preconception and maternal health: equity and...
TRANSCRIPT
Preconception and Maternal Health: Equity and Inclusiveness
April 25, 2018
Presenters: Kweli Rashied-Henry, Director of Health Equity for March of Dimes, Fiorella Horna, NCPHC Coordinator for the Latina
Sana Campaign, and Jennifer Vickery, NCPHC Western Regional Coordinator
Disclosures
• Neither Kweli Rashied-Henry, Fiorella Horna nor Jennifer Vickery, nor their respective partners, have relationships with commercial companies that could be perceived as a conflict of interest (within the past 12 months).
• This webinar training was developed by the North Carolina Preconception Health Campaign, a program of March of Dimes North Carolina
• Special thanks to Kweli Rashied-Henry for her expertise and significant contributions in developing and presenting this webinar training
• Thanks to Wake AHEC for their support in administering continuing education credits for this webinar
Acknowledgements
Housekeeping
• Obtaining credits
• Groups viewing together should email:
• Asking questions
• Accessing resources at a later date
• Credits and evaluation
Credits
Nursing: 1.0 Contact Hours
Wake AHEC, Nursing Education, is an approved provider of Continuing nursing education by the North Carolina Nurses
Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.
Wake AHEC CEU: Wake AHEC will provide 0.1 CEU to participants upon completion of this activity.
Certified Health Education Specialists (CHES)/Master Certified Health Education Specialists (MCHES):
Application has been made for1.0 total Category I continuing education hours. NCHEC Provider # 98985. Approval is pending.
National Association of Social Workers (NASW)
NC AHEC is a 2018 NASW-NC approved provider of distance continuing education. This program has been approved for 1.0
contact hours
A participant must attend 100% of the webinar to receive credit. Partial session credit will not be awarded.
Contact Hours: Wake AHEC will provide up to 1.0 Contact Hours to participants.
Wake AHEC is part of the North Carolina AHEC Program.
• A statewide initiative aimed at improving birth outcomes in NC by reaching out to women with important health messages before they become pregnant
• Formerly functioned as the NC Folic Acid Campaign
• Goals of the Campaign are to reduce infant mortality, birth defects, premature birth, and chronic health conditions in women, while also aiming to decrease unintended pregnancies in NC through promoting reproductive life planning.
• Seeks to raise awareness and inspire positive action among the general public, health care professionals, and community agencies
March of Dimes North Carolina
Preconception Health Campaign
Objectives
• Describe March of Dimes agenda on equity and preterm birth.
• Explain the role and function of the March of Dimes Prematurity Campaign Collaborative and how to get involved.
• Discuss examples of clinical, public health practice, and policy/communications interventions that demonstrate the importance of using an equity lens to reduce preterm birth.
Preconception and
Maternal Health:
Equity and
Inclusiveness
North Carolina Preconception
Health Campaign Webinar Series
Kweli Rashied-Henry
Director of Health Equity
April 25, 2018
Health equity means that
everyone has a
fair and just
opportunity to be
as healthy as
possible.
There are
significant
disparities in
birth outcomes
based on race
and/or ethnicity.
The preterm
birth rate for
black infants is
50% higher than
for non-Hispanic
white infants.
BIRTH EQUITY
“the assurance of the conditions
of optimal births for all people
with a willingness to address
racial and social inequalities in
a sustained effort.”
Dr. Joia Crear Perry, National
Birth Equity Collaborative
Why does health equity matter to March of Dimes?
Our values
Health-care &
societal costs
Social determinants
Birth & maternal
health data
OUR VALUES
HEALTHY
MOMS.
STRONG
BABIES.
We imagine a world in which every baby has
an opportunity to thrive, live the future they
choose and grow up to change the world.
OUR VISION
15
Guiding Principles
How (GUIDING PRINCIPALS)
1. Champion equity and inclusion
2. Be authentic
3. Tell the story
4. Accept and expect accountability
5. Build and nurture trusted relationships
6. Lead fearlessly
BIRTH AND MATERNAL
HEALTH DATA
TREND IN PREMATURITY
Premature/preterm is less than 37 weeks of gestation. Preterm birth rate is defined as the percentage of live births born preterm.
Source: National Center for Health Statistics, final natality data.
Prepared by March of Dimes Perinatal Data Center, February 2018.
INCREASING PREMATURITY & DISPARITY
Premature/preterm is less than 37 weeks of gestation. Preterm birth rate is defined as the percentage of live births born preterm.
