Moving towards measurable outcomes in maternal and child health

Yhenneko J. Taylor, MStat

State of the Science

Congress on Nursing Research

September 14, 2012

Acknowledgments

• Co-author– Mary A. Nies, PhD, RN

• Paper– Maternal and Child Health Journal

(Epub June 2012)

Overview

• MCH Issues• Study Objectives• Research Methods• Results of

Evaluation Studies• Conclusions &

Implications

Issues in maternal and child health

Healthy People 2020 Goal

Infant mortality 6.0 deaths per 1,000 live births

Early and adequate prenatal care

77.6% percent of pregnant women

Maternal mortality 11.4 deaths per 100,000 live births

Low birth weight 7.8% of live births

Preterm births 11.4% of live births

Preconception health

26.2% women taking folic acid

Strategies to address MCH issues

• Holistic approaches• Social determinants• Preconception care• Community building• Father involvement

Federal efforts around MCH Program Target BenefitHead Start

Children ≤5yo Education, medical, and dental

Healthy Start

Pregnant women and infants <2yo

Funds community projects to reduce infant mortality disparities

WIC Pregnant women and children <5yo

Supplemental food packages

Medicaid Pregnant women Prenatal, delivery, and postnatal care

Objectives

• Examine impact of programs that aim to improve the health of mothers and children under age five

• Focus on health status and healthcare outcomes

• Identify gaps in knowledge

Methods for literature review

• Searched Medline, Academic Search Premier, CINAHL and PsycInfo

• Inclusion criteria:

– Published during 2006 to 2011

– Assessed program impact on a health status or health care outcome

Four categories of studies

• Twenty peer-reviewed studies met inclusion criteria

Birth Outcomes

Breastfeeeding/Nutrition

Maternal Health

Unintended Pregnancy

0 2 4 6 8 10 12

11

4

3

2

Number of studies

Evaluations of birth outcomes

Measures• Infant mortality• Birth weight• Preterm birth• Small for gestational

age• Length of stay

Healthy Start• 5 studies• Mixed results

Medicaid• 4 studies• Lower LBW and PTB

WIC• 2 studies• Mixed results

Breastfeeding and nutrition

Measures• Breastfeeding

initiation• Food insecurity• Exclusive

breastfeeding

WIC (4 studies)

• Increased breastfeeding initiation

• Decreased food insecurity

• No change in exclusive breastfeeding

Maternal health outcomes

Measures• Depression• Family well-being• Length of hospital

stay

Head Start• 1 study• Reduced maternal

depression

Medicaid• 1 study• Decreased LOS for

disadvantaged women

Healthy Start• 1 study• No change in depression

Unintended pregnancy

Measures• Unintended

pregnancy rates• Cost savings

Medicaid Demonstrations• 2 studies

• $2.76 to $4.02 saved per Medicaid dollar

• 24% fewer unintended pregnancies

Limitations

• Findings from peer-reviewed studies only

• Variations in study quality

• Included only recent studies

Conclusions

• Large focus on infant and child health in comparison to maternal health

• Studies are local and utilize large computerized databases

• Variation in methodological rigor

• Program benefits may vary by location and setting

Implications for Practice

• Further research to increase our understanding of what works and help target resources

• More well-planned evaluation studies are needed

• Program data can help identify benefits for maternal health

Thank You

Yhenneko Taylor

ytaylor5@uncc.edu