Summary of the Maternal and Child Health Community Systems Assessment Report for the Winnebago County, Illinois Maternal, Infant and Early Childhood Home Visiting (MIECHV) Project November 19, 2013
Contributors Martin MacDowell, Dr.P.H., M.S., M.B.A. 1 Matthew Dalstrom, Ph.D. 3 Vicki Weidenbacher-Hoper, M.S.W 1 Dana Evans, M.S. 1 Charaine Boyd, M.O.L. 2 Ms. Karen Lytwyn, M.P.H. 2 _______________________________________ 1 National Center for Rural Health Professions University of Illinois Health Science Center at Rockford 1601 Parkview Avenue Rockford, IL 61107 2 Winnebago County Health Department 401 Division Street Rockford, IL 61110 3 Rockford University 5050 E State Street Rockford, 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 Socio-economic factors Low birth weight, and pre-term Availability, and access to births health services Cultural and educational Health behaviors
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 in births. Thirty-seven (37%) of births in the US were unintended at the time conception. The rate of unintended pregnancies among women whose income was below the federal poverty line was three (3) times that of women whose income was at least double the poverty level (Finer & Henshaw, 2006). Unmarried black women, and women with less education or income are much 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 among non-hispanic black women, unmarried women, and women with less income and 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.
Socio-economic determinants Child health status varies by such as race, ethnicity, both race, and ethnicity, as well education, and income levels, as by family income (Larson environment, and health and Halfon, 2010) and related insurance status influence factors, including educational maternal health as well as attainment among household pregnancy outcomes, and members and health insurance infant and child health . coverage (Larson et al., 2008). Overall, socio-demographic factors have a larger effect on poor educational outcomes than birth related factors (Resnick et al, 1999)
Environmental factors include: Health behaviors of the mother Access to health care, prior to pregnancy as well as Chronic stress, during pregnancy affect birth Inadequate nutrition, outcomes, as well as infant Alcohol consumption, and and child health; in some Smoking by the mother during pregnancy are among the cases, far into the future. Pre known risk factor for pregnancy health behaviors of psychological problems the mother are influenced by a including ADD, and behavior variety of environmental and problems in children as well as medical problems social factors. Consuming alcohol during pregnancy can harm the fetus, and may result in long-term medical problems like fetal alcohol syndrome in the child.
Pre term low birth weight Pregnant women who are (LBW) (<5.5lbs) and very low young, black, poor or a birth weight (VLBW) (<3.3lbs) combination of those factors babies are at increased risk of face a considerably higher risk infant mortality, and morbidity, of delivering LBW babies than developmental delays, and other mothers (Lee et al, child maltreatment (Lee et al, 2009). 2009). 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).
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 e quality of the e home e en environment(Kendrick et et al, , 2000) 2000) Pre revent child ild malt altre reat atment (Bilu ilukha, , 2005) 2005) and decr ecrease harsh paren enting Impro rove cognit itio ion, an and lan languag age development Red Reduce ce r risk of LBW Impro rove weig ight-for-ag age in in yo young child ildren, an and Red Reduce ce ch child hea ealth problems (Pea eaco cock ck, , et et at., ., 2013) 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 Bachelor’s Degree or Higher by % completing HS or Equivalent by ZIP code, Zip code, Winnebago County Winnebago County 16
% of Adults under 100% Federal Poverty Level (FPL) by ZIP Code, Winnebago County 17
Likewise, LBW rates (<5lbs) are also consistently higher for African-American infants in both Winnebago County, and Illinois as shown below. Low Birth h Weight ht Rates s by Race, IL and d Winn nneba bago Coun unty, 2007-10 10 160 140 120 100 LBW Rat ate pe per 80 IL rate 1,000 000 live births Winn. County Rate 60 40 20 0 Amer. Indian Asian or Black White Total or AK Native Pacific Islander
Low Birth Weight Rates by Ethnicity, IL and Winnebago County, 2007-10 16 14 12 10 Low Birth Weight Rate per 8 100 live births (%) 6 Winn. County Illinois 4 2 0 Non-Hispanic Black Puerto Rican Non-Hispanic other races Central or South Mer. Origin unknown Other Hispanic Mexican Non-Hispanic White Cuban TOTAL
% L BW by Mother's L evel of C ompleted E ducation, Winnebago C ounty, 1999-2009 12% 10.4% 10% 9.2% 8.8% 8.2% 8% 6.6% 6% 4% 2% 0% Less than High HS graduate or S ome C ollege C ollege Graduate or All Winnebago C o. S chool equivalent higher
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