Prenatal care

Experts, step aside

Centering II w text
Centering II w text

In the social services and healthcare fields, two experiments are underway that share a similar (and counter-intuitive) approach: Get the experts out of the way so that people can help each other. An anti-poverty organization called the Family Independence Initiative (FII) forbids its staff from offering help or advice to participating families – even when the families are making costly mistakes. Despite this, the organization's results in Oakland and San Francisco show an increase in earnings and savings of 23% and 240% respectively, with 17% of participating families buying homes and 70% of children improving their grades.

The way the Family Independence Initiative sees it, families will not stay out of poverty if they rely on a program or paid social worker for support. FII works to nurture robust social networks -- neighbors who help each other find jobs, buy homes, or with childcare. FII thinks that social workers, however well-intentioned, often get in the way and absorb resources that could go directly to poor families.

Likewise, the CenteringPregnancy model for prenatal healthcare teaches doctors and midwives to take off their white coats, sit in a circle with a group of their patients, and talk as little as possible. When the experts take a facilitative, rather than didactic approach to delivering healthcare, the women themselves share their own fears and experiences about pregnancy and childbirth with one another. They go from being passive recipients of expert advice to being active, powerful participants in the process.

It turns out, prenatal care delivered in this way simply gets better health outcomes. In a multi-site randomized control trial, CenteringPregnancy was shown to reduce the preterm birth rate among participants by 33%. That means for every two CenteringPregnancy groups, one baby is spared the trauma and risk associated with a preterm birth, and society saves an average of $52,000 in expenses.

For those of us who sometimes wonder whether we have too many experts and not enough community, these are welcome data points.