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November 19, 2013
Summary of theMaternal and Child Health Community Systems
Assessment Report for the Winnebago County, Illinois
Maternal, Infant and Early Childhood Home Visiting (MIECHV) Project
Contributors
Martin MacDowell, Dr.P.H., M.S., M.B.A.1 Matthew Dalstrom, Ph.D.3 Vicki Weidenbacher-Hoper, M.S.W1
Dana Evans, M.S.1 Charaine Boyd, M.O.L.2 Ms. Karen Lytwyn, M.P.H.2_______________________________________
1National Center for Rural Health ProfessionsUniversity of Illinois Health Science Center at Rockford1601 Parkview AvenueRockford, IL 61107
2Winnebago County Health Department401 Division StreetRockford, IL 61110
3Rockford University5050 E State StreetRockford, IL 61108
The purpose of this report is to provide an initial summary assessment of factors influencing Maternal and Child Health (preconception through age 5 in Winnebago County, IL )*. This assessment is not designed to incorporate all possible sources of information. The report does seek to make use of a variety of data sources including interviews with key informants, knowledgeable in maternal and child health issues in Winnebago County.
It is intended that the results of this assessment will be helpful in developing a strategic plan that will lead to actions, improving a wide range of MCH outcomes in the County. You are encouraged to review the full reports which provide additional and more detailed information.
*for purposes of this project
Many factors contribute to the short, and long-term health of a community’s moms, babies, and children. The first step is to identify factors that affect Maternal and Child Health as well as the availability of community resources. These factors include:
Unintended pregnancies Low birth weight, and pre-term
births Health behaviors
Socio-economic factors Availability, and access to
health services Cultural and educational
A diagram of the major categories of pediatric health outcomes below indicates the range of outcomes that can occur after birth.
Infant mortality is tragic for the family, and society, but the social, economic, and family impacts can be major for: Level 2 (children with a major and permanent disabilities):
Can take place over the child’s lifetime.
AND
Level 3 (neonatal intensive care use): For a normal full-term average baby, the cost of care is $2,830 vs
$41,610 for a premature baby (in 2010).
The goal is for every child to be at the lowest level of risk in the levels shown; which is a totally healthy child without any socio-economic problems in the child’s home or neighborhood.
Unintended births are associated with:
Delayed prenatal care Smoking during pregnancy Not breastfeeding the baby Worse health status during childhood More problematic outcomes for the mother, and the mother-child relationship
In a 2001 study, 49% of pregnancies were unintended, of which 44% resulted inbirths. Thirty-seven (37%) of births in the US were unintended at the timeconception. The rate of unintended pregnancies among women whose incomewas below the federal poverty line was three (3) times that of women whoseincome was at least double the poverty level (Finer & Henshaw, 2006).
Unmarried black women, and women with less education or income aremuch more likely to experience unintended births compared with married,white, college-educated, and high income women (Mosher et al., 2012).
Mosher also found that unintended births occur disproportionately amongnon-hispanic black women, unmarried women, and women with less incomeand education.
Related to unintended pregnancy is preconception care. If pregnancy is unintended, more than likely preconception care is non-existence, lacking in scope, or minimal at best. The Center for Disease Control (CDC) has developed ten recommendations to improve preconception Health, and health care. The recommendations focus on:
-Changes in knowledge-Changes in clinical practices-Public health programs, health care financing and data and research activities (Johnson, et al., 2006)
One recommendation is to increase awareness of the importance of preconception health behaviors, and healthcare across the population spectrum. To accomplish this, new social marketing, and health promotion campaigns focusing on how to prepare for childbearing, and parenting are needed, as well as age-appropriate health education programs in the schools.
Specifically CDC’s Goals and Recommendations to Improve Preconceptual Health are: (Full details at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5506a1.htm)
Four Goals: Goal 1. Improve the knowledge and attitudes, and behaviors of men and women
related to preconception health.
Goal 2. Assure that all women of childbearing age in the United States receive preconception care services (i.e., evidence-based risk screening, health promotion, and interventions) that will enable them to enter pregnancy in optimal health.
