of all pregnancy-related deaths, accounting for 23% of such deaths (e.g., deaths by suicide and overdose/poisoning related to substance use disorder)[18]. Death by suicide accounts for about 20% of postpartum deaths[19]. 

Pregnant and postpartum individuals also experience a 16% increase in the incidence of homicide compared to those who are not pregnant or postpartum. Homicide is the leading cause of all-cause maternal mortality during pregnancy or within 42 days of the end of pregnancy, accounting for more than two times the other leading causes of death during this period[20].  

Maternal morbidity includes any health problems that cause death from pregnancy, both short- and long-term, including cardiovascular disease, infection, bleeding, high blood pressure, and blood clots[21]. One estimate found that roughly 29% of pregnancies include some maternal complication or morbidity, with about 11% of pregnancies including a life-threatening complication[22]. Pregnant Black individuals experience higher rates of maternal morbidity caused by eclampsia/preeclampsia and venous thromboembolism or pulmonary embolism, while pregnant Asian/Pacific Islander individuals experience higher rates of severe postpartum hemorrhage[23]. 

Maternal Health and Social Needs

Pregnancy and postpartum can exacerbate health-related social needs and compound their negative effects. A pregnant individual’s access to screening for medical risk factors is affected by social and structural drivers of health, such as access to basic needs like transportation and childcare. However, even after such risks are identified, people who are pregnant may not be able to access resources to address those needs due to the same social and structural drivers of health that lead to poor health in the first place[24]. 

While emphasis is placed on the pregnancy and birth stages of maternal health, physical and mental health concerns remain significant in parenthood and are exacerbated by social needs. According to 2023 data, 48% of parents say that their stress is overwhelming most days compared to 26% among other adults[25]. Parental stressors include financial strain, economic instability, poverty, time demands, children’s health/safety concerns, parental isolation and loneliness, technology and social media, cultural pressures, and worry about children’s futures. Another parental stressor is the cost of childcare. The cost of childcare is inaccessible for many families as the cost is equivalent to 8%-19.3% of the median family income per year for each child in paid care[26].

Background on the Intervention

Maternal and early childhood home visiting are a home-based model designed to prevent early childhood adversity and promote physical health, mental health, and emotional development[27]. Home visiting programs vary based on population, service delivery, and focus. These programs typically support families with children under five years of age who have exposure to risk factors such as low socioeconomic status. During these home visits, parent educators, nurses, social workers, or peers may provide care coordination, education around health promotion and parenting, family support, and counseling[28]. There are a variety of evidence-based home visiting models operating within the United States including Maternal Infant Health Program, Parents as Teachers (PAT), and Early Head Start Home-Based Option

One key funding stream is the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program[29], which is a Health Resources and Services Administration (HRSA) grant-based program[30]. Grants can be provided to organizations offering a number of different eligible models of home visiting. A 2023 analysis found that at least 28 states offer some type of home visiting services through Medicaid[31]. Some states also supplement these two funding streams with general fund investments in home visiting. 

One of the biggest barriers to successful home visiting program implementation is varied attrition rates[32],[33],. The relationship quality between home visitors and participants appears to be the best predictor of success and promoting parent involvement and engagement[34].

Evidence Review
Note: The vocabulary used in the table is the same terminology used in the study in order to preserve the integrity of the summary. 
Study
Population
Intervention Summary
Type of Study Design
Outcomes
Bierman et al. (2021)

Prekindergarten children attending Head Start (55% White, 26% Black, 19% Hispanic/Latino, 56% male, mean age of 4.45 years at study initiation) and their caregivers.

The Research-based Developmentally Informed Parent program, a 16-session home-visiting intervention that bridged the preschool and kindergarten years.

Randomized control trial. Participants were 200 children and their primary caregivers. 

Social: By fifth grade, significant effects of the intervention were sustained in the domains of academic performance (e.g., reading skills, academic motivation, and learning engagement) and parent-child functioning (e.g., academic expectations and parenting stress). Significant moderation by parenting risk emerged on measures of social-emotional adjustment (e.g., social competence and student-teacher relationships); parenting risk also amplified effects on some measures of academic performance and parent-child functioning, with larger effects for children from families experiencing fewer risks.

