Healthy Moms, Healthy Babies: The Healthy Start Program

The United States has a shameful distinction among wealthy nations: it has one of the highest infant mortality rates in the developed world. Each year, approximately 20,000 babies die before their first birthday—and the disparities are staggering. Black infants die at more than twice the rate of white infants. American Indian/Alaska Native infant mortality rates are 50% higher than those for white infants. And within the United States, there are communities where infant death rates rival those of developing countries—neighborhoods where zip code is a stronger predictor of whether a baby will survive than any medical factor.

The Healthy Start program was created to change this. Established by Congress in 1991, Healthy Start targets the communities with the worst birth outcomes in America and provides intensive, culturally competent, community-based services to pregnant women, new mothers, fathers, and infants. The program currently operates in 101 communities across 37 states, the District of Columbia, and Puerto Rico—from inner-city neighborhoods to rural counties to tribal reservations—reaching approximately 150,000 participants each year.

Healthy Start’s approach is built on a simple but powerful premise: improving birth outcomes requires more than medical care. It requires addressing the social, economic, environmental, and behavioral factors that shape a mother’s health during pregnancy and a baby’s health during the critical first years of life. This means connecting families with prenatal care, yes—but also with food assistance, stable housing, mental health services, substance abuse treatment, domestic violence support, breastfeeding education, fatherhood engagement, and the full range of social determinants that influence whether a pregnancy results in a healthy birth and whether that baby thrives.

Opportunity Snapshot

Services Provided

Home Visiting and Care Coordination

At the heart of Healthy Start is the community health worker—a trained, trusted member of the community who builds relationships with participating families through regular home visits. Community health workers (also called family support workers, lay health educators, or promotoras in Hispanic communities) conduct home visits throughout pregnancy and the first two years of the child’s life. During these visits, they assess the family’s needs across multiple dimensions (health, nutrition, housing, safety, mental health, social support), develop an individualized care plan, provide health education in a culturally appropriate way, help families navigate the healthcare system and attend appointments, connect families with resources including WIC, SNAP, Medicaid, housing assistance, and other programs, screen for depression, intimate partner violence, and substance use, support breastfeeding initiation and continuation, and provide emotional support and encouragement.

The community health worker model is central to Healthy Start’s effectiveness because these workers come from the communities they serve. They understand the culture, speak the language, know the neighborhood, and have the trust of the families they work with—a trust that is often absent in clinical settings, particularly for communities with historical reasons to distrust healthcare systems.

Prenatal and Postpartum Support

Healthy Start ensures that pregnant women receive early and consistent prenatal care—one of the most effective interventions for improving birth outcomes. Program staff help women identify a prenatal care provider, schedule and attend appointments, understand what to expect during pregnancy, recognize warning signs that require medical attention, and prepare for labor, delivery, and the postpartum period.

After delivery, Healthy Start provides intensive postpartum support during the critical “fourth trimester” and beyond. This includes postpartum depression and anxiety screening (using validated tools like the Edinburgh Postnatal Depression Scale), connection to mental health treatment when needed, support with infant feeding, safe sleep practices, and newborn care, well-baby visit scheduling and appointment support, family planning counseling and contraception access, and interconception care to optimize health between pregnancies.

Breastfeeding Support

Breastfeeding is one of the most powerful interventions available for improving infant health, yet breastfeeding rates remain significantly lower in the communities that Healthy Start serves. Black women, for example, initiate breastfeeding at rates 15 percentage points lower than white women, and the disparities widen at 6 and 12 months.

Healthy Start addresses these disparities through prenatal breastfeeding education that addresses myths, cultural barriers, and concerns, peer counselor programs staffed by women from the community who have successfully breastfed, one-on-one lactation support including home visits during the critical first days and weeks, assistance obtaining breast pumps and supplies, workplace breastfeeding support and rights education, and at some sites, CLC (Certified Lactation Counselor) or IBCLC (International Board Certified Lactation Consultant) services.

Mental Health Services

Perinatal mood and anxiety disorders—including depression, anxiety, OCD, PTSD, and psychosis—affect approximately 1 in 5 women during pregnancy or the postpartum period. In high-risk communities, rates are even higher due to the cumulative effects of poverty, racism, trauma, violence, and social isolation. Left untreated, perinatal mental health disorders have devastating consequences for mothers, babies, and families.

Healthy Start screens all participants for mental health conditions using validated screening tools and provides crisis intervention and safety planning, referral and warm handoff to mental health treatment, support groups for women experiencing perinatal mood disorders, trauma-informed care throughout all program services, and connection to substance abuse treatment when needed.