Goal 3. Reduce risks indicated by a previous adverse pregnancy outcome through interventions during the interconception period, which can prevent or minimize health problems for a mother and her future children.
Goal 4. Reduce the disparities in adverse pregnancy outcomes.
Overall, socio-demographic factors have a larger effect on poor educational outcomes than birth related factors (Resnick et al, 1999)
Socio-economic determinants such as race, ethnicity, education, and income levels, environment, and health insurance status influence maternal health as well as pregnancy outcomes, and infant and child health.
Child health status varies by both race, and ethnicity, as well as by family income (Larson and Halfon, 2010) and related factors, including educational attainment among household members and health insurance coverage (Larson et al., 2008).
Consuming alcohol during pregnancy can harm the fetus, and may result in long-term medical problems like fetal alcohol syndrome in the child.
Health behaviors of the mother prior to pregnancy as well as during pregnancy affect birth outcomes, as well as infant and child health; in some cases, far into the future. Pre pregnancy health behaviors of the mother are influenced by a variety of environmental and social factors.
Environmental factors include: Access to health care, Chronic stress, Inadequate nutrition, Alcohol consumption, and Smoking by the mother
during pregnancy are among the known risk factor for psychological problems including ADD, and behavior problems in children as well as medical problems
The goal of Healthy People 2020 for pre-term births is 11.4%, 7.8% of LBW and 1.4% for VLBW. In 2011, 11.7% of all US births were born premature (<37wks) of which 8.1% were LBW (<5.5lbs) and 1.4% were VLBW (2lbs. 3oz).
Pre term low birth weight (LBW) (<5.5lbs) and very low birth weight (VLBW) (<3.3lbs) babies are at increased risk of infant mortality, and morbidity, developmental delays, and child maltreatment (Lee et al, 2009).
Pregnant women who are young, black, poor or a combination of those factors face a considerably higher risk of delivering LBW babies than other mothers (Lee et al, 2009).
Numerous studies have looked at home visiting as an intervention to improve pregnancy, and birth outcomes as well as provide education around infant/child development.
Home visiting has been shown to: Improve the quality of the home environment(Kendrick et al, 2000) Prevent child maltreatment (Bilukha, 2005) and decrease harsh parenting Improve cognition, and language development Reduce risk of LBW Improve weight-for-age in young children, and
Reduce child health problems (Peacock, et at., 2013)
What is not yet known and needs further research is the frequency of home visits needed, as well as the actual components or combination of components that makes home visiting successful as an intervention to improve MCH outcomes.
% completing HS or Equivalent by ZIP code, Winnebago County
% completing Bachelor’s Degree or Higher by Zip code, Winnebago County
16
% of Adults under 100% Federal Poverty Level (FPL) by ZIP Code, Winnebago County
17
0
20
40
60
80
100
120
140
160
Amer. Indianor AK Native
Asian orPacific Islander
Black White Total
LBW Rate per 1,000 live births
Low Birth Weight Rates by Race, IL and Winnebago County, 2007-10
IL rate
Winn. County Rate
Likewise, LBW rates (<5lbs) are also consistently higher for African-American infants in both Winnebago County, and Illinois as shown below.
Low Birth Weight Rates by Ethnicity, IL and Winnebago County, 2007-10
0
2
4
6
8
10
12
14
16
Non-Hispanic Black
Puerto Rican
Other Hispanic
Non-Hispanic other races
Mexican
Non-Hispanic White
Cuban
Central or South Mer.
Origin unknown
TOTAL
Low Birth Weight Rate per 100 live births (% )
Winn. County
Il l inois
% L B W by Mother's L evel of C ompleted E duc ation, Winnebag o C ounty, 1999-2009
10.4%
9.2%
8.2%
6.6%
8.8%
0%
2%
4%
6%
8%
10%
12%
L es s than HighS c hool
HS graduate orequivalent
S ome C ollege C ollege G raduate orhigher
A ll Winnebago C o.