Conti et al. (2024)

Women with no previous live births and at least two sociodemographic risk factors (unmarried, <12 years of education, unemployed) from June 1, 1990, through August 31, 1991. At registration during pregnancy, 727 mothers (98%) were unmarried, and 631 (85%) lived below the federal poverty level.

Prenatal and infancy home visitation via a public healthcare system in Memphis, Tennessee. Women assigned to the control group received free transportation for prenatal care and child developmental screening and referral when children were aged six, 12, and 24 months. Women assigned to nurse visitation received transportation and screening, plus prenatal and infant and toddler nurse home visits.

Randomized clinical trial. 742 women were enrolled. Of the 742 randomized participants (mean age, 18.1 [SD 3.2] years), interviews were completed with 594 mothers and 578 offspring at child age 12 years and 618 mothers and 629 offspring at child age 18 years. 

Obesity and hypertension among mothers and their offspring at children ages 12 and 18 years, although not hypothesized in the original trial design, were analyzed using the post–double selection lasso method. Obesity was assessed for 576 offspring at age 12 years and 605 at age 18 years and for 563 and 598 mothers at child ages 12 and 18 years, respectively. Blood pressure was assessed for 568 offspring aged 12 years and 596 aged 18 years, and 507 and 592 mothers with children ages 12 and 18 years, respectively.

Health: There were no overall treatment-control differences in offspring obesity or hypertension at ages 12 and 18 years combined, although nurse-visited female offspring, compared with controls, had a lower prevalence of obesity (P = .003) and severe obesity (P < .001). There were reductions at ages 12 and 18 years combined for stage 1 and stage 2 hypertension for nurse-visited vs. control group mothers, with differences limited to mothers of females (stage 1: P = .001; stage 2: P < .001). For both obesity and hypertension outcomes, there was no intervention effect among male offspring or the mothers of males—self-reported maternal health aligned with program effects on hypertension.

Dodge et al. (2019)

936 births at the Duke University Hospital from January 1, 2014, to June 30, 2014.  Of 936 births, 451 infants (48.2%) were female and 433 (46.3%) were from racial/ethnic minority groups.

The Family Connects (FC) program, a nurse-home visitation for families with newborns implemented by a community agency. The goals of the FC brief universal program were to assess family-specific needs, complete brief interventions, and connect families with community resources. Community agencies and families were aligned through an electronic data system.

The Family Connects (FC) program, a nurse-home visitation for families with newborns implemented by a community agency. The goals of the FC brief universal program were to assess family-specific needs, complete brief interventions, and connect families with community resources. Community agencies and families were aligned through an electronic data system.

Health: The intervention group’s rate of possible maternal anxiety or depression was 18.2% vs. 25.9% for the control group (P = .09).

Social: Analysis of the primary outcome of child abuse investigations revealed a mean of 0.10 (SD 0.30) investigations for the intervention group vs. 0.18 (SD 0.56) investigations for the control group (bP = .07).

Dodge et al. (2022)

Families with children in Durham, North Carolina. 

Family Connects (FC) is a universal perinatal home-visiting program that assesses family-specific needs, offers support, and provides connections to community resources to address identified needs. 

Secondary data analysis. Data from a randomized controlled trial of 4,777 birthing families in Durham, NC (RCT1), a replication randomized controlled trial of 923 birthing families in Durham, NC (RCT2), and a quasi-experiment of 988 birthing families in rural NC were included. 

Healthcare Cost, Utilization & Value: FC was associated with a statistically significant reduction in disparities between Black and Non-Hispanic White families for child emergency medical care in two of the three included data sources. 

Health: FC was associated with a statistically significant reduction in disparities between Black and Non-Hispanic White families for maternal anxiety in RCT1, maternal anxiety in the field quasi-experiment, and maternal depression in RCT1. 

Social: FC was associated with a statistically significant reduction in disparities between Black and Non-Hispanic White families for father non-support in the field quasi-experiment, and child maltreatment in RCT2.

