Following the success of the Child Care Project, in 1993, the Foundation launched its second major program on early childhood policy, focused on the French maternal and child health care system known as PMI (protection maternelle et infantile).
          This project was conceived in an environment of increasing concern among advocates and practitioners about the poor health outcomes which many children face in the United States. Nearly half of all American children under three years of age confront one or more major risks to health and well-being and thirty-five percent aged between 19 and 35 months lack recommended inoculations. At the time we launched this project, by some estimates, 12 million American children were without health insurance (over 350,000 in New York City alone). Among industrialized nations, only South Africa and the United States fail to insure their children's health.
           In contrast, for more than fifty years France has been developing a cost-effective system of national and regional programs to ensure that virtually every mother and child in the country receives basic preventive health care. Within the French universal health care system, the stand-alone PMI entity provides preventive health care services, at no direct cost, to all pregnant women and children to the age of six through private practice physicians, as well as through hundreds of local PMI health centers in the 96 départements in France. These are not clinics, but community sites run by teams of well-trained nurses, midwives and pediatricians. Much of PMI's success is due to its reliance on private-sector medicine which is linked to and overlapped by social services, decentralized structures of community surveillance and risk assessment, close ties to child care and early childhood education, and parent education and outreach. And the cost is low, with PMI representing (in 1992) only about 0.3% of the total French health care budget, or approximately $63 per year for each child under the age of six.

PMI Study Tour and Report

     The French-American Foundation, recognizing that efforts in France had dramatically reduced premature births, infant mortality, and maternal complications, and had promoted rises in inoculation rates, prenatal care, and preventive health exams, sought to analyze the systems which produced these achievements. As part of our continuing efforts to explore ways the two countries can learn from one another, and after a year of preparation, we organized a study tour in 1994 for thirteen carefully selected U.S. health care professionals of high standing. Their mission was to examine and interpret the French maternal and child health care system and present recommendations which could inform U.S. health care providers, policy and decision-makers. To develop the itinerary in France, the Foundation worked closely for six months with French national leaders and with dozens of French officials, professionals, and experts in five local jurisdictions.
     At the conclusion of the study mission, the delegation was enthusiastic about the many elements of PMI which it felt could be imported and prove compatible with US policies and practices. The delegates concluded that many of our own innovative programs and initiatives might well be combined or restructured more effectively to help improve the way we structure and deliver services to pregnant women and children based on the French system. The delegation’s findings and recommendations were summarized in an FAF report, A Welcome for Every Child II: How France Protects Maternal and Child Health -- A New Frame of Reference for the United States. The report was printed and disseminated (12,500 copies) through a grant from the U.S. Maternal and Child Health Bureau.

State Working Forums

       During the outreach phase of the project, we presented report findings to carefully targeted audiences through appearances at conferences sponsored by other national organizations and by our own series of French-American Foundation State Working Forums, five of which had direct costs funded by a grant from the Nathan Cummings Foundation ($111,000). We held successful Forums in California, Connecticut, Florida, Illinois, Maryland, Massachusetts, and Texas.
          The format of the state working forums was developed to encourage collaboration among state and local agencies, officials, and key decision-makers, particularly with regard to serving high-risk populations. States were chosen for this series of events according to criteria of population diversity, useful partnerships and need for improved services. The events generated considerable impact on state public policy and practice, as we sought to foster and enable a broad process, resulting in recommendations, actions and community mandates for improved children’s health care services that reflect a vision for the future – and that set the agenda for change.
     Press coverage of the PMI project included articles published in The International Herald Tribune, The Sun, Le Quotidien du Médécin, and in regional papers such as The Chicago Sun-Times, The Hartford Courant, and The San Antonio Express News.
 

“The Right Thing to Do For All Children”

      Following his experience on the Foundation study tour, Dr. Robert Ross (Director for Health Services, San Diego, California) said, “The PMI not only works well in France, it is the right thing to do for all children.” In reviewing our work, Dr. Deborah Prothrow-Stith, Harvard School of Public Health, said, “I found it [French-American Foundation report on maternal and child health] informative, perceptive and engaging. This report should be required reading for those in policy positions, politicians, and public health officials.” Colorado Governor Roy Romer said after reading our MCH report, “The progress France has made on behalf of young children challenges the United States to think about and compare our method of providing for children's health to that of other countries.”
     Our objective was to examine how this education policy is applied to pre-kindergarten education in France, and to identify any lessons the French policy might offer for efforts to reform and improve early education in the United States for children at risk of school failure. The French-American Foundation organized an intensive study visit to examine priority education policy in May, 2002, and published a report entitled Equal from the Start: Promoting Educational Opportunity for all Preschool Children: Learning from the French Experience.

Sharing Lessons Learned from France

     In February, 2000, following the publication of Ready to Learn, the French-American Foundation launched a major outreach effort for its Early Education Project. Following the example of its past projects in early childhood policy, it initiated a program of working forums to highlight the French early education system in the context of United States practices. The audience for these events typically consisted of state and municipal officials and legislators, officials from state agencies and education departments, educators, children’s development specialists, members of the child care community, the media, business leaders, and other key decision-makers. The Foundation organized forums in Florida, Pennsylvania, Vermont, California, Arkansas, Illinois, and Washington State. The Foundation’s program director also participated in numerous seminars and conferences on early education sponsored, for example, by the Albert Shanker Institute, Columbia’s Institute for Child and Family Policy, the National Association for the Education of Young Children, the American Federation of Teachers, the Foundation for Child Development, the Education Commission of the States, and the Rockefeller Brothers Fund.
      Other outreach efforts have aimed more directly at lawmakers. The Foundation arranged a briefing in Washington, D.C. in May 2000 at which several study tour delegates spoke. Shanny Peer, program director, was asked to testify before the Senate Committee on Health, Education, Labor, and Pensions in a hearing in March 2001 entitled “Early Education and Child Care: How Does the U.S. Measure Up?” She also briefed a team of early education advisors to California Governor Gray Davis.