Maternal and Child Health Journal

, Volume 17, Issue 5, pp 886–896 | Cite as

Measuring the Impact and Outcomes of Maternal Child Health Federal Programs



Improving maternal and child health is a key objective of the United Nations’ Millennium Development Goals and the Healthy People goals for improving the health of Americans. Government initiatives are important particularly for reducing disparities that affect disadvantaged populations. Head Start, Healthy Start, WIC and Medicaid are four federal programs that target disparities in maternal and child health outcomes. This paper reviews recent evaluations of these programs to identify outcomes assessed and opportunities for further evaluation of these programs. We conducted a review of recent evaluation studies assessing the impact of four maternal and child health programs on a health or healthcare outcome. Sources for published literature included the PubMed, Academic Search Complete, CINAHL and PsycInfo databases. Titles and abstracts of studies were examined to determine if they met inclusion criteria. Included studies were categorized by type of outcome examined. Twenty peer-reviewed studies published between January 2006 and June 2011 met inclusion criteria. The majority of studies examined infant outcomes (11), followed by breastfeeding/nutrition (4), maternal health (3), and unintended pregnancy (2). Measures used were consistent across studies; however, findings on the impact of programs were mixed reflecting differences in selection of comparison group, data source and statistical methods. The impact of maternal and child health programs may vary by setting and population served, but inconclusive findings remain. Health service researchers can build upon current evaluations to increase our understanding of what works, help target resources, and improve evaluation of programs in the future.


Maternal health services Child health services Federal programs Program evaluation 