Gabbe et al. (2017)

Pregnant women in an urban impoverished community in Ohio. 195 pregnant women attended one or more Moms2B sessions. 75% were African American with incomes below $800 per month and significant medical and social stressors.

Moms2B is a community-based pregnancy support program focused on improving nutrition coupled with increasing social and medical support. The program focuses on pregnancy through the infant’s first year of life. 

Pre-post analysis. Maternal and infant health characteristics in the community before and after program implementation were assessed. Outcomes from the two Weinland Park, Ohio, census tracts before and after implementing the Moms2B program were studied.

Health: From 2007 to 2010, there were 442 births in Weinland Park, Ohio, and six infant deaths for an infant mortality rate of 14.2/1000. From 2011 to 2014, the first four years of the Moms2B program, 195 pregnant women attended one or more Moms2B sessions at the Weinland Park (WP) location. In 2011–2014 there were 339 births and one infant death, giving an infant mortality rate of 2.9/1000, nearly a five-fold reduction in the rate of infant deaths. Among pregnant women who were covered by Medicaid, the breastfeeding initiation rate improved from 37.9% to 75.5% (p < .01) after the introduction of Moms2B.

Holland et al. (2022)

Families participating in the Connecticut Nurturing Families Network (NFN).

Home visiting programs.

Observational study with a comparison group. Birth-related outcomes (birth weight, preterm birth, cesarean section delivery, prenatal care utilization) of second children (n = 1,758) were compared to demographically similar propensity-score-matched families that were not enrolled in NFN (n = 5,200).

Healthcare Cost, Utilization & Value: Hispanic women in NFN were less likely to deliver by cesarean section for their second birth (p=0.03) compared to Black and Hispanic women in the comparison group, respectively. There was a protective program effect on the prematurity of the second child (p=0.03) for women with a preterm first birth. 

Health: There was no program effect for the full sample. The effect of NFN did not differ by maternal age or visit attendance pattern but did differ by maternal race and ethnicity for the birth outcome measures compared in the study. Black women in NFN were more likely to receive adequate prenatal care during their second pregnancy (OR 1.05; 95% CI 1.01, 1.09)

James Bell Associates (2016)

Home visiting participants.

State-level grants administered by HRSA and the Administration for Children and Families for home-visiting programs.

Descriptive study. Reports with performance measures customized to the needs and structures of target communities, local implementing agencies, and home-visiting models.

Across domains, 83% of state grantees improved overall in four of six benchmark areas three years post-implementation. The percentage of grantees demonstrating improvement in each benchmark area ranged from 66% to 85%, including: 

Healthcare Cost, Utilization & Value: Prevention of child injuries, child abuse, neglect, or maltreatment, and reduction of emergency department visits (66%).

Health: Improvements in nine maternal and newborn health measures (81%) ranging in topics from prenatal care to substance use, depression, repeat unplanned pregnancies, well-child visits, insurance coverage, and others.

Social: Improvements in school readiness and achievement (85%); reduction in crime or domestic violence (70%); improvements in family economic self-sufficiency (85%); improvements in the coordination and referrals for other community resources and supports (85%).

Marshall et al. (2018)

Home-visiting participants in Florida.

Home visiting programs for MIECHV participants. 

Qualitative. Content analysis of semi-structured telephone interviews with 45 home-visiting participants from five Florida MIECHV programs.

Social: Participants experienced multilayered social support from home-visiting staff. Families needed and received substantial emotional, instrumental, informational, and appraisal support at the individual level.

McConnell et al. (2022)

Low-income, nulliparous pregnant individuals at less than 28 weeks gestation.

An intensive nurse home visiting program administered through a nurse-family partnership.

Randomized clinical trial. 5,670 Medicaid-eligible, nulliparous pregnant individuals at less than 28 weeks gestation were enrolled between April 1, 2016, and March 17, 2020, with follow-up through February 2021.

Health: The incidence of adverse birth outcomes was 26.9% in the intervention group and 26.1% in the control group and results were not statistically significant. Outcomes for the intervention group were not significantly better for the maternal and newborn health primary or secondary outcomes in the overall sample or in the prespecified subgroups. 

