By Emily Blobaum, Fearless editor

When Amanda Jones found out she was pregnant in 2018 at age 25, she was surprised. She and her fiance, Aaron, had been dating for 1½ years and were both working as servers in Longview, Texas — Amanda at Cheddar’s and Aaron at Buffalo Wild Wings. 

“We weren’t in a position to have a baby,” Amanda said. “We wanted her, but our financials were just not there.” 

A man with a long brown beard and a blue face mask holds up a newborn baby who is crying. A woman is smiling on a bed in the background
Aaron and Amanda shortly after Saylor’s birth.

Upon their daughter’s birth and enrollment into Medicaid, Amanda and Aaron were given a handful of pamphlets detailing programs and services that they qualified for. Nurse-Family Partnership was one of them. 

Nurse-Family Partnership is a national home visiting program that pairs a first-time mom with a registered nurse. The nurse regularly visits with the mom during the prenatal period all the way up until the child’s second birthday. The program aims to improve pregnancy and child health outcomes by helping mothers engage in preventive health practices while also improving the economic self-sufficiency of the family. 

The program is a national organization that works with network partners in 40 states. Nurse-Family Partnership has served more than 340,000 families since its replication began in 1996. 

Originally on the fence about it — “I didn’t want someone coming into the house all the time” — Amanda decided to join the program shortly after their daughter, Saylor, was born. 

Less than a year later, Amanda, Aaron and Saylor moved to Central Iowa at the end of March 2020 to be closer to family. They continued participating in the Nurse-Family Partnership program through EveryStep, a nonprofit health care and social services organization based in Des Moines. 

A screenshot of two women on a video chat. On the top, a woman is wearing an orange sweater. On the bottom, a woman has glasses and is wearing a pink shirt.
Amanda (top) and Becky (bottom) on a video chat

Amanda was paired with Becky Borgman, who has worked in maternal care for 10 years and with Nurse-Family Partnership for six years. Due to COVID protocols, the two have mostly met virtually, either through FaceTime or phone calls. 

Saylor hated taking baths, wasn’t the greatest eater and was a big biter, Amanda said. “Becky helped us immensely. We talked about different techniques for discipline and working through difficulties. We’ve had calls where I say, ‘I don’t know what to do,’ and she’ll remind me that everything is going to be fine and it’s just a phase. Becky is the best. Nurse-Family Partnership has honestly changed our lives.” 

The rates of maternal mortality and morbidity in the U.S. are among the highest in the developed world and are on the rise. In 2019, the U.S. maternal mortality rate was 20.1 per 100,000 live births. At last count, Iowa’s pregnancy-related maternal mortality rate is 9.4 per 100,000 live births overall. 

In the latest report from Iowa’s Maternal Mortality Review Committee, 39 maternal deaths occurred between the last half of 2015 and the first half of 2018. Of those, 20 were considered to be possibly preventable. 

Recommendations brought forth by the committee to reduce maternal deaths include providing postpartum support for women with substance abuse history, screening women for intimate partner violence and providing screening for depression.

Designed to serve the highest-need and highest-risk families, Nurse-Family Partnership hopes to help decrease the rate of health complications. 

According to a fact sheet provided by Nurse-Family Partnership, 87% of babies in the program were born full-term, 86% of mothers initiated breastfeeding, 92% of babies received all immunizations by age 2, and 54% of clients above 18 were employed by the time their child was 2. Other successes include decreases in maternal alcohol use and smoking during pregnancies and a greater sense of confidence and empowerment in moms. 

To be eligible, participants must be a first-time parent and be eligible for Medicaid. In Iowa, a maximum annual household pretax income of $29,000 for three people qualifies for Medicaid. At time of enrollment into the program, 84% of Nurse-Family Partnership clients in Iowa are unmarried and the median household income for participants is between $9,000 and $12,000. 

The program also looks at other social determinants of health, like smoking and use of alcohol, substance abuse and mental health issues, and access to safe and reliable shelter. 

Free to the participant, Nurse-Family Partnership is funded through a variety of streams in the form of federal, state and private dollars. Jordan Wildermuth, senior government affairs manager for Nurse-Family Partnership, said the largest source of funding is federal dollars. Private philanthropic dollars make up 33% of its revenue and the remaining 25% comes from the state. 

Nurse-Family Partnership is currently only serving 13% of the eligible population in Iowa and is available in just six counties — Pottawattamie, Montgomery, Polk, Jackson, Clinton and Scott. That needs to change, Wildermuth said. “Iowa can do better in reaching some of these moms. We’re only serving a small number of families and there’s more that we could be doing.” 

Nurse-Family Partnership has asked the Iowa Legislature to support its services as a covered benefit under the Medicaid program. “Allowing NFP to be a covered Medicaid benefit is a win-win for Iowa lawmakers. It not only grows the number of families helped by the program, but it makes more efficient use of taxpayer dollars now and in the future,” Wildermuth said. 

“Our ultimate big-picture goal is to ensure that moms have the ability to access an NFP nurse no matter where they live.”