Addressing Maternal and Child Health Disparities Through Perinatal Home Visiting

Perinatal home visiting is a popular strategy for promoting maternal and child health in the United States. Despite considerable research on home visiting programs, little is known about the extent to which they engage populations that are disproportionately affected by health inequalities and their social determinants.

Administrative data were obtained for 6327 households served by Wisconsin's Family Foundations Home Visiting (FFHV) program from October 1, 2016, to September 30, 2023. Analyses were performed to calculate the proportion of households representing priority populations at risk of poor maternal and child health outcomes, yielding comparisons with similar estimates in the general population. A service saturation analysis also was performed to explore the extent to which evidence-based home visiting services reach low-opportunity communities across Wisconsin.

The findings confirmed that the FFHV program largely directs resources toward disadvantaged and marginalized populations. For instance, nearly two-thirds of the households served were below the federal poverty level, more than a third had a history of substance misuse, and more than half had a current tobacco user - exceeding comparative estimates in the general population by roughly 3-fold to 5-fold. Primary caregivers served were twice as likely to be Black or Hispanic and 5 times as likely to be American Indian or Alaska Native as they were to be White. Whereas 36.5% of Wisconsin ZIP codes were categorized as low-opportunity areas, 69.1% of families served were living in a low-opportunity ZIP code.

The FFHV program targets services to populations and communities at risk of maternal and infant health disparities. Additional strategies should be considered to bring home visiting to scale in Wisconsin and nationwide.