  1. 1.
    Blood-Siegfried, J., & Rende, E. K. (2010). The long-term effects of prenatal nicotine exposure on neurologic development. Journal of Midwifery Womens Health, 55(2), 143–152.CrossRefGoogle Scholar
  2. 2.
    Cetin, I., Berti, C., & Calabrese, S. (2010). Role of micronutrients in the periconceptional period. Human reproduction update, 16(1), 80–95.PubMedCrossRefGoogle Scholar
  3. 3.
    Ruager-Martin, R., Hyde, M. J., & Modi, N. (2010). Maternal obesity and infant outcomes. Early Human Development, 86(11), 715–722.PubMedCrossRefGoogle Scholar
  4. 4.
    Swamy, G. K., Ostbye, T., & Skjaerven, R. (2008). Association of preterm birth with long-term survival, reproduction, and next-generation preterm birth. JAMA, 299(12), 1429–1436.PubMedCrossRefGoogle Scholar
  5. 5.
    World Health Organization. (2011). Nigeria Midwives Service Scheme [Internet]. Global Health Workforce Alliance. 2011 [cited 2011 Aug 5]. Available from:
  6. 6.
    Victora, C. G., Aquino, E. M. L., do Carmo Leal, M., Monteiro, C. A., Barros, F. C., & Szwarcwald, C. L. (2011). Maternal and child health in Brazil: Progress and challenges. Lancet, 377(9780), 1863–1876.PubMedCrossRefGoogle Scholar
  7. 7.
    United Nations. (2009). The Millennium Development Goals report 2009. [Internet]. New York: United Nations Department of Economic and Social Affairs. Available from:
  8. 8.
    MacDorman, M. F., & Mathews, T. J. (2009). Behind international rankings of infant mortality: How the United States compares with Europe. NCHS Data Brief, 23, 1–8.PubMedGoogle Scholar
  9. 9.
    Burris, H. H., & Collins, J. W. (2010). Race and preterm birth—The case for epigenetic inquiry. Ethnicity and Disease, 20(3), 296–299.PubMedGoogle Scholar
  10. 10.
    Mathews, T. J., & MacDorman, M. F. (2010). Infant mortality statistics from the 2006 period linked birth/infant death data set. National Vital Statistics Reports, 58, 1–31.Google Scholar
  11. 11.
    Mathews, T. J., & MacDorman, M. F. (2011). Infant mortality statistics from the 2007 period linked birth/infant death data set. National Vital Statistics Reports, 59(6), 1–47.Google Scholar
  12. 12.
    National Center for Health Statistics. (2011). DATA2010: The healthy people 2010 database [Internet]. [cited 2011 Aug 5]. Available from:
  13. 13.
    U.S. Department of Health and Human Services. (2010). Healthy people 2020 topics and objectives [Internet]. 2010 [cited 2011 Jan 23]. Available from:
  14. 14.
    Bloom, T. L. (2011). The greatest asset: Addressing maternal–child health disparities in the United States. Western Journal of Nursing Research, 3(4), 483–485.Google Scholar
  15. 15.
    Johnson, K., Posner, S. F., Biermann, J., Cordero, J. F., Atrash, H. K., Parker, C. S., et al. (2006). Recommendations to improve preconception health and health care–United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recommendations and Reports, 55(RR-6), 1–23.Google Scholar
  16. 16.
    Lu, M. C., Kotelchuck, M., Hogan, V., Jones, L., Wright, K., Halfon N. (2010) Closing the Black-White gap in birth outcomes: A life-course approach. Ethnicity and Disease 20(1 Suppl 2):S2-62–S2-76.Google Scholar
  17. 17.
    Office of Head Start. (2010). Head Start Program Fact Sheet Fiscal Year 2010 [Internet]. Early Childhood Learning and Knowledge Center. [cited 2011 Aug 8]. Available from:
  18. 18.
    Health Resources and Services Administration (HRSA). (2010). Healthy Start [Internet]. Health Resources and Services Administration. [cited 2011 Aug 8]. Available from:
  19. 19.
    Food and Nutrition Service. (2009). WIC Fact Sheet [Internet]. [cited 2010 Dec 28]. Available from:
  20. 20.
    Kaiser Commisssion on Medicaid and the Uninsured. (2011). Federal core requirements and State options in Medicaid: current policies and key issues [Internet]. Washington, D.C.: The Henry J. Kaiser Family Foundation; [cited 2011 Aug 8]. Available from:
  21. 21.
    Oliveira V, Frazao E. (2009).The WIC program: Background, trends, and economic issues, 2009 Edition [Internet]. U.S. Department of Agriculture, Economic Research Service. Available from:
  22. 22.
    Owen, A. L., & Owen, G. M. (1997). Twenty years of WIC: A review of some effects of the program. Journal of the American Dietetic Association, 97, 777–782.PubMedCrossRefGoogle Scholar
  23. 23.
    Ludwig, J., & Phillips, D. A. (2008). Long-term effects of head start on low-income children. Annals of the New York Academy of Sciences, 1136, 257–268.PubMedCrossRefGoogle Scholar
  24. 24.
    Anderson, L. M., Shinn, C., Fullilove, M. T., Scrimshaw, S. C., Fielding, J. E., Normand, J., et al. (2003). The effectiveness of early childhood development programs. A systematic review. American Journal of Preventive Medicine, 24(3 Suppl), 32–46.PubMedCrossRefGoogle Scholar
  25. 25.
    Foster, E. M., Jiang, M., & Gibson-Davis, C. M. (2010). The effect of the WIC program on the health of newborns. Health Services Research, 45(4), 1083–1104.PubMedCrossRefGoogle Scholar
  26. 26.
    Mason, M. V., Poole-Yaeger, A., Lucas, B., Krueger, C. R., Ahmed, T., & Duncan, I. (2011). Effects of a pregnancy management program on birth outcomes in managed Medicaid. Managed Care, 20(4), 39–46.PubMedGoogle Scholar
  27. 27.
    Rosenbach, M., O’Neil, S., Cook, B., Trebino, L., & Walker, D. K. (2010). Characteristics, access, utilization, satisfaction, and outcomes of Healthy Start participants in eight sites. Maternal and Child Health Journal, 14(5), 666–679.PubMedCrossRefGoogle Scholar
  28. 28.
    Salihu, H. M., Mbah, A. K., Jeffers, D., Alio, A. P., & Berry, L. (2009). Healthy start program and feto-infant morbidity outcomes: Evaluation of program effectiveness. Maternal and Child Health Journal, 13(1), 56–65.PubMedCrossRefGoogle Scholar
  29. 29.
    Cramer, M. E., Chen, L.-W., Roberts, S., & Clute, D. (2007). Evaluating the social and economic impact of community-based prenatal care. Public Health Nursing, 24(4), 329–336.PubMedCrossRefGoogle Scholar