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
Less than HS HS grad Some college College grador higher
Total
Low birth weight rate per 100 live births (%)
Completed Education Level
LBW rates (%) by Education and Race, Winnebago County Resident Births, 2005-2009
White
Black
Asian
All Races
n=18
n =15
n=71
n=6
% L B W by Z ip C ode, Winnebag o C ounty, IL 1999-2009
11.6%11.5%
9.9% 9.8% 9.8% 9.5%8.8% 8.7%
8.2% 8.1% 7.7%7.1% 6.8% 6.6% 6.5% 6.4% 6.2% 5.9%
3.8%
8.8%
0%
2%
4%
6%
8%
10%
12%
14%
61101 (NW of downtown)
61102 (S W of downtown)
61104
61079
61077
61103
61115
61109
61108
61107
61114
61111
61073
61080
61072
61063
61088
61016
61024 (D urand)
A ll Winn. C o.
2.6%
2.4%
2.3%
2.1%
1.9%1.8%
1.7% 1.6%1.6%
1.5%
1.4%1.2%
1.2%1.1% 1.0% 1.0% 1.0%
0.0% 0.0%
1.7%
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
% Very LBW by Zip code, 1999-2009, Winnebago County, IL
2.502.39
2.24 2.222.04 1.98 1.94
1.73 1.65 1.61 1.60 1.521.33 1.29
1.060.91
0.50
0.00
0.50
1.00
1.50
2.00
2.50
3.00
%
Infants Age 0 to 10 days with Mothers Residence Winnebago County, % of Admissions with Length of Stay 30 days or more at any Hospital in Illinois, 2003-2007 by ZIP code.
0.0
50.0
100.0
150.0
200.0
250.0
15-19 20-24 25-29 30-34 35-39 40-44
Average fertility rate per 1,000 women
Age Group
Estimated Average Annual Fertility rates per 1,000 Women by Age and Race, Winnebago County, 2005-2009
White
Black
Asian
Total all races
Notes: Hispanic can be of any race. Population estimates provided by US Census.
Of the twenty nine women interviewed, all ofthem are enrolled in WIC (Women Infant and Child) and havethe medical card. Their ages range from 18 to 38. They have from zero to six previous pregnancies, and fourteen of them are considered to high-risk. Information from the interviews can begrouped into four categories: Experiences with the medical system Adverse health behaviors Reasons for medical non-compliance, and Experience of becoming pregnant
During their pregnancy, women were asked if they had any negative experiences with the medical system.
Negative Experiences with the Medical System (N=29)
02468
1012141618
Theme Frequency
Time◦ Women often complained of the time that it took to
get an appointment, time they lost at work, time waiting in the doctor’s office, and travel time.
Delivery of Medical Information◦ Many of the women did not read the materials given
and felt that the information was rushed. Some also felt that the doctors assumed that they knew things that they didn’t. In addition, they believed that medical providers were giving them pamphlets because they did not have time to talk with them.
Limited Access◦ Only a few providers in town accept the medical card
and it is hard to identify them. Also there are limited medical options before one becomes pregnant.
◦ Because of their prior problems getting appointments at Crusader, some women assumed the wait time would be the same for prenatal care.
Transportation◦ Women mentioned that the medical services were
far away and the bus system did not take them where they wanted to go. Some were afraid of public transportation. Others mentioned the burden that asking for rides placed on their social network.
Patient/Provider Interaction◦ Women generally wanted to spend more time with
their doctor, but the visits often felt rushed and they felt like they were not able to ask all of their questions. Some also felt that they were not being listened to.
Using the Medical Card◦ About 1/3 of the women did not know how the
medical card worked (co-pays, providers, eligibility)◦ Some postponed care until they received a
temporary or permanent card because they were afraid to pay the cost of care.
As one women explained, “The Blue Cross Blue Shield is very easy to navigate. You get your book at
the beginning. You can request to have the provider books sent to you at any time. You can always go online to see if your doctor is in or out the network. All of that, it’s laid out. I still haven’t figured out this medical card. That’s what I got - I’m going to go online, that was plan, so I can find out how do I find out which doctors I can and cannot see, who is in and out of network, is there a listing. I have no clue….They just kind of throw the card to you [Laughter] and you’re out the door.”
