Reducing Racial Disparities in Poor Birth Outcomes: A Review of 3 Strategies

1. Reducing Racial Disparities in Poor Birth Outcomes:A Review of 3 Strategies Janelle Wells, MD MPH Candidate ‘09

2. Overview • Background • Description of Projects • Evidence-Based Prenatal Care • Social-Marketing • Program Planning • Results • Conclusions • Acknowledgments

3. Background and Definitions Infant Mortality: Death occurring before age 1 Poor Birth Outcomes: Factors that increase risk of infant mortality Racial Disparities: Differences in health outcomes between racial groups that cannot be explained by other risk factors

4. Background: Infant Mortality

5. Infant Mortality by Country

6. Background: The Life-Course Perspective on Racial Disparities Good Birth Outcome White Reproductive Outcome Poor Nutrition Stress Abuse Tobacco, Alcohol, Drugs Poverty Lack of Access to Health Care Exposure to Toxins African American Poor Birth Outcome Puberty Age 0 5 Lu, 2003

7. Background: The Life Course Perspective on Racial Disparities White Reproductive Outcome Primary Care for Children Early Intervention Prenatal Care Internatal Care Primary Care for Women Poor Birth Outcome Puberty Pregnancy 0 5 Lu, 2003

8. Background: What’s being done? Wisconsin’s Framework for Action to Eliminate Racial and Ethnic Disparities in Birth Outcomes

9. Project 1: Evidence-Based Practices • Workgroup Charge: Explore medical and non-medical interventions that have the potential to reduce disparities in birth outcomes • 27 Topics reviewed • Methodology: • Systematic methodology utilizing: • Evidence-Based Public Health Portal, (via Ebling Library website) • Primary research specific to African-American pregnant women

10. Project 1: EBPW Topics Anemia Alcohol and Other Drug Use Bacterial Vaginosis Breastfeeding Chronic Diseases Community Health Worker / Doula / Home Visitor Domestic Violence Fatherhood Gestational Diabetes Mellitus Group B Beta Strep Health Literacy / Patient Education HIV Hypertension of Pregnancy Immunizations Interpregnancy Interval Malnutrition / Underweight Mental Health / Depression Oral health Preconception / Interconception Health Preterm Labor Awareness and Fetal Movement Recognition 17 alpha-hydroxyprogesterone (17-P) for Previous Preterm Birth Racism Sexually Transmitted Infections SUID/SIDS Substance Abuse Tobacco Unintended Pregnancy Urinary Tract Infections

11. Project 1: Results • Hypertensive Disorders of Pregnancy Recommendations • Increase screening for risk factors • Increase dietary supplementation with calcium • Aspirin should be used to prevent women at “high risk” • Health Literacy Recommendations • CenteringPregnancy should be provided and available to all pregnant women • Sexually Transmitted Infections Recommendations • Women should receive two screens for most STIs during the first and second half of the pregnancy • Increase recognition and treatment of STIs before pregnancy

12. Project 2: Program Planning • Site: MLK Heritage Health Center • Program Goal: Improve the health and well-being of pregnant and parenting African-American adolescents and their children • Planning Method: Logic Model • Program Components: CenteringPregnancy, CenteringParenting, SiHLE, Be Proud! Be Responsible! • Results: Submitted to United Way Healthy Girls

13. OUTCOMES Short Medium Long-term OUTPUTS Activities Reach INPUTS Increase self-efficacy for condom use Hire and Train Educators 1 CNM 1 MSW 3 FPs 4-5 Big Sisters 12 Health Educators 6 Peer Educators Space Funding Training Increase use of contraception At-Risk African-American Adolescents Increase knowledge of contraception Run 6 Sessions of SiHLE and Be Proud! Be Responsible! ↓ repeat pregnancy ↓ infant mortality ↓ abuse ↑ child and teen well-being Increase parenting skills Tailor topics for age & culture Increase recognition of developmental delay First-Time Pregnant & Parenting Black Adolescents Increase breastfeeding rates Pilot Group Visits Increase knowledge of child care Increased social support Pilot Big Sister Home Visits ↑ Adequacy of PNC Staff Hired Participants recruited Pre-Post Intervention Surveys Staff Trained Staff Meetings Attendance Rates Program Funded Pregnancy Rates Curriculum Developed Infant Mortality Rates EVALUATION

14. Project 3: Social Marketing • ABC’s for Healthy Families • Federally-funded social marketing grant to increase awareness of the life-course perspective • Aspects of Evaluation • Pre- Post-Intervention evaluation • General Public Survey • Target Audience: Providers, General Public, Social Programs

15. Future Implications • Evidence-Based Practices Workgroup: • More research, specific to African-Americans, is needed • Dissemination plan needs to be developed • Program Planning: • Funding sources are being identified • Evaluation will be needed • Social Marketing Grant: • Message development is currently underway

16. Conclusions • Evidence Based Practices • Provision of quality health care across a woman’s life-course is needed to improve birth outcomes • Social determinants of health have a greater impact on reproductive outcomes than health care • Social Marketing • Evaluation is an important part of public health and must be planned prior to the implementation of any public program • Program Planning • Successful clinic-based interventions requires significant planning time • Logic models are a helpful tool to organize programs

17. Conclusions • Racial disparities in birth outcomes are the result of multiple factors across a woman’s life-course • Preconception and interconception care are extremely important to improving birth outcomes, and may even be more important than prenatal care • Close collaboration and strong communication between the state and local health departments, clinics, and social programs will be required for success

18. Acknowledgments • Murray Katcher, MD, PhD • Patrice Onheiber MPA • Angie Rohan, PhD • Jill Denson, MSW • Byron Crouse, MD • Lorraine Lathen • WI Department of Health Services • MLK Heritage Health Center