McCue et al. (2022)

Women enrolled in Arizona’s Health Start Program between 2006 and 2016.

A community health worker home visiting intervention.

Observational study with a comparison group. Health Start administrative and state birth certificate data were used to identify women enrolled in the program during 2006–2016 (n = 7,117). Propensity score matching was used to generate a statistically similar comparison group (n = 53,213) of women who did not participate in the program. Odds ratios were used to compare rates of prenatal care utilization. The process was repeated for select subgroups, with post-match regression adjustments applied where necessary.

Health: Health Start participants were more likely to report any and adequate prenatal care, compared to controls. Additional specific subgroups were significantly more likely to receive any prenatal care: American Indian women, primipara women, teens, and women in rural border counties, and to receive adequate prenatal care: teens, women in rural border counties, primipara women, and women with less than a high school education. 

Nygren et al. (2018)

Participants in home visiting programs in Oregon.

Home visiting programs for parents.

Observational study. Multivariate regression models were used to explore the association of home visit dosage, home visit content, and cumulative risk factors on parents’ knowledge, attitudes, and stress levels. 

Social: Researchers found a correlation between the number of visits and visit content, reductions in parental stress, and changes in parenting knowledge and attitudes (e.g., corporal punishment discipline). The study also found that parents at higher risk (based on multiple factors including participant age, education, social support, housing, etc.) showed a greater positive effect on several measures.

Pan et al. (2020)

At-risk pregnant women in Rochester, New York. 

Community health worker-supported home visitor programs.

Observational study with a comparison group. Program data for 455 participants was merged with electronic medical records from July 2015 to October 2017.

Health: Program participants had fewer adverse outcomes than nonparticipants, including lower rates of preterm birth (12% vs 20%; P = .05) and low birth weight (14% vs 22%; P = .05). This program was effective at improving perinatal outcomes.

Tandon et al. (2020)

Pregnant women and new mothers participating in the HRSA’s MIECHV Program’s Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN), the first U.S. national application of the Institute for Healthcare Improvement’s Breakthrough Series (BTS) Model in home visiting programs. 14 home visiting programs in eight states participated in the program.

HV CoIIN strategies included specific policies and protocols for depression screening and home visitor response to screening results; home visitor training and supervision; delivery of prevention and treatment interventions; and tracking systems for screening, referral, and follow-up.

Quality improvement study. This study monitored and analyzed monthly data from local implementation agencies participating in HV CoIIN. Using run charts and time-series analysis, the team tracked process and outcome measures over time to identify trends, interpret the impact of specific interventions, and support continuous quality improvement.

Health: HV CoIIN improved symptoms among women who accessed services, from 51.1% to 59.9%. It also improved the percentage of women screened for depression, from 83.6% to 96.3%, and those with positive depression screens who accessed evidence-based services, from 41.6% to 65.5%.

Thorland et al. (2017)

First-time mothers who have low-incomes.

The Nurse-Family Partnership (NFP).

Observational study with a comparison group. A cohort of NFP clients beginning the program between July 1, 2007, and June 30, 2010, was compared to a reference cohort of first-time mothers from publicly available birth data (U.S. Natality Data). Employing propensity score matching, NFP clients (n = 27,195) were each matched to three controls based on maternal age, race-ethnicity, smoking status, education, and marital status. Measures of low birth weight and preterm births were compared between clients and controls using McNemar’s Tests. 

Health: No significant difference in low birth weight was observed (NFP 9.4%, matched controls 9.6%, p = 0.20). However, the incidence of preterm births in NFP clients was significantly lower than in matched controls (8.7% vs. 12.3%, respectively; p < 0.0001).

Williams et al. (2017)

First-time high-risk mothers in Kentucky.

The Kentucky Health Access Nurturing Development Services (HANDS) is a voluntary, home-visiting program serving first-time, high-risk mothers. 

Observational study with a comparison group. 2,253 mothers who were referred to HANDS between July 2011 and June 2012 and received a minimum of one prenatal home visit (mean number of prenatal visits = 12.9) were compared to a demographically similar group of women (n = 2,253) who did not receive a visit. Chi-square statistics and conditional logistic regression models were used to evaluate the impact of HANDS.

