It's proven. Support disadvantaged women during pregnancy and through the first two years of their children's lives and you produce positive changes in their lives.
The B.C. government deserves full credit for being the first in Canada to launch a nurse-family partnership program that will see nurses work closely with first-time moms who need support.
Specially trained public health nurses will connect with women early in their pregnancies beginning next year. The nurses will visit once a week during pregnancy and in the infant's first months, with visits tapering to monthly by the time the child turns two.
It's not a new idea. The approach has been used in the U.S. for more than 30 years and results rigorously tracked. And they are impressive.
That's not surprising. Lots of women have great support networks when they become pregnant, and the skills and resources to solve any problems that do come up. They've learned useful lessons growing up they can apply to the challenges of pregnancy and child-rearing.
But others don't. They're poor, perhaps alone in the world or less well-educated. Some have more experience with bad parenting than with good examples.
The program targets those women, likely about 5,000 a year in this province.
The nurse visits to talk about healthy eating and living during pregnancy, planning for the birth, relationship issues -- really, anything the women wants to talk about. For women without real support or advice, the presence of one caring, competent person in their lives makes a huge difference.
The visits continue after the baby is born, with the same goals of providing support, skills and helping mothers make smart decisions and plans.
The benefits seem obvious.
But major long-term research on U.S. versions of the program, which in some cases followed the life course of the mothers and children for almost two decades, are shocking (in a good way).
Dr. Charlotte Waddell, director of the Children's Health Policy Centre in the Faculty of Health Sciences at Simon Fraser University, says nurse visits can mean dramatic improvements in life for mothers and children.
"Even if that's all you do, you can track the mother and child 15 or 20 years later and find that not only is the mom doing much better, but the kids stayed in school," she says. "They didn't get involved in crime, they were at less risk of substance abuse, and there was a significant reduction in conduct disorder."
On one level, it's stunning that a brief intervention -- less than three years -- in the lives of mother and child can set them on a course that helps determine, 19 years later, a teen will be less likely to be involved in crime.
But on another, it's not that surprising. The program sets in a motion a whole range of changes which cascade through the participants' lives.
The research found, for example, that mothers in the program tended to delay any subsequent pregnancies for a longer period than peers who did not have nurse-family support. That meant more time for their first child, and more opportunity to find work and maintain a stable life.
The research also found that mothers who had received the support were more likely to be economically self-sufficient and in stable relationships in future years.
Children were healthier and one study found a 48 per cent reduction in cases of child abuse and neglect, and a 56 per cent reduction in emergency room visits during the child's second year of life. They also did better in school.
The B.C. program is part of a $23-million Health Start effort aimed at mothers and young children.
While governments are often not good at long-term efforts, particularly on social issues, this is an example of just how great the benefits can be.
Not just economically, although society can count on reduced future costs and greater contribution from those involved.
But we will, for a relatively small investment, be changing lives.
Footnote: The details will matter. Success depends, for example, on finding the right nurses to do the work and stability in the nurse-family relationship. It takes time to build trust and understanding; changes that disrupt the relationship undermine results.