Maternal rate based on “bridged” race; race categories exclude Hispanics.
Source: National Center for Health Statistics, 2014 and 2016 natality data
Prepared by March of Dimes Perinatal Data Center, February 2018.
Preterm is less than 37 weeks of gestation. All race categories exclude Hispanics. Source: National Center for Health Statistics, 2012-2014 natality dataPrepared by March of Dimes Perinatal Data Center, April 2017.
Notes: Premature/preterm is less than 37 weeks of gestation. All race categories exclude Hispanics. An infant death occurs within the first year of life. SIDS is sudden infant death syndrome.Sources: Infant mortality – NCHS, 2011-2013 linked birth/infant death Prepared by March of Dimes Perinatal Data Center, April 2017.
Prevalence of Total Neural Tube DefectsNorth Carolina by race/ethnicity, 2000-2010
Source: NC State Center for Health Statistics, 2013
Pregnancy-related mortality ratio is the number of pregnancy-related deaths per 100,000 live births. A pregnancy-related death is the death of a woman during pregnancy or within
one year of the end of pregnancy from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiologic effects of
pregnancy. Source: CDC, 1987-2013 (https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html)
Prepared by March of Dimes Perinatal Data Center, March, 2018.
TREND IN MATERNAL MORTALITY
Pregnancy-
related death
has more than
doubled over
the past 25
years.
U.S. Maternal Deaths
• Maternal mortality and morbidity are on the rise in the United States
• Black woman are three to four times more likely than white women in the US to die from pregnancy-related causes
• About half the states in the U.S. have a maternal mortality review committee in place; MMRCs conduct surveillance and quality improvement to recommend strategies to eliminate pregnancy-related deaths
• Black Mamas Matter Allianceo Black Maternal Health Week (April 11-17, 2018)
o #blackmaternalhealthweek
North Carolina 10.4%Preterm Birth Rate
DGrade
Premature Birth Report Card grades are assigned by comparing the
2016 preterm birth rate in a state or locality to the March of Dimes
goal of 8.1 percent by 2020. The Report Card highlights priority
areas for action with county and racial/ethnic disparities data and a
disparity ratio. Report Cards are intended to spur action to improve
equity and reduce preterm birth, with the goal of giving every
mother and baby a fair chance for a healthy pregnancy and birth.
2017 PREMATURE BIRTH REPORT CARD
marchofdimes.org/reportcard
Gestational age is based on obstetric estimate.
Source: National Center for Health Statistics, 2007-2016 natality data
Percentage of live births that are preterm
Health care and
societal costs
http://transform.childbirthconnection.org/resources/datacenter/chargeschart/
More than
12 times as much
Costs per infant include all employer payments for newborn medical care during the first year of life.
Source: Truven Health Analytics, Inc. Costs of Preterm Birth. Prepared for March of Dimes, 2013.
Average Expense to Employer
Newborn Care
Social Determinants
of Health
MARCH OF DIMES
FIELD ADVISORIES
National Reports on Health Equity
Social & Structural
Determinants of Health
Schroeder S. N Engl J Med 2007;357:1221-1228
• Health is 10% direct care, 30% genetics, 60% social
determinants of health (behavior, environment, social
circumstances)
• Social determinants are the conditions in which people are
born, grow, work, live and age
• Structural determinants relate to the social and political
context within a society that influences who has power and
access to resources
Rates of Incarceration:
US Trends
Charlotte Mecklenburg - Mapping the
Social Determinants of Health (2017)
https://www.northcarolinahealthnews.org/2017/02/20/mapping-social-determinants-proves-positive-rx-charlottes-underserved/
Food deserts, low
educational
attainment, high
poverty related to
increased prevalence
of diabetes and
preventable ER visits
Social Determinants
Screening Tools
healthleadsusa.org
Sample tool from HealthLeadsUSA
Interventions that work: Group Prenatal Care
PROCESS
• Peer Support in a Group Setting
• Education
• Empowerment
IMPACT• Preterm birth decreased by 33% and up to 40% among African American
women using CenteringPregnancy® model of group prenatal care
Ickovics et al. Obstet Gynecol2003;102:1051–7.
North Carolina Health Equity Impact
Assessment (#impactEquityNC)
http://www.ncchild.org/wp-content/uploads/2017/08/HEIA-Toolkit-Final.09.21.17.pdf
Provides a structured process to guide the development, implementation, and evaluation of policies, programs, and initiatives in order to reduce disparities and promote health equity.
