By Janice M. Smiley, MSN, RN
Director, State Perinatal Program, Bureau of Family Health Services, Alabama Department of Public Health
The Alabama Department of Public Health, State Perinatal Program (SPP) provides and initiates activities to strengthen the perinatal health care system throughout the state. Provider education is one initiative the program utilizes to enhance perinatal health. The program provides outreach education for physicians and their office staff with the support of the March of Dimes. One-hour continuing education sessions are available to family physicians, obstetricians and pediatricians and their staff on varied topics, including:
- the importance of preconception healthcare counseling to all women of childbearing age;
- smoking cessation-counseling training targeting pregnant women and families of infants;
- importance of folic acid supplementation for all women of childbearing age;
- importance of optimal weight prior to pregnancy;
- substance abuse patient education;
- safe sleep for infants; and
- the importance of breastfeeding promotion.
These educational programs have proven to be beneficial to the providers and the recipients of perinatal health care in Alabama.
By Mary Jo Chippendale, MS, PHN
Family and Women's Health Supervisor, Division of Community and Family Health, Maternal and Child Health, Minnesota Department of Health
Minnesota has one of the nation’s lowest infant mortality rates for the overall population (4.8 deaths per 1,000 live births for 2003-2005). The rate masks racial and ethnic disparities in infant mortality for African American and American Indian families whose infant mortality rates are 8.7 and 8.6, respectively, for the same period. Eliminating disparities in birth outcomes is a state priority identified by our 2005 MCH Needs Assessment. We see promoting culturally specific pre and interconceptional care to populations of color and American Indians as an important strategy to reduce disparities.
Since 2006, Minnesota’s MCH staff has been actively promoting preconception/interconception health to improve birth outcomes and promote women’s health. Recognizing the need to work across many disciplines, the preconception planning group includes representatives from the March of Dimes, University of Minnesota, health care systems, local public health, the Medicaid program, and Healthy Start project. The challenge of integrating pre and interconception care into practice involves changing consumer knowledge and behaviors, clinical practice, public health programs and health care financing.
One strategic approach has been holding annual professional education conferences. The planning for the November 2008 conference began with a Diversity Round Table Structured Discussion with professionals representing and working with populations of color and American Indians. Their guidance regarding how different populations view preconception care, child spacing and other preventive health measures provided valuable input for the 2008 conference. The group described what culturally appropriate accessible care would look like, barriers within their communities, and suggested how to frame preconception care messages. Their ideas are included as presentations for the Second Annual Preconception Conference: Reaching Diverse Communities. We anticipate 200-300 attendees and to make important progress toward our goals of improving birth outcomes and women’s health, and reducing disparities.
By Juanita Graham, MSN RN
Health Services Chief Nurse, Mississippi State Department of Health
The Mississippi State Department of Health continues to rank infant mortality as the Agency’s highest priority. Mississippi has experienced little change in infant mortality over the past decade. The 2007 infant mortality rate was 10.1 per 1,000 live births. This rate is slightly lower than the two prior years but there continues to be a high proportion of infant deaths related to low birthweight and premature birth. Among 2007 infant deaths, approximately 66% were low birthweight (<2,500g) or very low birthweight (<1,500g) (Figure 1) and more than 56% were born premature (<37 weeks gestation) (Figure 2).
Having identified low birthweight and prematurity as key contributors to Mississippi infant mortality, new funding has been acquired and new programs are being implemented to address maternal and infant health. In 2006, Health Services began to assess the relationship between maternal health and birth outcomes among Mississippi women.
Modeling after a program among high risk Georgia mothers (Dunlop et al, 2007), two projects were devised to work with women at risk for delivering a very low birthweight infant in Mississippi. The Metropolitan Infant Mortality Elimination (MIME) project is being implemented in the Jackson metropolitan area and the Delta Infant Mortality Elimination (DIME) project is being implemented in 18 Mississippi Delta counties. Combined, the DIME and MIME projects give varying perspectives – urban and rural -- of implementing interpregnancy care in Mississippi. Primarily, the projects seek to increase access to medical homes thus enhancing access to women’s preventive healthcare and chronic disease management. Outreach and educational services will be provided at individual, community, and professional education levels.
Spaces of Hope in Harlem
By Julius Dasmariñas
Evaluation Director, Central Harlem Healthy Start, Northern Manhattan Perinatal Partnership
Spaces created for human use and consumption known as the built environment can have debilitating impact on the health of marginal and vulnerable populations. In low-income neighborhoods where parks and sidewalks are unsafe, groceries lack healthier food options, and housing is decrepit, residents are observed to suffer more from obesity, depression, violent behavior, and poor birth outcomes. Add racism into the mix and the consequences could be worse. Poor birth outcomes for many African Americans, for instance, have been related to maternal stress and depression caused by life-long exposure to racial prejudice and discrimination and, to a certain extent, its translation in physical, social, economic and service milieus.
In Harlem, however, significant gains have been achieved in improving the health of mothers and their infants through interventions that dually address individual needs and structural reforms in the built environment.
Through clinical and group education intervention of the Northern Manhattan Perinatal Partnership (NMPP), a not-for-profit organization, and its Central Harlem Healthy Start Program, over 9,500 women and their children have been linked and maintained in care. Since the program’s inception in 1990 when the infant mortality rate (IMR) was 27.7 infant deaths per 1,000 live births, the IMR in Central Harlem has plummeted to 5.2 infant deaths per 1,000 live births in 2004, much better than the national IMR of 6.78; from 2001 to 2007 on average, there had been less than 10 infant deaths per 1,000 live births within the community.
The agency also actively advocated for reforms in urban services that directly affect the health of its target population. NMPP embarked on a campaign to reduce the number of bus depots in the Harlem community because of the established correlation between the type of air quality and diesel engine fumes emitted by buses with low birth weight. It likewise supported the building of supermarkets that provide healthier foods to its constituents while ensuring that the bid of the New York City government to construct 165,000 affordable housing is realized. A number of its Healthy Start consumers have availed of the over 82,000 units that had been built so far and are now raising their families in a decent and secure environment.
To sustain their family’s economic and physical well-being, NMPP introduced a job readiness program that had placed over 890 women in full-time and part-time employment. At the policy level, it supported the empowerment-zone legislation initiated over a decade ago which infused Harlem with up to $300 million in block grants for community revitalization and job-creation projects. With the advent of gentrification and its social and economic cost on poor and working class residents, NMPP coalesced with like-minded groups to put pressure on local public leaders and private sector representatives to increase the growth of affordable housing and help boost the business acumen of local vendors so they could compete with larger stores that have settled on 125th street.
‘Taking care of one’s space’ is something that NMPP instills among its consumers and partners. Whether it is through group work where mothers express their personal troubles and understand the societal basis of their predicament as they learn to deploy effective strategies for managing their pregnancy, or through the agency’s advocacy of equitable urban policies that mediate the built environment, the charge of the agency is as clear as ever. NMPP remains determined and hopeful to establish a healthy community for mothers and children in Harlem one space at a time.