David S. McKenna, M.D. Dayton/Montgomery County Infant Mortality Coalition Maternal-Fetal Medicine Miami Valley Hospital, Dayton OH
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1 David S. McKenna, M.D. Dayton/Montgomery County Infant Mortality Coalition Maternal-Fetal Medicine Miami Valley Hospital, Dayton OH
2 Describe local and state-wide efforts to improve overall birth outcomes and reduce the racial and ethnic disparities in infant mortality Share experience with clinical and community initiatives
3
4 Freestanding national membership organization City & County Health Depts, MCH programs & leaders Mission strengthen public health leaders and organizations to promote equity & improve the health of urban women, families & communities Institute for Equity in Birth Outcomes Help U.S. cities strengthen the evidence-base for reducing inequities in birth outcomes Each team - 2 year project Funding from the W.K. Kellogg Foundation
5 Equity Institute Training Upstream Strategies racism Prevention Vehicles Downstream Strategies
6 2013 Trained with 3 other cities Developed two projects for implementation Centering Pregnancy - upstream Progesterone for the prevention of preterm birth downstream Ohio Equity Institute CityMatCH trained 8 additional Ohio urban communities Each is implementing and upstream & downstream project
7 Dayton & Montgomery County Infant Mortality Initiative Target Area For 9 Zip Codes the Black IMR > 7.5 and the Number of Black Births > 100
8
9 The Life Course Approach- the concept that birth outcomes are influenced by a woman s health behaviors and life events over her entire life course, including infancy & childhood as well as reproductive years and pregnancy
10 Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Matern Child Health J. 2003;7:13-30.
11 The Life Course Approach (continued) In 1985 we said: Providing early and regular high-quality prenatal care will assure the best possible birth outcomes.
12 The Life Course Approach (continued) In 2015 we say: The best possible birth outcomes require highquality preventive health care from birth through a woman s reproductive years.
13 Social Determinants of Health- infant mortality is not just a medical/public health issue. Birth outcomes are affected by: Poverty/income status Behaviors Education Racism
14 Racial Disparities in Infant Mortality- Disparity exists even when controlling for known risk factors: *Health behaviors *Teen pregnancy *Marital status *Education *Poverty *Genetics
15 Racial Disparities (continued)- Studies suggest that it is not race itself, but something related to living in the U.S. as a black woman that caused the disparity. The leading hypothesis identifies that experience as racism and the stress caused by a lifetime of racial prejudice.
16 Current theory on how racism affects birth outcomes- RACISM Stress Release of Hormones Increased Infection Preterm Birth
17 Butler County Upstream: CenteringPregnancy Downstream: smoking cessation and safe sleep Cincinnati Upstream: Comprehensive Health Education in a Cincinnati Public School Downstream: Stress/depression Reduction; Empowerment; Pregnancy Intent (45211 Zip Code WIC clients) Cleveland/Cuyahoga County Upstream: Family planning / Preconception Care Downstream: CenteringPregnancy Columbus Upstream: Community building / Civic engagement, Parent education / Mentoring Downstream: Perinatal case management (zip codes and 43207) Dayton & Montgomery County Upstream: CenteringPregnancy Downstream: Progesterone therapy (9 zip codes with Black IMR > 7.5 and Number of Black Births > 100) Stark County Upstream: CenteringPregnancy Downstream: Safe Sleep initiatives Summit County Upstream: community support / Life Course Perspective Downstream: Progesterone treatment Toledo Upstream: Health Disparities and Racism (policy recognition) Downstream: Safe Sleep and Maternal Care Youngstown-Mahoning County Upstream: CenteringPregnancy Downstream: LARCs
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19 Racism- a system of structuring opportunity and assigning value based on the social interpretation of how we look, resulting in a system which unfairly disadvantages some and advantages others.
20 Institutionalized Racism- differential access by race to the goods, services, and opportunities of a society Personally Mediated Racism- prejudice (differential assumptions) and discrimination (differential actions) by individuals toward others Internalized Racism- acceptance by members of the stigmatized races of negative messages about their own abilities and intrinsic worth
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