Centering Mothers and Community to Prevent Maternal and Infant Mortality and Morbidity

Background & Purpose: The state of maternal and infant health in the U.S. belies a critical health inequity. Not only does the U.S. have the highest maternal mortality rate of all developed countries, but there are also vast racial disparities. Approximately 69.9 Black mothers die for every 100,000 live births a rate—nearly three times higher than White mothers. 40% of maternal deaths occur within six weeks after leaving the hospital, indicating a need to work for health equity in communities where women are at risk for adverse pregnancy and birth outcomes. Racism, lack of quality, continuous care and adverse social determinants of health are cited as drivers. Multiple data reports and studies indicate the need to tackle the problem of maternal and infant mortality at a community level by focusing efforts to address social determinants of health before, during and after pregnancy.

Building and disseminating knowledge at the community level is paramount for equity in perinatal outcomes. Eliminating barriers to accessible, affordable, and equitable care is necessary. Healthy Start (HS) is a community-based program that fills gaps in services during pregnancy and postpartum. The program serves pregnant to 18 months postpartum, providing long-term case management through home visits, doula services and nurse visits in high-risk communities. We serve 10 zip codes with infant mortality rates 1.5 times the national average. This study evaluated the efforts of a local HS site in its 3^rd out of 5-year funding cycle to assess progress toward the goals.

Methods: Service data was de-identified and extracted from a federally funded HS program that is situated in one of the poorest neighborhoods in the country’s fourth largest city. Indicators were gathered through standardized intake and case management forms and were input to the Well Family Systems Database by case managers and outreach staff. Data was taken from the latest case records of participants.

Results: Between January 2020 and December 2022 this HS site has served nearly 313 women, 225 infants and 132 dads. About 80% of participants identified as Black or African American. One hundred and seven babies were born to mothers while receiving services. Participant singleton births had 11.2% pre-term birth (PTB) rate, lower than the rate of 12.3% at the county level and lower than the national average among Black infants: 14.36%.

Factors contributing to maternal mortality were addressed—96.27% of participants were routinely screened for depression, 99.26% were screened for Interpersonal Violence and 60.2% of women who had babies while in the program had a postpartum well woman visit within 4-6 weeks.

Conclusion: Based on comparisons at the county level, participants in this HS experienced lower PTB rates, especially when compared to the average among Black women in county or nationwide. The depression rate of 7% is lower than national average (14%), and participants had higher return for well woman visit rates compared to a national dataset of Black women on Medicaid. The program appears to be meeting goals by reducing barriers and disparities in birth outcomes.