Women enrolled in the longitudinal interviews were asked about their risky behavior during the first and second trimester.
Adverse Health Behaviors (N=14)
0
2
4
6
8
10
12
AlcoholConsumption
Poor Nutrition Lack of Exercise Exposure toCigaratte Smoke
SmokingMarijuana
Theme Frequency
0
5
10
15
20
25
30
Stress Limited SocialSupport
BiologicalFather
Medical Beliefs Housing FinancialSituation
Transportation
Theme Frequency
Women were also asked what prevented them from following medical advice.
Non-Compliance (N=29)
Stress◦ Almost all of the women mentioned that they were very stressed.
The stress that a woman has impacts her ability to focus on the pregnancy and has negative health effects.
Limited Social Support◦ Many of the women complained that they were all alone and had
to be responsible for everything. This made it difficult to care for children, make medical appointments, handle household activities, and have financial security. Furthermore many women complained that they did not have someone to talk to.
Father of the Baby◦ If the father is present and willing to help, he can assist with
transportation and help around the house. However, many are not present, and were described as “immature,” “childlike” and in the minds of the women required as much supervision as their other children.
Medical Beliefs: Can be divided into perceptions of the quality of care and the beliefs surrounding care.
Quality of Care“I went in with the medical card and it was even worse. It was like you’re looked at, unless you go to like a Crusader or a health department, it’s like you’re looked down on. You can tell – I don’t know how to describe it. It’s just a different feeling you get from the doctor and the nurses. You don’t feel cared for.”-(Pregnant woman)
Beliefs Surrounding Care Women have conflicting beliefs surrounding contraceptives and safe sex.
Many are distrustful of them and believe that there is a high instance of side effects. Also many do not know how to use them correctly.
Treatments/Medicines: Sometimes women do not believe that the medical advice that they are given is good. This is exacerbated when they get conflicting information from parents, friends, and when they do not have a strong relationship with their medical provider.
Medical beliefs also impacted women’s drug use.
For instance one women said that her friend, “Couldn’t drink anything and I mean this is well off into the pregnancy. She just – it was like shewas dying. Every time she got pregnant, she made the decision on her own to start smoking pot. And that was the only way she was able to eat. She started picking up weight and she felt better. She was like, “I feel bad for doing it.” She was like, “But this child is going to kill me.” Or the child is going to die because she couldn’t eat. She did start smoking the marijuana and she was fine and she has two children. She had to end up doing it with her second one as well.”
Housing: Women often mentioned that they had housing problems. This made it difficult to for caseworkers and medical providers to maintain contact contact with them or use the mail for communication. It also limited women’s control over the household and exposed them to cigarette and marijuana smoke.As one woman explained, “They smoke cigarettes [in the apartment]…But yeah I’m
actually tryin to find somewhere else to live cuz my daughters gonna be here in 3 months and I don’t want cigarette smoke and weed smoke [in the apartment]
Finances: Women also complained about the cost associated with medical care.
As one woman explained,◦ “For the medical, some people can’t afford a lot of their
medication and stuff, people who are struggling with their rent and stuff, at least give them like a little more time to get their appointments and stuff together. And to let people know what the medical covers or what doesn’t the medical cover. Give papers to let people know what changes are going to be made instead of people going to doctor’s appointments and then them ending up having to pay and don’t know it. And then they get stuck with the bill.”
Many of the women mentioned how little they know/knew about pregnancy and their body. In many cases women did not know that they were pregnant, delayed care and engaged in risky behavior. 79% of the pregnancies were unplanned and only one received care in the first 9 weeks. One woman did not receive care until 7 months.
Many women did not know that they were pregnant as in the following examples,◦ “I was really sick and woozy. I did not have medical, so I could not go to a clinic or
anything. I ended up having a pregnancy test there and they told me it came in positive, and they asked me did I want an ultrasound. I did not believe them, I was like, “I am not pregnant”. They gave me ultrasound about two weeks later, and they told me according to the ultrasound, measuring the baby’s head, three months pregnant. Yeah, so I was shocked.”