Healthcare Cost, Utilization & Value: Those receiving at least one prenatal home visit had higher rates of receiving adequate prenatal care (73.6% vs. 71.0%).

Health: HANDS participants had lower rates of preterm delivery and low birth weight infants. HANDS participants also had a reduction in maternal complications during pregnancy. The rate of preterm birth among women receiving one to three prenatal home visits was 12.1%, the rate among women receiving four to six prenatal home visits was 13.2%, and the rate among those receiving seven or more prenatal home visits was 9.4%.

Social: HANDS participants were significantly less likely to have a substantiated report of child maltreatment compared to controls.

Systematic Reviews
Note: The vocabulary used in the table is the same terminology used in the study in order to preserve the integrity of the summary. 
Study
Population
Intervention Summary
Type of Study Design
Outcomes
Hadian et al. (2018)

Adolescent mothers. 

Home visiting.

Systematic review and meta-analysis. Seven randomized controlled trials were included in the analysis. 

Health: The meta-analysis result done on 375 persons indicated that mental health in the home visiting group was significantly better than the control group (routine care or care except considered intervention) (p=0.006). Also, a meta-analysis done on 185 persons showed that there was no significant difference between the two groups in terms of repeat pregnancy (p=0.67) and repeat birth (p= 0.820).

Leonard et al. (2020)

Mothers with mental illness and their families.

Family-focused home visiting for maternal mental illness. 

Systematic review and meta-analysis. 13 (n = 5,540 participants) studies met inclusion criteria. Eight studies included meta-analyses; five studies were reported narratively (qualitative).

Health: Home visiting interventions were not effective in reducing depression (p = .21) or maternal stress (p = .84).

Michalopoulos et al. (2019)

Mother and Infant Home Visiting Program Evaluation (MIHOPE): Pregnant women or families with children under six months, across 12 states, involving 4,229 families.

MIHOPE-Strong Start: Pregnant women in the first 32 weeks of pregnancy, primarily Medicaid recipients, were recruited from 66 programs in 17 states, involving 2,900 families.

MIHOPE involved four evidence-based home visiting models: Early Head Start – Home-based option, Healthy Families America (HFA), Nurse-Family Partnership (NFP), and Parents as Teachers (PAT). 

MIHOPE-Strong Start involved two models: Healthy Families America and Nurse-Family Partnership.

Results from two randomized controlled studies (MIHOPE and MIHOPE-Strong Start). 

Healthcare Cost, Utilization & Value: The MIHOPE study found meaningful reductions in emergency department visits and improvements in health insurance coverage.

Health: The MIHOPE-Strong Start study found no statistically significant effects on key birth outcomes, including preterm birth, low birth weight, or admission to a neonatal intensive care unit. It also found no statistically significant effects on breastfeeding at hospital discharge. MIHOPE found that home visiting resulted in improvements in women’s general health, and reductions in depressive symptoms.

Social: MIHOPE found positive effects when the child was 15 months old, that were statistically significant for the quality of the home environment, reduced frequency of psychological aggression toward the child, and fewer child behavior challenges. MIHOPE also found a reduced frequency in mothers’ experience with intimate partner violence and mothers’ use of interpersonal violence services. These effects may be associated with the statistically significant reductions in parental depression and parental stress that MIHOPE found, as well as with positive changes in parenting practices, including increased parental behavior management using gentle guidance. Reduced household aggression and improved parenting behaviors could also help explain observed reductions in child behavior challenges.

