Initiative Team Reduction of Infant Mortality Ensuring a Healthy Future for Women and Their Families

Initiative to Reduce Infant Tools to Prevent Infant Mortality -Prince George’s County... Factors contributing to Maryland high infant mortalityrate are multiple, complex and include: a h

Funded by Communities IMPACT Diabetes Center

-Mount Sinai School of Medicine

Acknowledgments

Communities IMPACT Diabetes Center - Mount Sinai School of

Medicine

Michele Johnson

Marcela Campoli, BA, MHA, PhD Candidate

Maryland Center Bowie State University

Health Resources Commission Maryland Community

Department of Health and Mental Health, Minority Health and

Disparities, Children and Material Services

Judy Hoyer Center

Hospital Center Prince George's County

Initiative to Reduce Infant

Tools to Prevent Infant Mortality

-Prince George’s County

that are disproportionately affected by social inequalities and health.

"Bright Beginnings" seeks to address the adverse pregnancy outcomes such as infant mortality, low birth weight and other complications during pregnancy The overall objective is to reduce the negative outcomes in pregnancies of low-income

women of Prince George and the consequences for their newborns.

" Securing a healthy future for women and their

families"

Fact Sheet

Stress during Pregnancy

• Very high levels of stress may contribute to an increased risk of premature delivery

• Low birth weight babies

• Overly high stress levels can increase your heart rate.

• Overly high stress levels can increase your blood pressure.

• Produce chronic anxiety.

• Produce certain hormones that can perhaps cause

miscarriage and that very likely can bring on preterm labor.

• Unpleasant feelings.

• Episodes of depression

• Racism throughout their lifetime

• Affect a woman’s behavior reacting to stress by smoking cigarettes , drinking alcohol or taking illicit drugs

Helpful Tips

How to Manage Stress during Pregnancy

 Eat a healthy, well balanced diet The more junk food you eat the more stressed your body will be.

 Get plenty of sleep The less sleep you get the more stressed you are likely to

be If you find you are having trouble sleeping invest in a comfortable body pillow You may find it helpful to take a relaxing bath before bed Also avoid eating up to one hour before bed to prevent heartburn, which can disrupt your sleep and increase your level of stress

 Exercise regularly It will also leave you feeling more energetic and ready to tackle the day's challenges Exercise can also help ease labor and alleviate some of the anxiety associated with the upcoming labor and delivery

 Try some natural stress reduction techniques including biofeedback, yoga or meditation These non conventional methods will help you focus, identify stressors and release stress in a healthy, safe and energy producing manner

 Talk regularly with your partner, friend or health provider They may be able

to help you work through your anxiety and help comfort you in times of high stress By communicating regularly and openly with others/partner you are bound to feel more prepared to deal with the challenges each day will bring.

 Reduce your workload If you find you are doing too much in a day find ways

to delegate certain tasks to others Carrying a baby for nine months is a lot of work You should expect that those around you will be willing to take on more responsibility to help you out in your time of need

FACT SHEET FOR SIDS -Sudden Infant Death Syndrome

1. Tummy (prone) or side sleeping

Infants who are put to sleep on their tummy or side are more likely to

die from SIDS than infants who sleep on their backs.

2. Soft sleep surfaces-

Sleeping on a waterbed, couch, sofa, or pillows, or sleeping with

stuffed toys has been associated with an increased risk for SIDS.

3. Loose Bedding-

Sleeping with pillows, loose bedding such as comforters, quilts, and

blankets increases and infant's risk for SIDS.

4. Overheating-

Infants who over heat because they are Overdressed, have too many

blankets on, or are in a room that is too hot are at a higher risk of SIDS.

5. Smoking-

Infants born to mothers who smoke during pregnancy are at increased

risk of SIDS Also infants exposed to smoke at home or at daycare are

more likely to die from SIDS.

6. Bed sharing-

Sharing a bed with anyone other than the parents or caregivers and

with people who smoke or are under the influence of alcohol or drugs,

increases an infant's risk for SIDS The safest place for an infant to sleep

is in their own crib or other separate safe sleep surface next to the

parent or caregiver's bed.

