Mother and Infant Home Visiting Program

Evaluation - Strong Start (MIHOPE-Strong Start)

Informing the Future of Home Visiting



Background: Adverse Birth Outcomes

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Although most pregnancies in the U.S. result in uncomplicated deliveries and healthy infants, adverse birth outcomes are generally more common in the U.S. than in other developed countries. Adverse birth outcomes include preterm births (medically defined as less than 37 weeks of gestation) and low birth weight (less than 5.5 pounds). These can lead to higher rates of illness and infection for newborns, as well as long-term neurological and health problems.

  • In 2009, approximately 12% of infants born in the U.S. were premature and roughly 8% classified as low birth weight (Martin et al., 2011).
  • African-American, Puerto Rican, and American Indian women at every level of socio-economic status have higher rates of poor birth outcomes than their white counterparts (Lu and Halfon, 2003).
  • Medicaid recipients are more likely to have more risk factors for adverse birth outcomes, compared with women with private insurance (Anum, Retchin, and Strauss, 2010).
  • Several studies have documented that rates of preterm birth are higher among women living in poverty than for higher-income women (Institute of Medicine, 2007).






The overarching goal of the Center for Medicare and Medicaid Innovation’s Strong Start Initiative, of which MIHOPE-Strong Start is a part, is to reduce the frequency of these adverse outcomes in the U.S., thereby improving infant health and reducing the related physical, psychological, and economic stresses they can cause.

Structured home visiting programs delivered during pregnancy have demonstrated the potential to reduce preterm births. MIHOPE-Strong Start will study the influence of these programs on improving birth outcomes.

Want to help inform the future of home visiting? The research team is currently recruiting sites.

Contact Sharon Rowser, part of the MIHOPE-Strong Start management team, at [email protected] for more information.




Anum, E.A., S.M. Retchin, and J.F. Strauss, III. (2010). “Medicaid and Preterm Birth and Low Birth Weight: The Last Two Decades,” Journal of Women’s Health, 19(3): 443-51.

Institute of Medicine Committee on Understanding Premature Birth and Assuring Healthy Outcomes. (2007). Preterm Birth: Causes, Consequences, and Prevention. Washington, DC: National Academies Press.

Lu, M.C., and N. Halfon, (2003), “Racial and ethnic disparities in birth outcomes: a life-course perspective,” Maternal Child Health Journal, 7(1): 13-30.

Martin, J.A., B.E. Hamilton, et al. (2011). Births: Final Data for 2009. National Vital Statistics Reports. Hyattsville, MD: National Center for Health Statistics. 60.