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Effect of an Intensive Nurse Home Visiting Program on Postpartum Contraceptive Use and Birth Spacing: A Randomized
Maria W Steenland1, Dea Oviedo, Mary Ann Bates
1Population Studies and Training Center, Brown University, Providence, Rhode Island; the Department of Global Health and Population, Harvard T.H. Chan School of Public Health, the RAND Corporation, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, and the Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, and the Abdul Latif Jameel Poverty Action Lab (J-PAL), Massachusetts Institute of Technology, and the National Bureau of Economic Research (NBER), Cambridge, Massachusetts; the Cradle-to-Career Data System, State of California, Sacramento, California; and the University of Chicago, Chicago, Illinois.
Objective:
To evaluate the effect of an intensive nurse home visiting program on postpartum contraceptive use and birth spacing among individuals with a first pregnancy who were eligible for Medicaid insurance in South Carolina.
Methods:
We conducted a nonblinded, randomized controlled trial of the Nurse-Family Partnership (NFP), an established intensive home visiting program that provides prenatal and postpartum home visits through 2 years after childbirth. The trial included patients who were eligible for Medicaid insurance with a first pregnancy at less than 28 weeks of gestation between April 1, 2016, and March 17, 2020, who were followed up through 2 years after childbirth. Participants were randomized 2:1 to NFP compared with standard of care treatment. The primary outcome was a birth interval of less than 21 months between the index pregnancy and a subsequent birth. The secondary outcomes were birth intervals of less than 15 and 24 months, receipt of a contraceptive implant or intrauterine device (IUD) immediately postpartum, any contraceptive use and receipt of a family planning visit (at both 6 weeks and 1 year postpartum), and IUD receipt at 1 year postpartum. We assessed outcomes using linked birth certificate records and Medicaid claims data.
Results:
A total of 4,932 trial participants (3,295 in the intervention group and 1,637 in the control group) were included in the study analysis. Within 21 months of the study index birth, 11.0% of individuals in the NFP group and 12.2% of the usual care group had a subsequent birth. The NFP did not have a statistically significant effect on birth intervals of less than 21 months (adjusted coefficient -1.1, 95% CI, -2.9 to 0.8). There were no statistically significant differences between the NFP and control groups for any of the study's eight secondary outcomes related to birth spacing and postpartum contraceptive use.
Conclusion:
Home visits with a registered nurse did not affect postpartum contraceptive use or birth spacing.
Clinical Trial Registration:
ClinicalTrials.gov, NCT03360539.
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