Potential Health Equity Solutions
• Community Partnerships / Community Engagement
• Health in All Policies
• Addressing Racism
• Diversity in Leadership
• Addressing the Social Determinants of Health
What are you or your agency
currently doing to advance
health equity?
Please enter your response in
the chat box.
PREMATURITY
CAMPAIGN
COLLABORATIVE
Health Equity
Workgroup
F
Engage Families, Communities and Other Strategic Partners Across Sectors Through a Collaborative Infrastructure G
HOptimize the Use of Data and Evaluation
to Drive Learning and Success
Emphasize the Health of Women and Adolescents
Align Multi-level
Support toImprove Health
Equity
Develop andImplement Messaging,
Policy & Practice
Strategies
ExpandDiscovery and
AccelerateTranslation and
Innovation
Securethe Funding
and ResourcesRequired for
Success
A B D EC
Increase Effective
Use of Evidence-Informed Clinicaland Public Health
Practice
March of Dimes Prematurity
Strategic Map for Mobilizing Support: 2016-2020
Achieve Equity and
Demonstrated
Improvements in Preterm
Birth
Health
Equity
Workgroup
Co-Chairs
Arthur R. James, MD, FACOG
Interim Executive Director,
Kirwan Institute for the Study of Race and Ethnicity
Associate Clinical Professor, Dept OB/GYN,
Wexner Medical Center
The Ohio State University
Diana Ramos, MD, MPH, FACOG
Public Health Medical Officer,
Maternal, Child and Adolescent Health Division,
California Department of Public Health
Associate Clinical Professor in
Obstetrics and Gynecology,
Keck University of Southern California
School of Medicine
Fleda Mask Jackson, PhD
Founder, Save 100 Babies
President and CEO, Majaica, LLC
University Affiliate, Columbia University
▪Develop communications about health
equity and prematurity
▪Identify research, policy and practice
areas in need of development
▪Identify and spread best and promising
practices and policies
▪Serve as expert resource to collaborative
organizations and others
▪Explore potential working group and/or
collaborative wide projects
▪Identify resources to achieve
improvements in preterm birth and health
equity
Health Equity Workgroup 2017 RecapJan
Feb Health Equity workgroup launched
Mar
Apr 1st Health Equity workgroup convening. 3 subgroups
formed.
May Began compiling health equity resources
Jun Continued compiling health equity resources
Jul Full workgroup meeting & subgroup meeting #1
Aug Began drafting subgroup products
Sep Full workgroup meeting & subgroup meeting #2
Oct
Nov Full workgroup meeting #5
Dec
GUIDING PRINCIPLES /
GLOSSARY: PURPOSE
• Develop guiding principles that
will assist other workgroups to
ensure that “equity” is at the
forefront of thinking as they
consider their work.
• Develop a glossary of terms and
concepts for all Collaborative
participants and workgroups.
Communicate the value of a variety of academic disciplines, specifically the social sciences, and their contributions to understanding and potential solving the problem of birth inequities.
CONSENSUS
STATEMENT:
PURPOSE
Communicate the value of a wide variety of academic disciplines, specifically the social sciences and their contributions, to understanding and potential solving
the problem of birth inequities.
March of Dimes
Prematurity Prevention Summit
“Building a Birth Equity Movement”
Date: May 21–22, 2018
Location: Renaissance Arlington Capital View Hotel,
Arlington, VA
Day 1: Plenary speakers, breakout sessions,
social event
Day 2: Collaborative workgroup meetings and
complementary lunch
Conclusion
• Health equity is a process and an outcome that may require doing things differently.
• Disparities in birth and maternal health outcomes persist by race/ethnicity and geography.
• Social determinants of health are multi-factorial and complex, and contribute to disparities.
• Community engagement, program and policy interventions are necessary to affect change.
• Prematurity Campaign Collaborative has engaged national health equity experts to achieve equity and demonstrated improvements in preterm birth.
Director of Health Equity
(919) 424-2158
To join the Prematurity Campaign Collaborative
visit marchofdimes.org/collaborative
Kweli Rashied-Henry, MPH
Goal: to improve maternal health and birth outcomes in NC
Reduce infant mortality, premature birth, birth defects,
unintended pregnancies, and chronic conditions in women
Raise awareness and inspire positive action among the
general public, health providers, and community agencies.
