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The fairy godmother effect

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    Go on, admit it—you don’t believe in fairy godmothers, do you? They only exist in Disney films, don’t they? Well the remarkable results of recent US research might help to change things, but for “fairy godmother” substitute home nurse or health visitor. A study that began over 20 years ago (Davis Olds and colleagues.Journal of the American Medical Association1998;280:1238–44) has shown that home visiting by nurses during pregnancy and the child’s first two years can reduce antisocial behaviour at adolescence in the children of disadvantaged families. Four hundred pregnant women with no previous livebirths were enrolled in 1978–80 and 315 of the children of these pregnancies were studied at age 15 years. Most (85%) were young, unmarried, or from low socioeconomic status (SES) households. The pregnant mothers were randomly assigned to four groups: group 1—sensory and developmental screening at 12 and 24 months with appropriate action; group 2—as group 1 but free transport to antenatal and well child clinics; group 3—as group 2 but nurse home visits during pregnancy; group 4—as group 3 but home visits continued until the child was 2 years old. The mean number of visits was 9 during pregnancy and 23 during the child’s first 2 years, and the nurses concentrated on three aims: to promote healthy behaviour during pregnancy and the child’s first 2 years, to promote good child care, and to help the mothers’ personal development in such aspects as family planning, education, and work.

    Of the 315 adolescents, 90% were born to white mothers, 60% to unmarried mothers, 60% to low SES mothers, and 50% to mothers under 19. The adolescent children of unmarried, low SES mothers in group 4 (prenatal and postnatal visits) reported significantly fewer problems than did those in the other groups. These problems included running away, arrest, convictions, probation violations, multiple sex partners, smoking cigarettes, and consuming alcohol. The children of mothers in group 3 (antenatal nurse home visiting only) did better than those of mothers in groups 1 and 2 but not as well as those of group 4 mothers.

    Although it has a certain “too good to be true” ring to it (it seems almost incredible that monthly visits can counter so much disadvantage and social exclusion) this work is in some respects in accord with studies of child rearing in non-human primates. The exact mechanism of the effect seems unclear but it is suggested that the nursing input reduces health risks to the fetus (by reducing tobacco and alcohol consumption, for instance) and improves the mothers’ education and emotional well being during child rearing. This may alter a developmental pathway that begins in early life and leads to antisocial behaviour. (Antisocial behaviour beginning in early childhood tends to be much worse than that beginning in adolescence.) The US Department of Justice is supporting efforts to extend the programme, concentrating on deprived communities with high rates of crime.

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