Now Viewing: Maternal & Infant Health

Can a Single Question Help Families Confront Poverty?

Apr 13, 2016, 10:30 AM, Posted by David Krol

A new recommendation for pediatricians aims to help the one in five children in the United States who live in poverty.

Father holds young child at doctor's office.

During most of the week, I spend my time here at RWJF working on programs to develop leaders in health and health care and to address childhood obesity. But on Friday afternoons, I am at Eric B. Chandler Health Center in New Brunswick, N.J., seeing children and families. Eric B. Chandler is a federally qualified health center, and we serve a lot of poor, immigrant families. The children I see are more likely to have asthma or tooth decay than are children who live not too far away. They’re also more likely to be overweight, and to face adverse childhood experiences like family trauma or violence.

In some sense, this isn’t surprising. Poverty is one of the biggest health risks that children face today. One in five young people in the United States lives in poverty, and it’s present in urban, suburban, and rural communities across the country. My colleagues James Marks and Kristin Schubert recently described what lasting impact poverty can have on children.

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U.S. Preterm Birth Rate Still Too High: Q&A with Jennifer L. Howse, PhD, the March of Dimes

Nov 12, 2014, 1:15 PM

NPH Public Health Q&A Banner, featuring Jennifer Howse.

Last week the March of Dimes releases its annual Premature Birth report card and gave a “C” grade to the United States. While the U.S. rate has seen improvement in recent years and rates of premature birth—which can cause death and lifelong disability—have dropped, the organization says there is still much room for improvement. With World Prematurity Day next week, NewPublicHealth recently spoke with Jennifer L. Howse, PhD, president of the March of Dimes, about the new report card and new efforts by the organization to study premature birth and vastly reduce the U.S. rates further.

NewPublicHealth: What’s most significant about the 2014 report card?

Jennifer Howse: The 2014 report card on premature birth in the United States shows continued improvement. In fact, rates of pre-term birth in the United States have improved. That is they’ve lowered every year for the last seven years and that means that the United States currently has a pre-term birth rate of 11.4 percent, and that rate of pre-term birth is the lowest that it’s been in the in the last 17 years. So we’re very pleased. Having said that, the United States is still short of the target set by the March of Dimes of 9.6 percent or less. Our state-by-state report card assigns a letter grade to the U.S. composite and then to each state up against that goal of 9.6 percent. So, the United States has a “C” overall, but we continue to see progress and improvements—incremental, but progress in far and away the majority of states. So it’s very important around this critical child health issue to set a target, measure the target, and to hold states and the nation accountable.

NPH: What are the things that March of Dimes is doing, has done and will continue to do that are helping that rate?

Howse: The March of Dimes has mobilized a very strong group of partners in this campaign to end premature birth. We have assembled very strong partnerships with clinicians, with state health officials, with hospital leadership, with governmental leaders—particularly in the area of Medicaid programs—and those partnerships have been activated and expanded over the last decade. Specifically, the March of Dimes has led the charge on a quality improvement program across the nation to reduce and eliminate elective induction and C-section before 39 weeks of completed gestation. That’s the QI 39 program, and now two-thirds of hospitals are showing positive results in that arena. 

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ASTHO Q&A: David Lakey

Sep 12, 2012, 9:34 AM

David L. Lakey, MD, Commissioner of the Texas Department of State Health Services, ends his term as president of the Association of State and Territorial Health Officers, (ASTHO)at the group’s annual meeting in Austin this week. NewPublicHealth spoke with Dr. Lakey about his tenure and about his Presidential Challenge to reduce the number of preterm births.  

NewPublicHealth: Did anything surprise you during your tenure as ASTHO president?

Dr. Lakey: I don’t think there was a specific surprise. It’s been a very busy year. Perhaps the one surprise might be that four years ago ASTHO started the Presidential Challenge under Judy Monroe, MD (then state health commissioner of Indiana, and now the head of the Office for State, Tribal, Local and Territorial Support at the Centers for Disease Control and Prevention) started this thing called the Presidential Challenge. Dr. Monroe started it as a charge to the state health officers to kind of walk the talk related to physical activity. And now, four years later, the Presidential Challenge really had its own legs and with a lot of support. This year’s challenge—reducing preterm births–became a pretty big initiative. We now have 49 states that have signed on to that initiative.

NPH:  What specific actions do you think have helped the decline of preterm births?

 

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U.S. Lags Behind 130 Other Nations in Preterm Birth Rate

May 2, 2012, 7:21 PM, Posted by NewPublicHealth

Preterm babies are born at a higher rate in the US than in 130 other countries, including many poorer nations, according to a report released today, Born Too Soon: The Global Action Report on Preterm Birth, published by the March of Dimes and almost fifty other groups, including the World Health Organization.

