This annual report - Taranaki District Health Board

antenatal care, including two nutritional programmes for teenagers, were consideredpromising.Home VisitingHome visiting has been identified as an intervention with potential for reducing intergenerationalhealth inequalities [250]. A 2004 ‘review of reviews’ published by NICEassessed the effectiveness of antenatal and post natal home-visiting programmes forimproving child and maternal outcomes [250]. The authors note that home visitingencompasses a wide variety of interventions, with diverse goals, target recipients, content,theory, mode and timing of delivery. This diversity makes demonstrating effectiveness ofsuch programmes difficult. Nine reviews were included in the report. The benefits of homevisitingprogrammes to parents of young children included: improvements in parenting andsome child behavioural problems; improved cognitive development, especially amongsome sub-groups of children such as those born prematurely or born with low birth weight;a reduction in accidental injury among children; and improved detection and managementof post-natal depression. There was either no evidence or inconclusive evidence for theimpact of home visiting on the other outcomes, including child abuse, increased uptake ofimmunisation, reduced hospital admissions or maternal participation in education or in theworkforce. Some of these reviews addressing interventions with particular target recipientsand goals are considered individually below.Provision of Financial SupportThe association between poverty and adverse pregnancy outcomes raises the question ofthe value of providing financial support during pregnancy. In Europe, antenatal care hasemphasised primary prevention, by providing social and financial support to all pregnantwomen, although this support has not been tested in RCTs [251]. In the United States, astate-level analysis examined the temporal relationships between welfare reforms and theincidence of reported and substantiated cases of maltreatment [252]. The study found thatthe incidence of specific types of substantiated maltreatment (physical abuse and neglect)and the number of children living in out-of-home care increased between 1990 and 1998,following reductions in state welfare benefit levels, tightening of lifetime benefit restrictionsand tougher sanctions for non-compliance. The study found that higher welfare benefits tomothers were associated with fewer cases of child neglect and out of home placement.Parental employment among single-parent families was also associated with lower rates ofchild maltreatment.Box 4. Key points emerging from the literature on interventions aimed at sociallyvulnerable women in general RCTs assessing the benefit of additional social supports in pregnancy have failed todemonstrate significant improvements in perinatal outcomes. The evidence base for interventions that aim to increase the early initiation ofcomprehensive antenatal care is limited with very few RCTs. One paraprofessional homevisiting intervention for pregnant teenagers was associated with a statistically significantincrease in the uptake of early antenatal care. There is a limited evidence base for specific antenatal interventions aimed at reducinginfant mortality among disadvantaged groups, but group antenatal care, enhanced clinicbased care for at risk women and nutritional programmes provided to teenagers as anadjunct to routine care, have shown promise.Services for Teenage ParentsA number of studies and reviews have considered interventions aimed at supporting youngparents during pregnancy and the postnatal period.Clinical guidelinesThe UK government has published guidance on providing maternity services for pregnantteenagers and young fathers [253,254]. “Getting maternity services right for pregnantteenagers and young fathers” provides a practical guide for midwives, doctors andmaternity support workers and receptionists [253]. “Teenage parents: who cares? A guideIn-Depth Topic: Adversity in Pregnancy - 294