7. Preterm and low birth weight infants-

Infants born premature or low birth weight are more likely to die from

Executive Summary

Maryland progress in reducing infant mortality has stalled in recent yearsand a comprehensive, multi-faceted plan is needed to reduce its infantmortality rate by 10% by 2012 (Maryland Department of Health andMental Hygiene) Factors contributing to Maryland high infant mortalityrate are multiple, complex and include: a high percentage of unintendedpregnancies (including a recent rise in the teen birth rate), a worseningearly prenatal care rate, and an unacceptable high racial disparity in birthoutcomes

The decline in the overall infant mortality rate (IMR) in the state of Maryland was due to a20.6% decline in the white infant mortality rate, which fell from 5.2 per 1,000 live births in 2008

to 4.1 per 1,000 live births in 2009 Although the 2009 white infant mortality fell to its lowestrecorded rate in 2009, the African American infant mortality rate increased from 123.4 in 2008 to13.6 in 2009 The IMR was 3.2 per 1,000 live births among Asians and 3.1 per 1,000 live birthsamong Hispanics

Access to Wholistic and Productive Living Institute Inc., seeks to address these disparities

through its Bright Beginnings of Prince George’s County; Infant Mortality Reduction

Initiative The overall goal of the initiative is to address significant disparities in perinatal health

and barriers to health care confronting minority populations residing in Prince George’s CountyMaryland

Prior to the inception of the program, it was clear that in order to reduce infant mortality in thecounty all sectors of care must work together in harmony, devotion and with consistency toaddress the social determinants of infant mortality which contributes to infant mortality in PGC.Only as a team, can we create and sustain a model program for Prince George’s County and thestate of Maryland which we aim to replicate throughout Maryland

Background

Infant mortality is a public health challenge in Prince George’s County, Maryland and the UnitedStates (with an infant mortality rate of 6.8 deaths/1,000 live births) ranks 30th among developednations and Maryland (rate of 8.0/1,000) ranks 39th among states in infant mortality Althoughthere has been a 32% reduction in Maryland’s infant mortality rate over the past 25 years,progress has stalled this decade Despite the large decline in infant deaths in 2009, infantmortality rates (IMR) have fallen only slightly in Maryland over the past decade The rate fellfrom an average of 7.9 per 1,000 live births in the years 2000-2004 to an average of 7.7 in theyears of 2005-2009, a 3.1% decline

Prince George’s County (PGC) leads the state of Maryland in numerous adverse pregnancyoutcomes, including infant mortality, low birth weight, and very low birth weight Womenresiding in Prince George’s County are more likely to receive late or no prenatal care Women ofcolor are disproportionately represented in these statistics

Causes of Infant Mortality

The leading causes of infant mortality are preterm/low birth weight births, congenitalabnormalities, and sudden infant death syndrome (SIDS) Preterm/low birth weight births areassociated with 2/3 of all infant deaths Overall, the infant mortality rate for very low birthweight infants (those with birth weights of less than 1,500 grams or 31/2 pounds) is 240/1,000,more than 100 times the mortality rate for normal birth weight infants

Risks Factors for Infant Mortality

Risk factors for infant mortality are multiple and include behavioral and environmental risks,health care risks, and socio-demographic risks (MDHMH) Behavioral risks such as unintendedpregnancy increase neonatal mortality more than two-fold Healthcare risks such as late prenatalcare increases infant mortality more than 40% Socio-demographic risks involving age,education and income are also associated with increased infant mortality However, thecomplexity of infant mortality is reflected by the fact that racial disparities in infant mortalitycannot be explained by socio-economic factors alone (MDHMH) For example, college educatedBack women have worse pregnancy outcomes than women of other races/ethnicities (White,Hispanic, and Asian) with less than an 8th grade education

Cost

The economic costs of preterm low-birth-weight births leading to infant mortality are high Verylow birth weight infants require neonatal intensive care unit (NICU) care with daily costsexceeding $3,500 per infant and total costs which can exceed $1 million for a prolonged stay.Beyond NICU costs are the extraordinary costs of managing the medical, educational and socialneeds of low birth weight infants Caring for the special healthcare needs of children who maydevelop neurological sequelae or chronic diseases can drain a family financially, physically andemotionally

Governor O’Malley’s 15 Strategic Policy Goals

Reduce Infant Mortality in Maryland by 10% by 2012

Governor O’Malley’s 15 Strategic Policy Goals

To ensure the health and well being of Maryland’s infants, the O’Malley-Brown Administrationhas set a goal and is implementing a plan to reduce infant mortality in Maryland by 10% by