◦ “I was drinking a lot. By the time I did find out I was pregnant, I knew in the back of my mind it’s too late because I’ve done way too much and I got into my fourth month and that’s when I miscarried.”
Pregnancy Tests◦ Women went to Crusader Clinic, WCHD, RAPCC, and
the emergency room to confirm their pregnancy. Risky Behavior◦ In over half of the unplanned pregnancies, women
were engaged in risky behavior.◦ After finding out that they were pregnant, all but
one woman changed their behaviors.◦ In 83% of the planned pregnancies women were not
engaged in risky behavior.
Many of the women were also in a state of crisis when they found out they were pregnant, meaning that they had other pressing concerns aside from their pregnancy that impacted their ability to access and use prenatal services. One physician explained the situation,
“And regardless of their culture a lot of our patients are in a state of crisis. If you are borderline or are homeless, if you're a drug user or a drug pusher, or whatever…If you are in danger of being beat up or whatever, your pregnancy is not your first priority, you're just trying to survive.”
22.8% 22.1%18.4%
14.7% 12.5% 12.0% 9.8% 9.6% 9.0% 8.4% 8.3% 8.2% 7.3% 5.7% 5.5% 5.3% 5.2% 5.1% 3.9%
12.8%
57.5% 57.0%59.9%
57.3% 59.5% 59.1%
56.1% 55.7% 57.2%55.1%
75.0%
50.5% 51.1% 52.0%
42.7%46.1% 45.4%
48.9%47.4%
55.3%
13.1% 13.4% 14.6%
18.9% 19.0% 19.5%
12.2%
22.7% 23.7%24.2%
8.3%
25.8% 26.6% 25.4%
32.7%32.1%
30.0%
30.5%31.7%
20.9%
6.6% 7.5% 7.2% 9.1% 9.0% 9.4%
22.0%
12.0% 10.1% 12.4%8.3%
15.5% 14.9% 16.9% 19.2% 16.4%19.4%
15.5% 16.9%11.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Age 35+Age 30-34Age 20-29Age <20
During focus groups and interviews, medical providers and caseworkers discussed what they saw as barriers they face providing care. In total, 43 people were interviewed from 9 organizations.
For more details from provider interviews please refer to pages 28-34 of the report
0
1
2
3
4
5
6
Number of Organizations thatExpressed Theme
Location◦ For many women the location of medical services made
it difficult to access because it was far away, the bus took to long, or they had to ask for rides. “Probably the big thing I had when I was pregnant… I do not
have a way to get busses and stuff.” (postpartum mom) Some believed that the location on the east side of Rockford,
“wasn’t right because poor women need care too.” Finding a provider◦ Aside from Crusader Health Clinic, it was difficult for
women to find a provider who took the medical card, because they “didn’t know who to call.” Therefore, it took some women weeks to find a provider.
Lack of medical provider’s time and compassion◦ Women want someone to be compassionate, spend time with them, and
explain what is going on with their bodies. However in some situations, medical providers were not able to meet their needs.
◦ As one woman explained,“It’s like “Slow down.” Make sure your patients comprehend what you’re telling them and what needs to happen afterwards. A lot of people they can look in your eye and say yes, okay, but they don’t understand two words that have come out of your mouth. If you’re not connecting with that person, you won’t pickup on that. The connection is broken between the patient and the doctor. So I don’t know how that could be fixed but something needs to go on to help patients, to make sure they understand what’s going on with their healthcare. Writing a bunch of pamphlets and information, I’m telling you, nobody is reading them. So it needs to come in another form, if it’s nothing but making another appointment and maybe somebody that handles just that to make sure they’re understanding, they know exactly what’s going on.”
Sharing of Medical Information◦ About half of the women were high risk and had to see multiple
medical providers during their pregnancy, however some women felt, their doctors were not sharing information leading to consequences as duplicate tests, confusing diagnoses, and too many appointments. One woman mentioned that three doctors gave her three different due dates for her pregnancy.
