OverviewBackgroundDescription of Projects

Evidence-Based Prenatal CareSocial-MarketingProgram Planning

ResultsConclusionsAcknowledgments

Background and DefinitionsInfant 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

Background: Infant Mortality

Infant Mortality by Country

Rank Country

IMR Rate Rank Country

IMR Rate

12Macau S.A.R. 4.39 67 Bahrain

17.91

13 Switzerland 4.43 68 Jordan18.1

1

14 Spain 4.48 69 Malaysia18.3

5

15 Slovenia 4.5 WI Black 19.2

  WI White 4.5 70 Qatar19.3

2

16 Denmark 4.63 71 Georgia19.3

4

Poor NutritionStressAbuseTobacco, Alcohol, DrugsPovertyLack of Access to Health CareExposure to Toxins

Poor Birth Outcome

0 5Puberty

Age

White

AfricanAmerican

Lu, 2003

Good Birth Outcome

Background: The Life-Course Perspective on Racial Disparities

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Background: The Life Course Perspective on Racial Disparities

Prenatal Care

Poor Birth Outcome

0 5

Internatal Care

Primary Care for Women

Early Intervention

Primary Care for Children

White

Lu, 2003

Rep

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Puberty Pregnancy

Wisconsin’s Framework for Actionto Eliminate Racial and

Ethnic Disparities in Birth Outcomes

Background: What’s being done?

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

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

Project 1: ResultsHypertensive Disorders of Pregnancy

RecommendationsIncrease screening for risk factorsIncrease dietary supplementation with calciumAspirin should be used to prevent women at “high risk”

Health Literacy RecommendationsCenteringPregnancy should be provided and available to

all pregnant womenSexually 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

Project 2: Program PlanningSite: 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

1 CNM 1 MSW 3 FPs 4-5 Big Sisters 12 Health Educators6 Peer EducatorsSpace FundingTraining

Hire and Train Educators

Tailor topics for age & culture

At-Risk African-American Adolescents

Run 6 Sessions of SiHLE and Be Proud! Be Responsible!

First-Time Pregnant & Parenting Black Adolescents

Increase self-efficacy for condom use

INPUTS

OUTPUTSActivities Reach

OUTCOMES Short Medium Long-term

Pilot Group Visits

Pilot Big Sister Home Visits

Increase breastfeeding rates

Increase knowledge of child care

Increase recognition of developmental delay

Increase knowledge of contraception

↑ Adequacy of PNC

Staff Hired Participants recruited Pre-Post Intervention SurveysStaff Trained Staff MeetingsAttendance RatesProgram Funded Pregnancy RatesCurriculum Developed Infant Mortality Rates

Increase parenting skills

Increase use of contraception ↓ repeat

pregnancy

↓ infant mortality

↓ abuse

↑ child and teen well-being

Increased social support

EVALUATION

Project 3: Social MarketingABC’s for Healthy Families

Federally-funded social marketing grant to increase awareness of the life-course perspective

Aspects of EvaluationPre- Post-Intervention evaluationGeneral Public SurveyTarget Audience: Providers, General Public,

Social Programs

Future ImplicationsEvidence-Based Practices Workgroup:

More research, specific to African-Americans, is needed

Dissemination plan needs to be developed

Program Planning:Funding sources are being identifiedEvaluation will be needed

Social Marketing Grant:Message development is currently underway

ConclusionsEvidence 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 MarketingEvaluation is an important part of public health and

must be planned prior to the implementation of any public program

Program PlanningSuccessful clinic-based interventions requires

significant planning timeLogic models are a helpful tool to organize programs

ConclusionsRacial 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

AcknowledgmentsMurray Katcher, MD, PhDPatrice Onheiber MPAAngie Rohan, PhDJill Denson, MSWByron Crouse, MDLorraine LathenWI Department of Health ServicesMLK Heritage Health Center