2012 In 2007, Maryland’s number of infant deaths was 622 and its IMR was 8.0/1,000 By theend of 2012, Maryland aims to have 60 fewer infant deaths, resulting in an IMR of 7.2/1,000,which would be Maryland’s lowest recorded IMR in Maryland’s history

Progress to Date

The 10% reduction in infant mortality goal was achieved in 2010 (100% goal attainment) However, the rate for the African-American population increased, reaffirming the need for thetargeted strategies that DHMH and partner agencies are pursuing

During Pregnancy - Earlier Entry into Prenatal Care

• Process applications for pregnant women in a more quickly For example, FamilyInvestment Aides within local Departments of Social Services (funded by ARRA) willscreen all applications for services for pregnant women so they can be prioritized andprocessed in a timely manner In addition, the Medicaid-only application will be changed

to instruct all pregnant women to submit their applications to the local health departmentfor processing in 10 days

• Monitor department performance of eligibility determinations for pregnant women toensure 10 day requirement

• Send a letter to all prenatal providers encouraging uninsured pregnant women to apply

for Medicaid

• Train substance abuse and mental health providers concerning Medicaid eligibility and

services for pregnant women

After Pregnancy - More Comprehensive Follow up Care

• Increase the number of Medicaid women of childbearing age receiving Family Planningservices

• Increase the number of Medicaid postpartum women receiving follow-up services

• Increase the number of hospitals that have adopted standardized discharge protocols andplan

Delivering Results

• Launched Comprehensive Women’s Health Centers to expand the services of familyplanning clinics, serving over 500 women per month in Baltimore City, Prince George’sCounty, and Somerset County

• Developed protocols to ensure that pregnant women applying for Medicaid receiveprenatal care as early as possible, serving over 550 women in the first three months of thenew protocols

• Funded Perinatal Navigators to assist at-risk women in navigating through the prenataland perinatal care systems to insure infant and maternal health

Progress toward delivery is monitored by the GDU, and assessed regularly at agency and agency Stat meetings

cross-Overview of the Bright Beginnings of Prince George’s County Infant Mortality

Reduction Initiative

The Bright Beginnings of Prince George’s County is an initiative implemented by Access to Wholistic and

Productive Living Institute, Inc., (AWPLI) (an Access Services Community Health Resource) seeks to address adverse pregnancy outcomes, including infant mortality, low birth weight, and very low birth

weight in Prince George’s County Maryland The overall goal of Bright Beginnings is to reduce poor

pregnancy outcomes (low birth weight, infant mortality, maternal pregnancy complications, etc.) among low income pregnant women living in Prince George’s County

The specific objectives of Bright Beginnings include: (1) By June 30, 2012 provide case management

services to 300 women (100 women annually); (2) Annually, identify 30 women who did not know they

were pregnant and link them to prenatal care; (3) Annually provide smoking cessation services to 20 pregnant women; (4) Annually, provide health education (e.g parenting skills, nutrition, SIDS prevention, stress management, etc.) to 100 pregnant women; and (5) Annually link 100 pregnant/post partum women

to medical homes for primary care (prenatal/postpartum and well child care).

Specific program services delivered by Access Institute and its partners will include linking clients to appropriate prenatal and post-partum services through referrals (e.g WIC, Medicaid, health care etc.), providing health education for risk reduction and prevention, ensuring infants receive well child checks-

up, and providing pregnancy registration campaigns to identify women who may not know that they are pregnant to ensure that they are linked to prenatal care early Direct health care services will be delivered

by community partners such as Greater Baden Medical Systems, Dimension Healthcare Systems, Prince George’s Social Service and the Prince George’s County Health Department Project services will cover the pregnancy and early post partum phases for women and infants living in the target area.

These intensive outreach and case management services will produce the following improved outcomes

by the end of the three year period (June 2012):

• reduce the proportion of women enrolled prenatally in case management who deliverLBW infants;

• reduce the proportion of women enrolled prenatally in case management who deliverLBW infants;

• increase the proportion of women enrolled prenatally in case management who enterprenatal care in the first trimester;

• increase the proportion of women enrolled prenatally in case management who arelinked to a primary care provider (medical home);

• increase the proportion of infant whose mothers are enrolled prenatally in casemanagement who are linked to a primary care provider (medical home) and receiveappropriate well child visits; and

• increase the proportion of women enrolled prenatally in case management who arescreened for risks and linked to appropriate wraparound services (e.g WIC,Medicaid, housing etc.)