Assessment Synthesis Criteria
Strong Evidence
There is strong evidence that the intervention will produce the intended outcomes.
  • At least one well-conducted systematic review or meta-analysis (including two or more large, randomized trials) showing a significant and clinically meaningful health effect; and  
  • Consistent findings of health effects from other studies (cohort, case-control, and other designs).
Sufficient Evidence
There is sufficient evidence that the intervention will produce the intended outcomes.
  • At least one well-conducted systematic review or meta-analysis (including two or more large, randomized trials) showing a significant and clinically meaningful health effect, but inconsistent findings in other studies; or
  • Consistent findings from at least three non-randomized control trial studies (cohorts, practical trials, analysis of secondary data); or
  • A single, sufficiently large well-conducted randomized controlled trial demonstrating clinically meaningful health effect and consistent evidence from other studies; or 
  • Multiple expert opinions/government agencies supporting the intervention.
More Evidence Needed or Mixed Evidence
There is insufficient evidence that the intervention will produce the intended outcomes, however the results may indicate potential impact.
  • Lack of demonstration of improved health outcomes based on any of the following: (a) a systematic review or meta-analysis; (b) a large randomized controlled trial; (c) consistent positive results from multiple studies in high-quality journals; or (d) multiple expert opinions or government agencies supporting the intervention. 
  • An insufficient evidence rating does not mean there is no evidence, or that the intervention is unsafe or ineffective. 
  • In many cases, there is a need for more research or longer-term follow-up.
There is strong evidence that the intervention will produce the intended outcomes.
There is sufficient evidence that the intervention will produce the intended outcomes.
There is insufficient evidence that the intervention will produce the intended outcomes, however the results may indicate potential impact.
  • At least one well-conducted systematic review or meta-analysis (including two or more large, randomized trials) showing a significant and clinically meaningful health effect; and  
  • Consistent findings of health effects from other studies (cohort, case-control, and other designs).
  • At least one well-conducted systematic review or meta-analysis (including two or more large, randomized trials) showing a significant and clinically meaningful health effect, but inconsistent findings in other studies; or
  • Consistent findings from at least three non-randomized control trial studies (cohorts, practical trials, analysis of secondary data); or
  • A single, sufficiently large well-conducted randomized controlled trial demonstrating clinically meaningful health effect and consistent evidence from other studies; or 
  • Multiple expert opinions/government agencies supporting the intervention.
  • Lack of demonstration of improved health outcomes based on any of the following: (a) a systematic review or meta-analysis; (b) a large randomized controlled trial; (c) consistent positive results from multiple studies in high-quality journals; or (d) multiple expert opinions or government agencies supporting the intervention. 
  • An insufficient evidence rating does not mean there is no evidence, or that the intervention is unsafe or ineffective. 
  • In many cases, there is a need for more research or longer-term follow-up.
Sources

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[2]  Centers for Disease Control and Prevention. (2022, May 24). Births rose for the first time in seven years in 2021. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/20220524.htm 

[3]  Center for Medicaid and CHIP Services. 2024 Medicaid and CHIP Beneficiaries at a Glance: Maternal Health. Centers for Medicare & Medicaid Services. Baltimore, MD. Released May 2024.

[4]  Valenzuela, C., & Osterman, M. (2023, May 25). Characteristics of Mothers by Source of Payment for the Delivery: United States, 2021. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db468.htm 

[5]   Valenzuela, C., & Osterman, M. (2023, May 25). Characteristics of Mothers by Source of Payment for the Delivery: United States, 2021. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db468.htm 

[6]  U.S. Department of Health and Human Services. (n.d.). Increase the proportion of pregnant women who receive early and adequate prenatal care - mich‑08. Increase the proportion of pregnant women who receive early and adequate prenatal care - MICH‑08 - Healthy People 2030. https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/increase-proportion-pregnant-women-who-receive-early-and-adequate-prenatal-care-mich-08 

[7]  Martin, J., Hamilton, B., & Osterman, M. (2024, August 20). Births in the United States, 2023. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db507.htm#:~:text=The%20percentage%20of%20mothers%20receiving%20no%20prenatal%20care%20increased%205,2021%20(2.1%25)%20to%202022

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[9]  Interrante JD, Admon LK, Carroll C, Henning-Smith C, Chastain P, Kozhimannil KB. Association of Health Insurance, Geography, and Race and Ethnicity With Disparities in Receipt of Recommended Postpartum Care in the US. JAMA Health Forum. 2022;3(10):e223292. doi:10.1001/jamahealthforum.2022.3292 

[10] Falck FAOK, Dhejne CMU, Frisén LMM, Armuand GM. Subjective Experiences of Pregnancy, Delivery, and Nursing in Transgender Men and Non-Binary Individuals: A Qualitative Analysis of Gender and Mental Health Concerns. Arch Sex Behav. 2024 May;53(5):1981-2002. doi: 10.1007/s10508-023-02787-0. Epub 2024 Jan 16. PMID: 38228983; PMCID: PMC11106200.

