According to a Washington Times news account by Cheryl Wetzstein in Washington Times (1/12/2010), the Obama healthcare bill will contain $1 billion over five years for a new federal welfare program. It is a maternal home-visit service in which a volunteering mother with a new baby will receive, for up to two years, nurse visits once or twice a month to help the younger mother cope with the daily demands of a growing child. Wetzstein adds, This maternal home-visit service is on its way to becoming a massive federal program....

President Obama touted the Nurse-Family Partnership (NFP), during the campaign. NFP was devised by in the late 1970s by psychologist David Olds, now a professor at the University of Colorado, Denver. True to his word, Obama is pushing this program now.

In an accompanying analysis piece, Wetzsteins focuses her only fire on the lack of attention paid to fathers by the program. Howerver, there are other concerns. The first that struck me was this: so what happens when the poor, at-risk, poorly educated mother doesnt do what the friendly nurse instructs? What if she doesnt stop smoking, for example? How close is the link between the visiting nurses and social services enforcement division in your local community? These nurses have to be filing reports on their student moms and evaluating them. Are there jurisdictions in which NFP visits have led to mothers losing custodial rights over their children?

Intimations of various degrees of governmental intrusion come in the news article: The House bill also stipulates that home-visiting professionals will, when appropriate, provide referrals to other programs serving children and families. For example, the House bill apparently contains the goal of increasing birth intervals between pregnancies. (Aside: the wife of a colleague with a newborn was recently lectured by her ob/gyn about birth spacing when she indicated that she wanted to soon have another child.)

So, lets say a woman becomes pregnant at a time that doesnt comport with the latest social science models optimal birth spacing. Pro-life advocates like E. Christian Brugger, an ethicist and senior fellow at Culture of Life Foundation, worry that there will be referrals to Planned Parenthood and other abortion providing institutions.

James Harden, president and chief executive of CompassCare Pregnancy Services in Rochester, N.Y., observes:

Increasing birth intervals is a very loaded phrase, and where it goes in the future, no one can know, Mr. Harden said. What is the birth interval? Is it two years between children? Three years between children? Five years between two children? From my perspective, [increasing] birth intervals relates to a backdoor approach to population control.

Anyone who thinks Harden is exaggerating, in my opinion, does not understand the manner in which bureaucracies slowly gain more and more power. Finally, how long will it be before all new families have to have an initial screening from the friendly nurses and the very friendly public health officials.

Wetzstein quotes an NFP spokesman, Julian Kesner, as strongly disputing Hardens idea. Kesner states there has been no documented situation in which a nurse has told a mother to get pregnant or not to get pregnant, he said. Thats good to hear.

However, direct commands arent the only way control can be exerted by governments. Financial carrots and sticks, anyone? The bigger point is that there are numerous deep ethical matters that go into the decisions to form families and have children. Contrary to what the public health community would have us believe, these are not value neutral decisions. Nobody has elected the public healthers to impose these values, nor will they receive much scrutiny.

On the contrary, a good case can be made that with the massive retirements coming from the Baby Boom, our country would be better off reducing spacing between children not increasing the spacing. Where is the public debate on this? Notice and comment periods?

Finally, it seems clear that this program is designed to enmesh the mother and her baby into the welfare system through referrals. Is that a good thing?

In closing, before we create another massive federal welfare bureaucracy it seems that much more needs to be learned about all the various facets of this program and how NFP works in practice where the rubber meets the road.