Fatherhood and Male Engagement

Healthy Start recognizes that fathers and male partners play a critical role in maternal and infant health outcomes. Research shows that father involvement during pregnancy and early childhood is associated with better prenatal care utilization by the mother, lower rates of preterm birth and low birth weight, improved breastfeeding duration, better child developmental outcomes, and reduced maternal stress and depression.

Healthy Start fatherhood programs provide prenatal education for fathers including what to expect during pregnancy and birth, parenting skills and child development education, co-parenting communication skills, employment and career development support, connection to legal services (custody, child support), and peer support groups and mentoring.

Health Education

Healthy Start provides comprehensive health education on topics directly related to healthy pregnancies and healthy babies, including nutrition during pregnancy and early childhood, safe sleep practices (reducing the risk of Sudden Infant Death Syndrome/SIDS), injury prevention and child safety, immunization education and scheduling, family planning and contraception, sexually transmitted infection prevention, tobacco, alcohol, and substance use cessation, environmental health (lead, mold, pests, water quality), and stress reduction and self-care.

Health education is delivered through individual home visits, group classes, community events, and increasingly through digital platforms including text messaging programs that send timely, stage-appropriate health information throughout pregnancy and the first year.

Where Healthy Start Operates

Healthy Start is not a nationwide program—it operates in 101 specifically selected communities that have the worst birth outcomes in the country. These communities were chosen based on infant mortality rates, rates of low birth weight and preterm birth, racial and ethnic disparities in birth outcomes, poverty rates and social determinant indicators, and geographic distribution to ensure coverage across different regions and settings.

Healthy Start communities include large urban areas such as Detroit, Memphis, Philadelphia, Cleveland, Oakland, Houston, and Chicago. They include rural communities in the Mississippi Delta, Appalachian region, and Great Plains. They include tribal communities including the Navajo Nation and other reservations. And they include territories including communities in Puerto Rico.

To find out if you live in a Healthy Start service area, contact your local health department or visit the HRSA website to search for Healthy Start grantees by state.

Evidence of Effectiveness

Research on Healthy Start has documented significant improvements in birth outcomes in communities where the program operates. Studies have found that Healthy Start participants are more likely to receive early and adequate prenatal care compared to similar women not enrolled, that Healthy Start communities have experienced greater reductions in infant mortality than comparable communities without the program, that participants have higher breastfeeding initiation and continuation rates, that Healthy Start’s screening and referral protocols identify and address perinatal depression at significantly higher rates than standard care, and that the program’s community health worker model is cost-effective, with estimated savings of $3 to $5 for every $1 invested through reductions in NICU admissions, preterm births, and other costly adverse outcomes.

A 2019 evaluation by the Urban Institute found that Healthy Start participants had a 27% lower rate of preterm birth compared to a matched comparison group—a clinically and statistically significant finding that translates to fewer babies in neonatal intensive care, fewer infant deaths, and fewer long-term developmental disabilities.

Frequently Asked Questions

Do I need to be referred by a doctor? No. Healthy Start accepts self-referrals. You can contact your local Healthy Start program directly.

Can I participate if I already have a doctor or midwife? Absolutely. Healthy Start complements clinical care—it does not replace it. The program’s community health workers coordinate with your medical provider, not substitute for them.

Is the program only for first-time mothers? No. Healthy Start serves women in all pregnancies, and interconception care for women between pregnancies is a key program component.

Are fathers really welcome? Yes. Fatherhood engagement is a core component of Healthy Start. Many programs have dedicated fatherhood coordinators and offer services specifically designed for men.

How long can I participate? Women can enroll during pregnancy and continue receiving services until the child’s second birthday. Some programs offer interconception services between pregnancies.

What if I don’t live in a Healthy Start area? If you don’t live in a Healthy Start community, similar services may be available through the MIECHV home visiting program, your local WIC office, community health centers, or your local health department’s maternal and child health programs.

Do I need insurance? No. Healthy Start services are free regardless of insurance status. Program staff can also help you enroll in Medicaid or Marketplace insurance if you are eligible.

How to Get Started

1. Visit mchb.hrsa.gov/healthy-start to find Healthy Start programs near you
2. Call your local health department and ask about Healthy Start services
3. Ask your OB/GYN, midwife, or community health center for a referral
4. Contact your local WIC office for Healthy Start referrals
5. Call 211 for maternal and infant health services in your community
6. Call the HRSA Information Center at 1-877-464-4772 for help finding services

Every mother deserves a healthy pregnancy. Every baby deserves a healthy start. If you are pregnant or recently had a baby and live in a Healthy Start community, this program is here for you—free, supportive, and focused entirely on helping you and your baby thrive.