  30. 30.
    Smith, M. V., Shao, L., Howell, H., Lin, H., & Yonkers, K. A. (2011). Perinatal depression and birth outcomes in a Healthy Start project. Maternal and Child Health Journal, 15(3), 401–409.PubMedCrossRefGoogle Scholar
  31. 31.
    Levandowski, B. A., Sharma, P., Lane, S. D., Webster, N., Nestor, A. M., Cibula, D. A., et al. (2006). Parental literacy and infant health: An evidence-based healthy start intervention. Health Promotion Practice, 7(1), 95–102.PubMedCrossRefGoogle Scholar
  32. 32.
    Van Dijk, J., Anderko, L., & Stetzer, F. (2011). The impact of prenatal care coordination on birth outcomes. JOGNN, 40(1), 98–108.PubMedCrossRefGoogle Scholar
  33. 33.
    Arima, Y., Guthrie, B., Rhew, I., & De Roos, A. (2009). The impact of the First Steps prenatal care program on birth outcomes among women receiving Medicaid in Washington State. Health Policy, 92(1), 49–54.PubMedCrossRefGoogle Scholar
  34. 34.
    Silva, R., Thomas, M., Caetano, R., & Aragaki, C. (2006). Preventing low birth weight in Illinois: Outcomes of the family case management program. Maternal and Child Health Journal, 10(6), 481–488.PubMedCrossRefGoogle Scholar
  35. 35.
    Khanani, I., Elam, J., Hearn, R., Jones, C., & Maseru, N. (2010). The impact of prenatal WIC participation on infant mortality and racial disparities. American Journal of Public Health, 100(S1), S204–S209.PubMedCrossRefGoogle Scholar
  36. 36.
    Yun, S., Liu, Q., Mertzlufft, K., Kruse, C., White, M., Fuller, P., et al. (2010). Evaluation of the Missouri WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) breast-feeding peer counselling programme. Public Health Nutrition, 13(2), 229–237.PubMedCrossRefGoogle Scholar
  37. 37.
    Gross, S. M., Resnik, A. K., Cross-Barnet, C., Nanda, J. P., Augustyn, M., & Paige, D. M. (2009). The differential impact of WIC peer counseling programs on breastfeeding initiation across the state of Maryland. Journal of Human Lactation, 25(4), 435–443.PubMedCrossRefGoogle Scholar
  38. 38.
    Petrova, A., Ayers, C., Stechna, S., Gerling, J. A., & Mehta, R. (2009). Effectiveness of exclusive breastfeeding promotion in low-income mothers: A randomized controlled study. Breastfeeding Medicine, 4(2), 63–69.PubMedCrossRefGoogle Scholar
  39. 39.
    Rossman, B. (2007). Breastfeeding peer counselors in the United States: Helping to build a culture and tradition of breastfeeding. Journal of Midwifery and Women’s Health, 52(6), 631–637.PubMedCrossRefGoogle Scholar
  40. 40.
    Metallinos-Katsaras, E., Gorman, K. S., Wilde, P., & Kallio, J. (2011). A longitudinal study of WIC participation on household food insecurity. Maternal and Child Health Journal, 15(5), 627–633.PubMedCrossRefGoogle Scholar
  41. 41.
    Chazan-Cohen, R., Ayoub, C., Pan, B. A., Roggman, L., Raikes, H., Mckelvey, L., et al. (2007). It takes time: Impacts of Early Head Start that lead to reductions in maternal depression two years later. Infant Mental Health Journal, 28(2), 151–170.CrossRefGoogle Scholar
  42. 42.
    Yonkers, K. A., Smith, M. V., Lin, H., Howell, H. B., Shao, L., & Rosenheck, R. A. (2009). Depression screening of perinatal women: An evaluation of the healthy start depression initiative. Psychiatric Services, 60(3), 322–328.PubMedCrossRefGoogle Scholar
  43. 43.
    Conway, K. S., & Kutinova, A. (2006). Maternal health: Does prenatal care make a difference? Health Economics, 15, 461–488.PubMedCrossRefGoogle Scholar
  44. 44.
    Amaral, G., Foster, D. G., Biggs, M. A., Jasik, C. B., Judd, S., & Brindis, C. D. (2007). Public savings from the prevention of unintended pregnancy: A cost analysis of family planning services in California. Health Services Research, 42(5), 1960–1980.PubMedCrossRefGoogle Scholar
  45. 45.
    Frost, J., Finer, L., & Tapales, A. (2008). The impact of publicly funded family planning clinic services on unintended pregnancies and government cost savings. Journal of Health Care for the Poor and Underserved, 19(3), 778–796.PubMedCrossRefGoogle Scholar
  46. 46.
    Bernstein, P. S., & Merkatz, I. R. (2010). A life course perspective on women’s reproductive health and the outcome of pregnancy. Journal of Women’s Health (Larchmt), 19(3), 555–560.CrossRefGoogle Scholar
  47. 47.
    Fox, M. K., Hamilton, W., Biing-Hwan L. (2004). Effects of food assistance and nutrition programs on nutrition and health: Volume 3 [Internet]. Washington, D.C.: USDA Economic Research Service. Available from:
  48. 48.
    Baser, O. (2006). Too much ado about propensity score models? Comparing methods of propensity score matching. Value in Health, 9(6), 377–385.PubMedCrossRefGoogle Scholar
  49. 49.
    Institute for Social Research. (2011). PSID main interview user manual: Release 2011.1 [Internet]. [cited 2011 Aug 14]. Available from:
  50. 50.
    Centers for Disease Control and Prevention. (2010). What is PNSS? [Internet]. CDC’s Pediatric and Pregnancy Nutrition Surveillance System. [cited 2011 Aug 15]. Available from:
  51. 51.
    National Center for Health Statistics. (2011). Surveys and data collection systems homepage [Internet]. [cited 2011 Aug 15]. Available from:
  52. 52.
    Joyce, T., Racine, A., & Yunzal-Butler, C. (2008). Reassessing the WIC effect: Evidence from the pregnancy nutrition surveillance system. Journal of Policy Analysis and Management, 27(2), 277–303.PubMedCrossRefGoogle Scholar
  53. 53.
    Figlio, D., Hamersma, S., & Roth, J. (2009). Does prenatal WIC participation improve birth outcomes? New evidence from Florida. Journal of Public Economics, 93(1–2), 235–245.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Public Health SciencesThe University of North Carolina at CharlotteCharlotteUSA
  2. 2.School of Nursing, College of Health and Human ServicesUniversity of North Carolina at CharlotteCharlotteUSA

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