From Data to Program and Policy: Michigan’s Success Story on Preventing Unintended Pregnancy
In Michigan, great strides have been made to address the reduction of unintended pregnancy in the state. However, the prevalence of unintended pregnancy remains stagnant, at approximately 40%, since 1988 (Pregnancy Risk Assessment Monitoring System—PRAMS*—findings).
Michigan PRAMS, the only data source for this particular matter, has been extensively used. Different studies and analyses were conducted to better understand the determinants as well as the characteristics of women who experienced an unintended pregnancy. The findings were broadly disseminated and shared with different stakeholders and policy makers in an effort to develop program initiatives, to promote policies aimed at reducing unintended pregnancy, and attract additional funds to support such programs.
As a result, unintended pregnancy was identified as a priority public health concern and objectives of developing programs and policies capable of monitoring indicators associated with unintended pregnancy were set.
At the direction of the Governor and beginning in 2003, a workgroup created the Blueprint for Preventing Unintended Pregnancies. This blueprint includes the following goals:
- Plan First! Program—Through this program, the Michigan Department of Community Health (MDCH) currently provides family planning services to women ages 19 to 44 who otherwise would not have medical coverage for these services.
- Talk Early & Talk Often—This program helps parents of middle school children develop the necessary skills to talk to their children about abstinence and sexuality. Since it began in October 2005, more than 70 workshops have been held throughout Michigan in public and parochial schools, medical centers, worship centers, health departments, and libraries, reaching more than 800 parents. Survey results from parents who participated have been overwhelmingly positive. For more information, visit http://www.michigan.gov/miparentresources/0,1607,7-107-37383---,00.html.
- Contraceptive Equity—The Governor has called upon the Legislature to require that health plans that cover prescription drugs also cover birth control.
- Prevention of Unintended Pregnancy in Adults guidelines—Michigan Quality Improvement Consortium (MQIC) 2007 Prevention of Unintended Pregnancy in Adults 18 Years and Older guideline was approved by the MQIC Medical Directors’ Committee and endorsed for distribution/publication effective June 20, 2007.
As a long term goal, the prevention of unintended pregnancies due to expanded family planning services would improve the birth outcomes.
Training to Increase Understanding of Micronesian People: Hawaii’s Use of an AMCHP Data Mini-Grant
In 2007, the Hawaii State Department of Health, Family Health Services Division was awarded a Data and Assessment Technical Assistance (DATA) Mini-Grant from AMCHP. The grant provided us the opportunity to address an emerging issue in the State of Hawaii, that of the migration of Micronesians into the state. The grant supported training in understanding of how Micronesian cultural practices influence health care practices, as well as the access and use of the health care system.
Department staff from throughout the state attended the training. The training created a tool, a matrix that summarizes the various Micronesian people and selected social/cultural characteristics such as: "what is illness," non-verbal communication, willingness to divulge personal/ sensitive information, birth practices, and prenatal care. There was consensus by the participants that the training provided a better understanding of the Micronesian peoples and how we can better address their issues, whether it be through program development, policy development or services. Staff took home the lessons learned, and one county has replicated the training for their staff.
Translating MCH Data into Policy: An Integrated Approach to Improve Preconception Health and Birth Outcomes in Los Angeles County
How to use data to develop and fund MCH programs:
Antelope Valley (AV) is the largest of eight Service Planning Areas comprising Los Angeles County (LAC). Between 1999 and 2002, the infant mortality rate in this geographically isolated, sparsely populated region increased from 5.0 to 10.6 per 1,000 births (over double the county rate). Of most concern was a spike in the African American rate, rising from 11.0 per 1,000 live births (N=7) in 1999 to 32.7 per 1,000 live births (N=27) in 2002. The LAC Department of Public Health, Maternal, Child, and Adolescent Health (DPH MCAH) Programs partnered with Antelope Valley Partners for Health, a public-private collaborative that had been working to improve AV community health and services, to study the problem and form a strategic action plan.
LAC DPH MCAH used the Perinatal Periods of Risk (PPOR) approach to identify and quantify problem areas and mobilize community action. Analyses used multiple data sources to identify factors associated with poor birth outcomes and infant deaths and potential areas of intervention. Data included: 2002 Vital Statistics files from the California DPH to identify areas with the highest excess rates of fetal and infant mortality; case reviews of the 2002 infant deaths (N=53) following California’s approved FIMR protocol; and population-based survey data of AV mothers who recently delivered a live born infant (Los Angeles Mommy and Baby Project) to identify factors associated with poor birth outcomes. Analyses identified two key areas for continued research and intervention: maternal health/prematurity and infant health. Community stakeholders reviewed findings and developed targeted actions to address infant mortality. Key funders and policy makers invested additional funds to promote healthy births in AV. This work also prompted the launch of a major stakeholder effort focusing on preconception health promotion.
Oregon’s Use of Data to Create and Pass a State Policy
Oregon State PRAMS data and national research combined made for a successful policy change through legislative change. In Oregon, over 89 percent of women start out breast feeding – one of the highest rates in the nation. Unfortunately, less than 27 percent of Oregon infants are exclusivelybreast-fed for the six months as recommended by the American Academy of Pediatrics. The high initiation rates make it clear that Oregon mothers want to breast-feed. The majority of them are unable to continue for the recommended six months due to the many barriers they face – the primary obstacle being the lack of accommodations for breast feeding mothers upon returning to the workplace.
To address this issue, a public-private coalition worked through two legislative sessions to achieve the passage of landmark legislation on Employer requirements for accommodation. The advocates worked with legislators to create the “Oregon House Bill 2372, the Return to Work and Breast feeding”, which supported women who chose to breast-feed after they returned to work. The Oregon legislature passed the bill in May 2007. The bill requires employers of 25 or more employees to provide a mother unpaid time and a private place to express milk every four hours during the work day. For more information on the legislation or implementation tools go to http://www.oregon.gov/DHS/ph/bf/.