Housing Insecurity◦ About half of the women moved at least once during their
pregnancy. Therefore it made it difficult for them to receive mail and the forms that they required for the medical card. “I was moving to different places, they were sending my medical - when
I finally got it in April, they were trying to send my medical card to me, and everyplace I went to they would say return to sender. My case worker told me that every time we send a card out to you, they are going to return it back saying “return to sender.” He said we did not know where you were at, we did not know where you live.”
1) Maternal and Newborn Health (106)2) Prevention of Child Abuse and Neglect (83)3) Improved School Readiness and Achievement (92)4) Reduction in Crime or Domestic Violence (77)5) Improvements in Family; Economic Self-sufficiency (310)
For purposes of local information, review, and data collections, three additional benchmarks were added:
6) Support agencies for at-risk children (133)7) Preconception Healthcare, (45) and8) Support agencies for Adolescent/Teens (121)
When women became pregnant, their social networks contracted, and they felt like they were doing it “alone.”◦ Many women needed emotional and financial support,
but few women knew where to go and what was offered.◦ In most situations they found out about services through
word of mouth. Caseworkers also provided information about
social services to women who went to Crusader and WCHD, but they complained that most of the services were reserved for first time mothers and women under 21.
When women received social services, it helped stabilize their lives by providing food, housing, parenting classes, and health care.
Home visitors were seen as very important because they provided medical and social service information along with emotional support.
As one women explained, [She] “Helped me with a lot of services like bus passes, information also
about shelters and food pantries. Just giving me stuff every month. Like Week 37 of pregnancy, she was bringing me papers about the pregnancy and about stuff like what I’m gonna go through, what’s the baby is growing and what’s the baby – her body’s doing and different stuff she was bringing me every month when she would visit me... She was there a lot for me. When I didn’t have no one to talk to me and she would give me advice and stuff about other stuff, too.”
1) Health was incorporated/embedded in Physical Education classes2) Districts used various portions of the Illinois Learning Standards, depending on grade levels
including: Acquire movement skills and understand concepts needed to engage in health-enhancing
physical activity (Goal19) Achieve & maintain a health-enhancing level of physical fitness based upon continual self-
assessment (Goal 20) Develop team-building skills by working with others through physical activity (Goal 21) Health Promotion, Prevention and Treatment (Goal 22- attached) Human Body Systems (Goal 23-attached), and Communications and Decision-Making (Goal 24 - attached)
3) Districts have the option of using Illinois School Board Education (ISBE) resources that support Physical Development /Health to supplement in creating/designing their own health curriculums. The resources are primarily web-sites such as National Campaign to Prevent Teen and Unplanned Pregnancy and the Resource Center for Adolescent Pregnancy Prevention.
4) Physical Education/Health was recently updated to include new mandates to the Illinois School Code that appear to be more reflective of MIECHV benchmarks.
Most schools have a school nurse, but at the Auburn Campus, Rockford Public Schools is opening a student health clinic that will provide a variety of health services to middle school and high school age teens.
The South Beloit school system also has school-based health clinics at the middle school and high school that will be staffed by UIC family medicine providers starting in January 2014.
Such clinics can provide access to acute and preventive medical as well as dental services. Because the providers can bill Medicaid or other health insurance coverage access to care can be enhanced in a way that is financially sustainable.
Medical providers frequently complained about the problems associated with health literacy.◦ As one OB/GYN explained, “I will have girls come in and they do not even understand parts of their
body. So we need to start, depending on where they are coming from with just teaching, what is going on in their body. And the whole entire visit is focused around education.”
Patients on the other hand, complained about the way that medical providers attempted to educate them about pregnancy.◦ One woman explained, “Like the first folder I got, oh my God, there are so many pamphlets in there.
You just get tired of looking at it and it’s like, I don’t even want to know. If the doctors wasn’t double booked, maybe they’d have the time in the room to tell me some of this information because even if it doesn’t come up, what if I come to a question, now I’m not in the room with you…Now, I don’t know - by the time the next appointment comes, you have pregnancy brain, at least I did, you probably forgot what it was you wanted to ask. It’s just like there’s has to be a better way to do this. I shouldn’t have to go home and play doctor.”
Another woman complained that brochures are not enough to help her,◦ “They always want to give you a brochure to read
up on. I don’t want a brochure. You’re the doctor. You know what’s going on. I would like you to explain it to me before I leave here. I don’t to leave here with any questions”
Because of their problems accessing information from their providers, women utilized many different sources.
Interviews were used to discover where women get their medical information from and also the relative importance of each source of information. To do this, women were asked to list all the places/people where they received healthcare information.
The premise behind this technique is that people will recall the most important sources of information first, and as they make their way down the list, the level of importance will decrease.
Sources of Information (N=22)
Item Percent (%) Salience – the higher the salience the more important
the source
Mom 62 0.47
Doctor 52 0.43
Friend 42 0.21
Maternalgrandmother
38 0.20
Sister 24 0.14
WIC 24 0.15
Doula 19 0.15
For a complete list see pp. 54-56 of the Interview Report
1) The community should be made aware that there are disparities in MCH outcomes that are impacting children, the schools, and the community in a variety of ways.
2) Women with health MCH disparities should be included in development of a strategic plan (they are a stakeholder in efforts to improve MCH outcomes). What are their view of whether unintended pregnancy is a concern for example? What do they think would improve their life situation and/or that of their child(ren)? Improve patient provider relationship through cultural awareness.
3) Efforts should be made to have primary care physicians take a preconception health approach to women of child bearing age (which is occurring as young as age 13.) This would include focusing on pregnancy being a decision that has lifelong effects on the life of the mother, father, and future child. The goal would be for every pregnancy in the county to be intended at the time it occurs. Family planning services should be readily/easily available regardless of income, location or insurance status.
4) .
4) School districts should carefully review their health curriculums with regard to what concepts and ideas are taught at each grade level and examine whether MCH related topics related to biological knowledge, and behaviors are being taught in a way that is understood and remembered by young people. This question needs to be answered: “Where are the future parents in the county going to get information needed to make informed decisions about becoming parents and functioning as responsible parents?” Standardized age-appropriate sex education should be adopted as well as evaluate health to improve women’s knowledge of preconceptual and pregnancy issues.
5) If expansion of the home visitor program occurs in the future, agencies hiring home visitors should be sure to provide comprehensive training and orientation about their role and now to effectively interact in home situations and best approaches resolving situations and issues they will encounter. Education should include family members and not just the woman being visited.
6) Efforts should be made to help all children do well in school and function to their full ability. The critical step of being able to “read to learn” needs to be reached by all children. Children cannot stop at the step of simply “learning to read” to function effectively in today’s society.
7) If not already in place, a community directory should be developed on a website where providers and consumers can search for sources of medical, mental, and social services, and get details about who to contact for questions. Dr. Schultz, a pediatrician at Crusader Community Health has taken the lead in developing a website (http://cap4kids.org/rockford/ ) that lists services related to children by topic area in the Rockford area. A similar site should be developed related to services for women of child bearing age, and parents in general.
8) A leadership group needs to be created that includes medical, social service, educational, and governmental representation to focus on what can be done in the neighborhoods where MCH outcomes are most adverse with regard to LBW, VLBW, and NICU use and lack of adult completion of education beyond high school. A few key initiatives should be chosen and worked on using an operational plan.
9) Some type of media campaign needs to occur using a multimedia approach over a long period of time to adequately reach the community using patient education (classes and individual education), social media tools, and even perhaps text messaging to some patients to communicate key points related to MCH topics such as these and others:
◦ the importance of deliberately planning pregnancy.◦ the importance of early prenatal care.◦ where to access MCH related services of various types.◦ the importance of maternal/parental behavior as an influence on the health
of the infant before AND after birth, and ◦ the importance of and key concepts for supporting and developing
children birth to age 5.◦ Advertise social services and promote use to stabilize women’s crisis
events.
