Preparing to parent — while coping with multiple adversities

October 25, 2018

Life has been challenging for many of the girls and young women participating in BC’s randomized controlled trial that is evaluating the Nurse-Family Partnership (NFP) program for the first time in Canada.

The first data report on participants’ profiles when they entered the trial in early pregnancy has just been released. This report reveals a group of 739 girls and young women who were pregnant and preparing to parent for the first time and selected based on socioeconomic disadvantage. They were age 24 or younger and experiencing low income, low education and/or being single.

The data show that some 83% of these girls and young women were earning less than $20,000 annually, while 53% of them had not completed high school. Most were also single. As well, almost half had experienced homelessness in their lifetime and a third had recently experienced housing insecurity (having to move more than three times within the past year).

Most participants — some 74% — also reported having coped with serious long-term mental and physical health conditions. Nearly half reported coping with severe anxiety or depression and 22% reported they had diagnosed mental disorders.

More than half reported having experienced moderate-to-severe child maltreatment when they were younger. Half also report experiencing intimate partner violence more recently.

While 77% had recently visited primary healthcare providers for physical health concerns, only 28% had received prenatal classes. Perhaps most surprising, only 29% had recently received important BC benefits for people living on low income such as Income and Disability Assistance.

Overall, 89% of these girls and young women were experiencing three or more forms of disadvantage, with 77% experiencing four or more and 56% experiencing five or more.

“Our data show there are unacceptable pockets of deep socioeconomic disadvantage for BC girls and young women who are preparing to parent for the first time,” said lead principal investigator Charlotte Waddell. “This finding has important policy implications,” she added.

An intensive home-visiting program provided by public health nurses, NFP starts early in pregnancy and continues until children reach their second birthday. First developed more than 40 years ago in the United States, NFP has shown many benefits in that country including:

  • reducing prenatal substance use
  • reducing childhood injuries
  • improving children’s mental health and cognitive development, and
  • helping lift young mothers out of poverty

Through the BC trial, we may discover similar benefits for young mothers and their children here. Trial recruitment began in October 2013 and closed in December 2016. The study team is now following the 739 families, who are participating in research interviews until children reach their second birthday (the duration of the NFP program). Study results will be available later in 2020.

Participating regional Health Authorities are also offering NFP to all eligible girls and young women and their children as an enhanced public health service. Trial results will help strengthen the program across BC.

Based in the Faculty of Health Sciences at SFU, the trial is funded by the BC Ministry of Health with support from the BC Ministry of Children and Family Development and from four Health Authorities (Fraser Health, Interior Health, Island Health and Vancouver Coastal Health). Funding is also being provided by the Mowafaghian and R. and J. Stern Family Foundations.

Charlotte Waddell and Harriet MacMillan are the Nominated Co-Principal Investigators. Nicole Catherine is the Scientific Director and Co-Principal Investigator. Susan Jack and Debbie Sheehan are also Co-Principal Investigators. A larger Scientific Team provides guidance, including from collaborators at McMaster University, UBC, the University of Victoria and the Public Health Agency of Canada.

Anyone in BC who wishes to be referred to the Nurse-Family Partnership program should contact their primary care practitioner or their local Health Authority. For more information about Nurse-Family Partnership, see here. The BC Healthy Connections Project Study Team can be reached by email at: