AMCHP staff interviewed two AMCHP members - Loretta (Deliana) Fuddy (HI) and Suzanna Dooley (OK) - to gain insight on promising strategies and approaches to reduce infant mortality. Both Title V Directors described some emerging and innovative strategies to reduce infant mortality in their state.
Loretta J. Fuddy, A.C.S.W., M.P.H.
Chief, Family Health Services Division
State of Hawaii
Department of Health
State Infant Mortality Rate- 6.5 per 1,000 live births.
What challenges have you faced while integrating data and epidemiology into your program work?
First, finding resources to hire staff with formal education in epidemiology proved problematic. A combination of factors contributed to this tenderness: Maine being a rural state, a lower pay scale, and a lack of people interested in living in Maine brought difficulty in recruiting qualified data staff. We maintained our commitment to hire epidemiologists who met national educational standards required for epidemiology. It took 18 months to find and interview a viable candidate.
How can AMCHP help your state enhance epidemiology capacity to communicate your research and data to state legislators to improve MCH public health policies?
AMCHP can help in many ways: promote the integration of evaluation and epidemiology; for evaluation is a critical part of improving the quality, capacity and effectiveness of our department programs and policies. AMCHP could assist in identifying more resources, particularly for states that have been unable to build their epidemiology capacity, would help; and identifying tools to educate legislators to understand the quality of MCH data, e.g., congenital birth defects data fact sheets. And AMCHP providing samples of how other states have utilized data in their states would also help.
Infant mortality is a complicated issue, with no singular prevention strategy. Hawaii is fortunate to have better insurance coverage for pregnant women and young children than most states, so insurance coverage is less of an issue. Recent Hawaii PRAMS analysis reveals that only 2.4 percent of women were without prenatal coverage; and 1.8 percent of pregnant women were without coverage at the time of delivery. However, access is more than just having medical insurance. Availability of medical care providers, especially in our more rural island communities is an ever-growing concern. We are experiencing a phenomenon where health care providers are leaving the field of obstetrics because of liability issues and low reimbursement, particularly in communities where the most vulnerable populations reside. The ethnic groups known to be at greatest risk for infant mortality in Hawaii are Native Hawaiian and other Pacific Islanders, and we have experienced an influx of many recent immigrants (Samoan, Palauan, Marshallese, Chuukese and Micronesian).
Hawaii’s approach to addressing infant mortality has been to complement standard prenatal care with “women to women” support in a culturally acceptable manner. Three programs showing good results include: the Malama Perinatal Program in Hawaii County, “Crossing Cultural Bridges” program within the Kokua Kalihi Valley Community Health Center, and the “Centering Pregnancy” program within the Kalihi Palama Health Community Health Center. The common theme is the use of bilingual outreach staff and/or volunteers to increase enrollment in prenatal care and to provide health assessment and education in small group settings. The models promote a greater sense of responsibility, social support, and sharing among the women; which ultimately guides the health care providers to respond to their culturally unique prenatal needs.
Hawaii’s population is very diverse and cultural behaviors have a strong influence on health behaviors. Therefore, it is important to provide education of health care providers so that they can respond to and understand their patients in a culturally appropriate way. Recently, the Maternal and Child Health Branch sponsored a series of trainings related to culturally unique practices among the various Pacific Island communities, which affect health behaviors across the state. Kokua Kalihi Valley Health Center has developed a Cross Cultural Childbirth Education series specifically for Chuukese, Samoan and Tagalog-speaking women.
Finally, we cannot address the reduction of infant mortality without having broad based community support. The Malama Perinatal Project has more than 100 active consortium participants, from all sectors of the community, to identify unique ways to improve birth outcomes for women. The Maternal and Child Health Branch will host a statewide Perinatal Summit in October 2008 to develop community driven action plans towards improving our health care response to women prior to, during and after pregnancy. We believe that it is only through consistent, quality and culturally appropriate health care, and the promotion of a community which honors, protects and supports women throughout their life span, that we will be able to reduce the rates of infant mortality in Hawaii.
Suzanna D. Dooley, M.S., A.R.N.P
Title V MCH Director
Oklahoma State Department of Health
State Infant Mortality Rate- 8.1 per 1,000 live births.
In May 2007 the Oklahoma State Department of Health Commissioner’s Action Team on Reduction of Infant Mortality convened with the overarching goal to reduce infant mortality. As a result of this meeting, a strategic plan was developed to outline specific action steps to be taken in order to reduce infant mortality, adverse birth outcomes, and racial disparities within the state. Oklahoma is actively engaging a variety of state partners to focus its efforts on impacting the infant mortality rate. Within these efforts is a specific focus on African American and Native American populations.
Emerging and Innovative activities include:
1. Adopting and promoting a common message of preconception and interconception care for all females of reproductive age.
2. Improving access to quality health care for populations disproportionately impacted by infant mortality.
-Engaging African American churches and communities to gain information on barriers to health care services.
3. Reducing prenatal sexually transmitted infections by identification and treatment.
-Exploring the role of sexually transmitted infections in preterm labor and accessing treatments.
4. Promoting infant safe sleep.
- Surveying hospitals to accurately assess infant safe sleep policies and educational needs of mothers.
5. Enhancing tobacco use prevention activities with pregnant and postpartum females, their families and health care providers.
6. Promoting and modeling the importance of breastfeeding.
- Partnering with the state Chamber in the initiative to promote breastfeeding in the workplace. Businesses are being recognized as Breastfeeding Friendly Worksites. Those meeting at least three additional criteria are designated as Gold Star Employers.
7. Expanding family planning services. There is currently limited documentation where African American females of reproductive age are going for family planning services. Work has begun with Title X and securing additional federal funding in order to expand clinical services to this population within the two largest urban areas, Oklahoma and Tulsa counties.
8. Expanding family support and education services in geographic areas of high infant mortality.
9. Strengthening capacity of the MCH Data Center to enhance data collection and surveillance around maternal and infant health morbidity and mortality.
10. Implementing a statewide public awareness and education campaign on infant mortality to include targeted messaging for high-risk populations.
11. The Oklahoma Health Care Authority – Oklahoma State Department of Health Perinatal Advisory Task Force has facilitated multiple changes to Medicaid policy that will impact infant outcomes, including diagnostic services, ultrasounds, lactation consulting, genetic counseling, etc.
12. Developing a close relationship between Title V and Medicaid agencies.