Strong Start for Mothers and Newborns experiences growing pains in year one

The Strong Start for Mothers and Newborns initiative has experienced “growing pains” in its development, according to a study by the Urban Institute, Health Management Associates, American Institutes for Research, and Briljent. The study evaluates the implementation and impacts of the Strong Start initiative on health care delivery, outcomes, and cost, based on qualitative case studies, participant-level process evaluation, and impact analysis, as well as numerous program monitoring measures. The purpose of the report is to present early findings of the evaluation, summarize the status of the evaluation’s research efforts, and present a plan for the next year of work.


The Strong Start initiative is funded under Section 3021 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) with the goal of improving maternal and infant outcomes for pregnancies covered by Medicaid and the Children’s Health Insurance Program (CHIP). It funds three enhanced prenatal care models: (1) maternity care homes; (2) group prenatal care; and (3) birth centers. The initiative currently supports 27 awardees and 213 provider sites across 30 states, the District of Columbia, and Puerto Rico, serving a target of 80,000 women.

Awardees and sites

Of the 27 Strong Start awardees, 13 are implementing the maternity care home model, 12 are implementing group prenatal care, one is implementing birth center care, and two are implementing more than one model. Of the 213 provider sites, 133 are implementing maternity home care, 42 are implementing group prenatal care, and 38 are offering birth center care. All of these awardees maintain a goal of reducing preterm birth and decrease the rate of low birth rate. Other common goals include decreasing the cost of care, increasing Medicaid and CHIP outreach to inform them of Strong Start, and increasing rates of breastfeeding.

Early observations

Though enrollment in Strong Start was lower than expected during the program’s first year, with slow development of intake and enrollment processes and barriers such as time commitments and transportation identified as possible causes, enrollment is steadily increasing. The study also determined that participants have high levels of emotional and psychosocial needs.Strong Start providers work diligently to address those needs but are constrained by resource limitations and Medicaid- and CHIP-related barriers.

While it is too early to make generalizations about the effects of Strong Start, current data suggests that women served by the program have lower than average Cesarean section rates, higher rates of breastfeeding, and lower rates of preterm deliveries than the country as a whole. Participants also expressed overwhelming satisfaction with their prenatal care, though satisfaction with delivery experiences is somewhat lower

Progress of the study

Much of year one was spent developing foundational documents to set the stage for data gathering. The launch of data collection occurred in the second half of the project year. Year two of evaluation calls for continued data collection and could possibly see the collection and compilation of the first wave of data to be used in the study’s impact analysis.