preconception and maternal health: equity and...

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:

randerson@marchofdimes.org

• 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

krashied-henry@marchofdimes.org

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!