Demonstrating Solutions for Health Equities in Maternal and Infant Birth Outcomes: Findings from a Community-Based Program

Background: The United States has the highest maternal and infant mortality and morbidity rates among all developed nations. Currently, racial disparities persist among Black infants. According to CDC (Osterman et al., 2021), the national preterm rates and low birth weight were 10.09% and 8.24% in 2020, but they were the highest among Black mothers (14.36%, 14.19%, respectively). Inadequate prenatal care is a known risk factor for adverse birth outcomes (Heaman et al., 2019; Tayebi et al., 2013). Since one-third of maternal death happens within one year postpartum (MACPAC, 2020), access to postpartum healthcare is also critical.

Healthy Start (HS) programs address racial perinatal health disparities through home visits for pregnant and postpartum women and their infants. Using data from one HS site, this study aimed to 1) describe a sub-sample of mothers who gave birth while receiving HS services; 2) draw parallels between their outcomes and population of similar demographics.

Methods: We analyzed data collected by case managers during home visiting services. To explore the impact of the services, we only included women enrolled as pregnant and received services until after delivery. Mothers’ background data were collected during enrollment, and the children’s data were collected after birth. We described various social determinants of health, including race and ethnicity, age, education, income, insurance, housing, and scores on the shortened Everyday Discrimination Scale (Sternthal et al., 2011). The outcomes were preterm birth (less than 37 weeks), low birth weight (less than 5 lb. 8 oz.), and postpartum visit attendance within six weeks after delivery. We conducted descriptive analysis in SPSS.

Results: The final sample included 78 mothers and 80 babies served by HS between 2019 to 2021. Most mothers were non-Hispanic Black (59, 75.64%) and covered by Medicaid (61, 78.21%), but some had gaps in coverage (15, 19.2%). Half of the participants were aged 25 to 34 (40, 51.3%). More than half of them had household income less than $16,000 (49, 62.8%), about 1/3 had less than high school education (25, 32.1%), and 1/6 had housing concerns (13, 16.7%). Their scores on perceived discrimination ranged from 1 to 4, with a mean of 1.46 (SD=.77).

Among the Black infants, the preterm birth rates were 11.11%, lower than the national average of 14.36%. Their low birthweight rates were 9.52%, also lower than the national average of 14.19%. Among mothers on Medicaid (n=61), 43 (70.49%) had prenatal visits within the first trimester, which is similar to the national average (MACPAC, 2018); while 38 (62.30%) had a postpartum visit within six weeks of delivery, higher than the rate of 49.5% reported in a recent study (Masho et al., 2018).

Conclusions: Improved birth outcomes and increased postpartum visits among HS mothers may indicate its potential to reduce disparities in mortality and morbidity during the first year postpartum. However, we cannot infer the causality with this research design using service data. Future research should investigate facilitators and barriers to the continuum of care among this population.