Effectiveness of Federal Healthy Start in improving feto-infant morbidity associated with absent fathers: A quasi-experimental design

Background: The absence of fathers during pregnancy increases the risk of feto-infant morbidities, including low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA). Although previous research has shown that Central Hillsborough Healthy Start (CHHS) – a federally-funded initiative in Tampa, Florida – has effectively improved birth outcomes, its effectiveness in ameliorating adverse effects of fathers' absence during pregnancy has not been explored. Methods: This population-based, retrospective cohort study used records from a Federal Healthy Start project (CHHS) linked to vital statistics and hospital discharge data (1998-2007). The study population consisted of women who had a singleton birth with an absent father during pregnancy. Women were categorized based on whether they resided within the CHHS service area. To provide unbiased estimation of treatment-effects, propensity score matching was performed to match cases (CHHS) to controls (rest of Florida). Conditional logistic regression was employed to generate odds ratios (OR) and 95% confidence intervals (CI) for matched observations. Results: Women residing within the CHHS service area were more likely to be black, younger (<35 years), and to have at least a high school degree with adequate prenatal care compared to controls (p<0.01). These differences disappeared after propensity score matching. Mothers in the CHHS service area had a reduced likelihood of LBW (OR=0.76, 95% CI=0.65-0.89) and PTB (OR=0.72, 95% CI=0.62-0.84) compared to the rest of the state. Conclusions: Our study demonstrates that a Federal Healthy Start project contributed to a significant reduction in adverse birth outcomes among families with absent fathers.