Babies Born Healthy: An Infant Mortality Reduction Initiative
By Alison Whitney, MSW, MPH
Health Policy Advisor, Maternal and Child Health Bureau, Maryland Department of Health and Mental Hygiene
Ilise Marrazzo, RN, BSN, MPH
Director, Maternal and Child Health Bureau, Maryland Department of Health and Mental Hygiene
The Babies Born Healthy (BBH) program was initiated in 2007 with the following goals: to reduce infant mortality, improve birth outcomes and reduce racial disparities in those outcomes. This program was originally part of the Governor's Delivery Unit, targeting funding toward the eight jurisdictions in Maryland with the highest infant mortality rates and focusing interventions in the preconception, prenatal and perinatal periods. Interventions included access to QuickStart prenatal care, perinatal navigation and the provision of comprehensive women's health care – including screening for obesity, depression, substance abuse, mental health and intimate-partner violence. Since the program's inception in 2007, the overall infant mortality rate in Maryland decreased by nearly 19 percent from 8.0 infant deaths per 1,000 live births in 2007, to 6.5 infant deaths per 1,000 live births in 2014.
Now that Title X clinics in the state are required to take a more comprehensive approach to family planning services, in order to avoid overlap, BBH has transitioned to a more data-driven program with a focus on both clinic- and systems-level interventions. Jurisdictions are now required to implement selected interventions in the following strategy areas: tobacco cessation, prenatal care access, substance abuse and mental health prevention and treatment, long-acting reversible contraception (LARC) promotion, as well as any other relevant strategy areas based on supporting data. Intervention examples include hospital partnerships to ensure access to postpartum LARC placement, Medicaid application assistance for pregnant women and Maryland Quitline trainings to local pharmacy staff and obstetricians.
MCHB recently gained an expert staff of epidemiologists and data specialists. This "data team" supports offices within the bureau and will be providing extensive analyses in order to update the Maryland Plan to Reduce Infant Mortality. In order to support the recent BBH transition to become more data driven, MCHB produced "county snapshots" for all grantees. For each snapshot, the data team analyzed hospital discharge data on the following risk factors and outcomes: low birth weight; very low birth weight; preterm and early preterm birth; early, late and no prenatal care; maternal hypertension; obesity; diabetes; depression; opioid dependence/abuse; drug dependence; tobacco use; and family planning. Results were stratified by age and race, and county levels were compared with overall state levels. Because many jurisdictions lack epidemiologists, providing this tool will enable them to tailor interventions in order to focus on the most pressing factors and high-risk populations in their communities.
While Maryland has seen a steady decline in overall infant mortality in the past several decades, the black-white racial disparity has remained fairly the same, around three times as high for black infants in the same time period. In order to gain a more detailed understanding of where and why these disparities persist, the data team will be providing perinatal periods of risk (PPOR) analyses to BBH sites, promoting the goal of reducing racial disparities in birth outcomes. They also will provide epidemiology 101 trainings to empower staff to understand, utilize and share maternal and child health data on a local level. More broadly, the BBH sites are acting as pilots. MCHB intends to transform its infant mortality programs, so that these trainings, snapshots and analyses will be offered to all jurisdictions in the state as part of the Maryland Plan to Reduce Infant Mortality.
Coming of the Blessing: A March of Dimes American Indian/Alaska Native Perinatal Initiative
By Carol M Arnold, PhD, RN, LCCE
Associate Professor of Nursing, Texas Woman's University
Andrea Ellis-Harrison, BA
Planning Coordinator, Seminole Nation of Oklahoma
Belinda Rogers, BS, AND
Director, Programs & Government Affairs, March of Dimes Oklahoma Chapter
According to the 2010 Census, there are approximately 5.2 million American Indian and Alaska Natives (AI/AN) living in the United States today representing 566 federally recognized Nations. More than 40,000 American Indian and Alaska Native babies are born in the United States each year, with more than 13 percent of those born premature. AI/AN have the second highest rate of infant mortality and the highest rate of late or no prenatal care. Early and continuous prenatal care has been demonstrated to help reduce health concerns during pregnancy. One barrier to prenatal care for AI/AN includes the lack of culturally appropriate prenatal education materials.
A volunteer group of AI/AN women came together with the Western Region of the March of Dimes in 2006 to look at the prenatal health challenges faced by the AI/AN communities. This group of women represented 10 different Nations. They united with the March of Dimes, and together created a culturally appropriate prenatal education tool to support AI/AN 
women with prenatal education and encouragement to receive early and continuous prenatal care as well as supporting her traditional beliefs, lessons from her ancestors and including her partner in the circle of support during the pregnancy and after.
The committee was empowered to grow and mentor community prenatal facilitators across the Western United States. The Coming of the Blessing® is now a national initiative and reaches AI/AN families across the United States.
The March of Dimes Oklahoma Chapter is leading the way in transforming the lives of Native families by improving birth outcomes through The Coming of the Blessing® pilot programs. Outcomes from these programs have shown significant decreases in preterm birth rates by almost half, decreases in smoking rates, and improvements in breastfeeding and nutrition during pregnancy.
One of the most successful pilots, with the Seminole Nation of Oklahoma, brought great awareness to the community through outreach in group and individual efforts. The Seminole Nation of Oklahoma was one of the first tribal communities to introduce the Coming of Blessing initiative into a native community. The Seminole Nation thrives on the cultural aspect and maintaining the traditional ways of living. The Seminole Nation is recognized as a one of the Five Civilized Tribes within Oklahoma and takes pride in being unique with a rich culture and heritage. Although, the Coming of the Blessing initiative is not tribal specific it does indeed support the connection of how tribal communities are unique when it comes to healthy pregnancies and the connection within the family unit on a tribal level. "Coming of the Blessing provides our young mothers with access to vital information regarding the health of their babies," stated, Principal Chief Leonard M. Harjo of the Seminole Nation of Oklahoma. "The March of Dimes has been truly a blessing for providing much needed educational resources to the community where there are very limited resources available," added Andrea Ellis-Harrison, planning coordinator, Seminole Nation and Coming of the Blessing pilot site coordinator.
In Oklahoma and the nation this culturally rich program is improving lives, integrating cultural health practices and building strong relationships in Native communities – changing the future of health care for Native families.