[11]   The language used in this assessment reflects what is used in the literature (e.g., “women”). While it may accurately reflect the study data, it may not be inclusive of or relevant to the experience of gender-diverse individuals.

[12]  World Health Organization. International statistical classification of diseases and related health problems, 10th revision (ICD–10). 2008 ed. Geneva, Switzerland. 2009.

[13]  Slaughter-Acey J, Behrens K, Claussen AM, et al. Social and Structural Determinants of Maternal Morbidity and Mortality: An Evidence Map [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2023 Dec. (Comparative Effectiveness Review, No. 264.) Chapter 1, Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK598890/#

[14]  Hoyert DL. Maternal mortality rates in the United States, 2022. NCHS Health E-Stats. 2024. DOI: https://dx.doi.org/10.15620/cdc/152992

[15]  Centers for Disease Control and Prevention. (2024, June 3). Maternal health. Centers for Disease Control and Prevention. https://www.cdc.gov/cdi/indicator-definitions/maternal-health.html#:~:text=Maternal%20health%20refers%20to%20women%27s,or%20infant%27s%20health%20at%20risk

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[19]  Chin K, Wendt A, Bennett IM, Bhat A. Suicide and Maternal Mortality. Curr Psychiatry Rep. 2022 Apr;24(4):239-275. doi: 10.1007/s11920-022-01334-3. Epub 2022 Apr 2. PMID: 35366195; PMCID: PMC8976222.

[20]  Wallace M, Gillispie-Bell V, Cruz K, Davis K, Vilda D. Homicide During Pregnancy and the Postpartum Period in the United States, 2018-2019. Obstet Gynecol. 2021 Nov 1;138(5):762-769. doi: 10.1097/AOG.0000000000004567. Erratum in: Obstet Gynecol. 2022 Feb 1;139(2):347. doi: 10.1097/AOG.0000000000004671. PMID: 34619735; PMCID: PMC9134264.

[21]  U.S. Department of Health and Human Services. (2021, June 9). Maternal morbidity and mortality. National Institutes of Health. https://www.nichd.nih.gov/health/topics/maternal-morbidity-mortality 

[22]  Declercq, E., & Zephyrin, L. (2021, October 28). Severe maternal morbidity in the United States: A Primer. Maternal Morbidity in the U.S. | Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2021/oct/severe-maternal-morbidity-united-states-primer#:~:text=While%20maternal%20deaths%20in%20the,maternal%20morbidity%20can%20be%20avoided

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[28]  Thompson, V & Hasan, A. (2023) Medicaid Reimbursement for Home Visiting: Findings from a 50 State Analysis. National Academy for State Health Policy. Retrieved 11/20/2024

[29]   HRSA Maternal & Child Health. (2024) The Maternal, Infant, and Early Childhood Home Visiting Program. Retrieved on 11/20/2024

[30]  HRSA Maternal & Child Health. (2024) The Maternal, Infant, and Early Childhood Home Visiting Program. Retrieved on 11/20/2024

[31]  Thompson, V & Hasan, A. (2023) Medicaid Reimbursement for Home Visiting: Findings from a 50 State Analysis. National Academy for State Health Policy. Retrieved 11/20/2024

[32]  Bower KM, Nimer M, West AL, et al. Parent involvement in maternal, infant, and early childhood home visiting programs: an integrative review. Prev Sci. 2020;21(5):728-747.

[33]  Dodge KA, Benjamin Goodman W, Bai Y, et al. Maximizing the return on investment in early childhood home visiting through enhanced eligibility screening. Child Abuse Negl. 2021;122:105339.

[34]   Thompson, V & Hasan, A. (2023) Medicaid Reimbursement for Home Visiting: Findings from a 50 State Analysis. National Academy for State Health Policy. Retrieved 11/20/2024

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