The Primeiros Laços (‘First Ties’) program improves the quality of the family environment and the maternal bond

The finding is from a study by the Center for Research and Innovation in Mental Health. The program is aimed at young pregnant women.

Agência FAPESP* – A study evaluated data collected from the Primeiros Laços (“First Ties”) program and confirmed its effectiveness in improving the quality of the family environment and the bond between teenage mothers and their children. The program consists of home visits by nurses to monitor the mental health of young, first-time mothers and the development of their babies from pregnancy until the child is two years old.

The conclusion of the analysis was published in an article in the journal Frontiers in Global Women's Health.

The program is currently being conducted in the municipalities of Indaiatuba and Jaguariúna, in the interior of the state of São Paulo, Brazil, by the Center for Research and Innovation in Mental Health (CISM) in partnership with the University Center of Jaguariúna, the Max Planck University Center, and the local governments of both cities.

The CISM is a partnership between the University of São Paulo (USP), the Federal University of São Paulo (UNIFESP), and the Federal University of Rio Grande do Sul (UFRGS), as well as one of FAPESP's Applied Research Centers (ARCs).

The study evaluated data collected from project participants between August 2015 and May 2018. A total of 169 pregnant women were recruited, 80 of whom completed the follow-up: half in the intervention group and the other half in the control group. At the time, the program was called “Young Caregiving Mothers” and was developed in health services in the western zone of São Paulo, the capital of the state of the same name, targeting vulnerable communities.

The participants were between 14 and 19 years old, a group considered at high risk for negative child development outcomes. Each young woman received 60 to 63 home visits from trained nurses. Topics such as emotional bonding, cognitive stimulation, care practices, and maternal and child health were addressed during the service.

Impact

To measure the impact of the project, the researchers used the Infant Toddler Home Observation for Measurement of the Environment (IT-HOME), an international instrument that evaluates the quality of a child’s home environment and the level of support for child development, including cognitive stimulation and emotional support.

The data showed significant gains for program participants. At 24 months of age, mothers in the intervention group – those who received home visits from nurses – had a median IT-HOME score of 30, while those in the control group scored 25. This difference of 5 points indicates a higher quality family environment for children’s growth.

The researchers who conducted the study consider this difference to be significant, especially in a context of high social vulnerability.

One of the most notable advances was seen in the analysis related to the ability of the young women to be emotionally and verbally responsible. Mothers with an elementary school education in the intervention group scored 4.5 points higher than the control group participants at six months postpartum and three points higher at 24 months.

“The impact of the program was most significant among mothers with lower levels of education, a group traditionally more exposed to barriers when accessing information and care practices,” said Letícia Aparecida da Silva, a researcher with the program. According to the nurse, the results reinforce the importance of public policies that support positive parenting and child development in the early years of a child’s life.

Silva says the study shows that strategies like those used by Primeiros Laços can reduce inequalities in child development by promoting a favorable family environment early in children’s lives.

“In a country with high rates of teenage pregnancy and marked by social inequalities, investing in structured, home-based programs appears to be a viable way to strengthen early childhood care – a decisive period for children’s full physical, cognitive, and emotional development,” the nurse concludes. 

The article “The impact of a home visiting program on the care environment of Brazilian adolescent mothers – A descriptive exploratory study” can be read at www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2025.1530351/full. 

* With information from Mainary Nascimento from the CISM