When Lisa Bonfield became a mother in New Orleans, she received a type of support that has become rare in much of the United States: home visits from registered nurses. Through Family Connects New Orleans, a program run by the city health department, Bonfield was eligible for up to three free home visits after giving birth.
"Everything is so abstract before you have a baby," Bonfield said. "You are going to have questions you never even thought about."
Louisiana faces significant challenges in maternal and infant health. The state consistently ranks among the worst in the country for preterm births, unnecessary cesarean sections, and maternal and infant mortality rates. According to data from organizations such as March of Dimes and the United Health Foundation, Louisiana was recently named the "least healthy" state for women and children.
"We got to do some real things real differently, unless you like being No. 50 all the time,” said Jennifer Avegno, director of the New Orleans Health Department.
Family Connects aims to address these issues by providing early intervention through home visits during the critical weeks following childbirth. The model originated in Durham, North Carolina in 2008 as a partnership with Duke University and has since expanded to communities across 20 states. In New Orleans, Avegno helped launch the local version of the program in 2023.
The visits are available at no cost to anyone who gives birth at a New Orleans hospital, regardless of insurance or income status. Nurses bring essential newborn supplies and conduct health checks on both babies and mothers. They also offer referrals to other services and assess household needs such as food security and safe storage of firearms.
"There is no more critical time and vulnerable time than right at birth and in the few weeks to months following birth," Avegno said.
Bonfield appreciated her nurse’s advice on breastmilk storage during their two-hour visit. "I've never felt so well taken care of and listened to," she said.
The program operates against a backdrop of strict abortion laws in Louisiana, which have complicated obstetrical care due to legal uncertainties around pregnancy terminations or miscarriage treatments. While Avegno opposes these policies, she notes that Family Connects can still help mothers access reproductive health information such as birth control options.
"We can't give them abortion access," she said. "That's not the goal of this program, and that wouldn't be possible anyway. But we can make sure they're healthy and understand what their options are for reproductive health care."
Despite political divides over abortion rights, postpartum home visits have bipartisan backing in Louisiana. Last year, lawmakers passed legislation requiring private insurers to cover these visits statewide.
"One of the slings used against advocates against abortion is that we're pro-birth, and not truly pro-life," said Republican state Rep. Mike Bayham, who sponsored the bill. "And this bill is proof that we care about the overall well-being of our mothers and our newborns."
Preliminary research from Tulane University suggests positive outcomes from Family Connects New Orleans: families receiving visits were more likely to attend recommended medical checkups; hospitalizations declined among mothers and infants; Medicaid spending per family dropped; and more cases of postpartum depression were identified early compared with those who did not receive visits.
In North Carolina's Family Connects program, similar results were found—emergency room trips for infants dropped by half within their first year when families received three to seven home visits.
Avegno highlighted improvements in identifying postpartum depression among new mothers: about 10% participating in Family Connects were diagnosed with postpartum depression versus 6% without home visits—a timely diagnosis considered crucial for preventing severe outcomes like suicidal thoughts or difficulty bonding with newborns.
Lizzie Frederick benefited from early detection after her nurse conducted a mental health screening during a visit shortly after her son’s birth.
"I think that I would have felt a lot more alone if I hadn't had this visit, and struggled in other ways without the resources that the nurse provided," Frederick said.
Melissa Goldin Evans from Tulane's School of Public Health described participant feedback as overwhelmingly positive: "This is like a gold-standard public health project, in my opinion."
Operating costs for Family Connects total about $1.5 million annually—roughly $700 per birth—but studies indicate it may reduce healthcare expenses overall; research on North Carolina’s version found each dollar invested saved over three dollars before children turned two years old.
Bayham supports expanding coverage further: "The nurses and medical practitioners will be able to monitor potential problems on the front end so that they could be handled without a trip to the emergency room or something even more drastic," he said.
Avegno advocates integrating Family Connects into Louisiana’s Medicaid program since most births statewide are covered by Medicaid—a recommendation echoed by recent legislative reports.
