In 1991, the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) funded 15 urban and rural sites in communities with infant mortality rates that were 1.5 - 2.5 times the national average to begin the Healthy Start Initiative. The program began with a five-year demonstration phase to identify and develop community-based systems approaches to reducing infant mortality by 50% over the five-year period and to improve the health and well-being of women, infants, children and their families.

Since its inception, the Healthy Start Program has been located in HRSA. Healthy Start is a component of the Maternal and Child Health Bureau and resides in the Division of Perinatal Systems and Women's Health.

Originally funded under the authority of Section 301 of the Public Health Services Act, Healthy Start was recently authorized by the Congress as part of the Children's Health Act of 2000.

The common principles underlying the Healthy Start program are:

• Innovations in service delivery;
• Community commitment and involvement;
• Personal responsibility demonstrated by expectant parents;
• Integration of health and social services;
• Multi-agency participation;
• Increased access to care; and
• Public education.

Healthy Start projects address multiple issues, including:

• Providing adequate prenatal care;
• Promoting positive prenatal health behaviors;
• Meeting basic health needs (nutrition, housing, psychosocial support);
• Reducing barriers to access;
• Enabling client empowerment.

An additional seven sites were funded in 1994 as special projects with the goal of significantly reducing infant mortality through more limited interventions. In the second, or "replication," phase, Healthy Start added 75 projects in 1998, 19 in 1999 and three more in 2000. In 2001, Healthy Start entered its third phase, and added nine new grantees. Twelve existing projects that were categorized as "approved, but not funded" in 2001 received new funding early in 2002. Presently, there are 96 federally-funded Healthy Start projects, and five main types of Healthy Start grants: Perinatal Health, Border Health, Interconceptional Care, Perinatal Depression and Family Violence, the last just awarded by the MCHB in May 2002. Some projects have more than one grant type.
(Source: Telling the Healthy Start Story: A Report on the Impact of the 22 Demonstration Projects, National Center for Education in Maternal and Child Health, 1999.)

Click Infant Mortality, Low Birthweight and Racial Disparity in Perinatal Outcomes or visit www.hrsa.gov (Maternal and Child Health Bureau) for more information about infant mortality and low birthweight.

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