By Kay Johnson
For more than 30 years, the federal Healthy Start program has been investing in community-based solutions to reduce maternal and infant mortality in communities with infant mortality rates at least 1.5 times the U.S. national average. At a time when many are rightly calling for more community and family engagement to reduce maternal and infant mortality, Healthy Start is the only federal program with that explicit design and purpose. Beyond maternal and infant mortality reduction, the goals of Healthy Start include: reducing disparities in access to and utilization of health services, improving the local health care system, and increasing consumer and community input into health care decisions.
Healthy Start was first established as a presidential initiative. I was in the Rose Garden that day in 1991 President George H. W. Bush announced his commitment to reducing infant mortality in communities with elevated risks. Since that time, urban and rural communities across the country have engaged in direct service delivery, care coordination, and community partnerships to reduce risks and deaths. Today, it serves more than 100 communities and nearly 50,000 women, most of whom are Black and Native American/Alaska Native mothers who face 2-3 times the risk of maternal mortality.
Healthy Start has a clear track record of improving the lives of the families it serves. Compared to national averages, Healthy Start clients receive more early prenatal care, more well-woman visits, more screening for depression, more fathers engaged, and more support for family survival and self-sufficiency.
A series of national evaluations and program wide research has found positive impact from focusing on community engagement to improve access to care using care coordination with individuals. Multiple studies of specific communities point to the impact of Healthy Start on use of prenatal care, access to doula services, identification of perinatal depression, increase in breastfeeding initiation, satisfaction with care, reduction in low-birthweight births, and reductions in infant mortality.
The Office of Management and Budget (OMB) has also confirmed that Healthy Start funding is “being used directly and effectively to meet the program’s purpose.” It is also the basis for the design of the “Benefits Bundle” project designed by the OMB and collaborating agencies to connect families of new babies with a bundle of supportive services in the transition to parenthood.
Despite its track record, pending legislation in the House Appropriations Committee proposes to eliminate funding for Healthy Start, which has successfully served moms, babies, and families for decades. Some confusion about Healthy Start versus federal home visiting programs, also funded by HHS’s Health Resources and Services Administration, led lawmakers to consider these cuts. But Healthy Start’s program approach is distinct from the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, with greater emphasis and demonstrated impact on maternal and infant mortality. Whereas home visiting has more impact on child development and parent success, Healthy Start aims to help moms and babies survive and thrive. Even combined the two programs are not reaching nearly the number of families who could benefit.
In response, a bipartisan letter signed by nearly 100 Members of Congress and sent to the House Appropriations Subcommittee on Labor, Health and Human Services, Education & Related Agencies on April 30, 2024 emphasized the importance of Healthy Start.
“The Healthy Start program provides funding to support community-based strategies to improve perinatal outcomes for women and children in communities with acute infant mortality rates. […] This approach saves money; promotes equity, as pregnant women respond better to women with the same lived experiences; bolsters employment rates; and serves as a workforce pipeline, making the Healthy Start program a critical component of federal efforts to reduce maternal and infant mortality.”
Another bi-partisan letter signed by 34 Senators and sent on May 14, 2024 to the Senate Appropriations Subcommittee on Labor, Health and Human Services, further emphasized how:
“In particular, the Healthy Start program seeks to reduce disparities in infant and maternal mortality by empowering women and their families to identify and access maternal and infant health services in their communities. Locally funded Healthy Start programs provide services such as prenatal care, nutrition assistance, and help to connect low-income families with other vital resources.”
In June, the House Appropriations Committee press release said: “Investments in this bill also support the well-being of the most precious among us: America’s children.” At the same time, the bill proposed to eliminate funding for the Healthy Start program.
In April 2024, HRSA invested $105 million from previous appropriations in the Healthy Start community-based organizations who anchor our nation’s efforts to improve maternal and infant health among those at greatest risk. Stretching from the border area of San Diego County, CA to Flint, MI and Columbus, OH in the Midwest to Macon, GA and Miami, FL in the Southeast, to the Bronx, NY and Boston, MA in the Northeast, the 100+ Healthy Start communities need continued federal funding at the current level of $145 million. Mothers’ and babies’ lives depend upon it. These communities lift up important examples of the kinds of investments and models that can surround Medicaid-covered services and work together to more effectively serve and reach more young families. Healthy Start communities represent our most basic efforts to direct maternal and infant mortality prevention dollars where they are needed. Maternal and infant mortality rates remain at critical levels; now is not the time to undercut communities making a difference. As Congress returns to finish this year’s budget, will it keep this widely lauded program?
Kay Johnson has been a leader in health policy for women, children, and families for 40 years, focusing on Medicaid and MCH policy at the federal and state levels since 1984 and advising more than 45 state health and/or Medicaid agencies. Her work on this analysis of federal maternal health policy was supported by the David and Lucile Packard Foundation.