Multi-level approach…
• Health Education for women (and men) of
childbearing age
• Continuing education and resources for
health providers
• Advocacy for policies that support the health of
women and babies
• Relies on data to inform work
• Engages the community
• Addresses lifestyle behaviors
and social determinants
Risk Factors Affecting
Maternal Health & Birth Outcomes
• Pre-existing chronic conditions
• Woman’s weight before and weight gain during pregnancy
• Unplanned and unintended pregnancy
• Harmful behaviors (smoking, alcohol/substance abuse, exposure to toxic chemicals
Economic Stability
Education
Social and Community Context
Health and Health Care
Neighborhood and Built Environment
Health Providers must take into account Social Determinants of Health
Social Factors Affecting
Maternal Health & Birth Outcomes
Data reveals…
- Growing young population;
median age 28
- make up 15% of the births
- The challenge…
• 8% preterm birth in NC
• 7% are low birth weight
• Higher rates of unintended and mistimed pregnancies
• Higher rated of Neural Tube Defects
Why focus on Latinx?
1.5 – 3 x Greater Risk of
Neural Tube Defects
Spina Bifida
Anencephaly
Encephalocele
Social determinants…
• 30% live in poverty
• 34% lack access to affordable Care
• 81% speak a language other than
English in the home
• 48% foreign born; cultural differences
• Stressors related to racism & discrimination
Why focus on Latinx?
Message
- Plan for pregnancy which begins 3-6 months before conception
- Birth outcomes are affected by lifestyle choices of women AND men
- Taking folic acid (400 mcg) before & during early pregnancy can help prevent birth defects
- Maternal health and birth outcomes are a social responsibility
A Need for Change…
Approach
• Culturally grounded intervention
• Peer education model (Promotoras)
• Build Relationships of Trust
• Small group education & support
• Distribute multi-vitamins (folic acid)
• Link women to community resources
A Need for Change…
• Leaders in their community
• complete two-day training
• Attend continued education, forums, and other workshops
• 15 Promotoras across the state
• Reach over 1200 Latinas in NC each year
• Media Interventions support messaging latinasananc.org
Latina Sana NC Promotoras
www. LatinaSanaNC.org
Health Equity
fair and just opportunity to be healthy;
removal of barriers to health
such as poverty and discrimination while
creating access
to good jobs with fair pay,
quality education,
affordable housing,
safe environments, and quality healthcare.
NC Preconception
Health Campaign and
Health Equity
Jennifer Vickery, Western Regional Coordinator
Goal of NCPHC
The North Carolina Preconception Health Campaign seeks to reduce infant mortality, birth defects, premature birth, and chronic health conditions in women, while also aiming to increase intended pregnancies in North Carolina. To do this we must improve women’s wellness, improve reproductive outcomes, and reduce health disparities.
Healthy Babies are Worth the Wait®
A key tenet of this training:
• To decrease preterm birth rates by providing resources to increase knowledge about factors that cause preterm birth
Healthy Babies are Worth the Wait®
Sistas Caring 4 Sistas
Trained as Folic Acid Community Ambassadors
5 A’s Tobacco Cessation
Highest rates among women with low levels of educational attainment and/or high levels of poverty
Source: NC Behavioral Risk Factor Surveillance System, 2016; Photograph: Jeff Swensen
In Summary
• There are multiple opportunities to apply an equity lens to clinical care, public health practice, policy and communications across diverse communities in order to promote preconception health.
• The March of Dimes North Carolina Preconception Health Campaign aligns our stance on using the health equity framework to provide education and trainings to providers and consumers.
• Contact your local Preconception Health Campaign coordinator to schedule FREE and accredited educational trainings and to obtain the resources mentioned today.
Resources
• Communities in Action: Pathways to Health Equity
https://www.ncbi.nlm.nih.gov/books/NBK425839
• Healthy Babies are Worth the Wait Toolkit
https://www.marchofdimes.org/professionals/healthy-babies-are-worth-
the-wait.aspx
• Health Leads’ Social Determinants of Health Screening Tool
(Provided via PDF)
• A Practitioners Guide to Advancing Health Equity
https://www.cdc.gov/nccdphp/dch/pdf/HealthEquityGuide.pdf
Questions? Comments?
• For more information about the Campaign and other preconception health topics visit,
EveryWomanNC.org
LatinaSananc.org
• Find us on Facebook and Twitter: @everywomannc
@latinasananc
THANK YOU!
More trainings/webinars to come!
Date Time Webinar Topic
May 16, 201811:30 am –
1:30 pm
The Link Between ACEs, Preconception Health,
and Birth Outcomes
THANK
YOU!