Preterm birth (birth before 37 weeks completed gestation) is the leading cause of newborn death in the US—nearly half a million US babies are born too early each year. Babies who survive an early birth often have breathing problems, cerebral palsy, intellectual disabilities, and other lifelong problems. Even babies born just a few weeks early have higher rates of hospitalization and illness than full-term infants, and the costs exceed $26 billion each year. “While our country excels in helping preemies survive, we have failed to do enough to prevent preterm births and help more mothers carry their babies full-term," says Jennifer L. Howse, president of the March of Dimes.

The report also highlights health disparities for newborns in the US. The rate of preterm births for African American mothers is 18 percent; the rate for white mothers is 11 percent.

Worldwide, the new report finds that 15 million babies are born preterm each year, and more than one million die due to preterm complications. Of these babies, the report notes, three-quarters could be saved if current cost-effective interventions were made more widely available. Those interventions, according to Dr. Howse, include:

  • Giving all women of childbearing age in the U.S. access to health care, including adolescents, and including care before, between, and during pregnancy
  • Behavioral changes to reduce the risk of an early birth, such as not smoking during pregnancy
  • Progesterone treatments for women who have had a previous preterm birth
  • Better management of fertility treatments that result in multiple births
  • Hospital quality improvement initiatives to reduce early inductions and Cesarean deliveries before a full 39 weeks of pregnancy unless medically necessary

“This report underscores the need for action to reduce premature birth in the U.S., and state and territorial health officials have a critical role in championing and implementing proven solutions,” says David L. Lakey, M.D., president of the Association of State and Territorial Health Officials and Commissioner of the Texas Department of State Health Services. “Interventions that promote full term, 39-week pregnancies and improve the health of babies can significantly reduce health care costs.” Reducing preterm births is Dr. Lakey’s Presidential Challenge during his term as ASTHO president.

In February, the Department of Health and Human Services announced “Strong Start," an initiative that includes funding for enhanced prenatal care and hospital quality improvement programs. And the March of Dimes has launched its “Healthy Babies Are Worth the Wait” campaign to let women know that if their pregnancy is healthy, it’s best to wait for labor to begin on its own rather than scheduling a delivery. Elizabeth Mason, MD, director of the Department of Maternal, Newborn, Child and Adolescent Health for the WHO says model practices in other countries that have reduced preterm births include creating medical homes for expectant mothers, reducing hospital infection rates and both prenatal care and care throughout a pregnancy to monitor for concerns.

Christopher Howson, PHD, Vice President for Global Programs at the March of Dimes Birth Defects Foundation, says the current worldwide rate of preterm births could be halved by 2025 if the recommended interventions are carried out. “That is eminently, eminently feasible,” says Howson.

Bonus Reading: For a state-by-state breakdown of preterm birth rates within the U.S., see the March of Dimes 2011 Premature Birth Report Card online at marchofdimes.com/prematurity.

This commentary originally appeared on the RWJF New Public Health blog.

Healthy Babies: HHS Adds an Initiative to Help Reduce Preterm Births

Feb 9, 2012, 7:32 PM, Posted by NewPublicHealth

Healthy Babies is the focus of the annual President’s Challenge of the Association of State and Territorial Health Officials, and this week the U.S. Department of Health and Human Services (HHS) put funding behind the issue as well, announcing the Start Strong initiative. The first activity of the initiative will be to give out more than $40 million in grants, through the Center for Medicare and Medicaid Innovation, to test ways to reduce the current high rate of premature births.

According to HHS, more than half a million infants are born prematurely in America each year, a rate that has grown by 36 percent over the last 20 years. Children born preterm are at risk for death and also often require significant medical attention, early intervention services and special education, and have conditions that may affect their productivity as adults.

The Center will award grants to health care providers and coalitions to improve prenatal care to women covered by Medicaid. The grants will support the testing of enhanced prenatal care through several approaches under evaluation, including:

  • group visits with other pregnant women,
  • birth centers providing case management, and
  • maternity care homes where pregnant women have expanded access to better coordinated, enhanced prenatal care.

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Healthy Babies Minnesota: A Q&A with State Health Officer Edward Ehlinger

Jan 12, 2012, 4:52 PM, Posted by NewPublicHealth

Healthy Babies Minnesota is an umbrella of activities aimed at using prenatal and first-year initiatives to make Minnesotans healthier throughout their lives. NewPublicHealth spoke with Edward Ehlinger, MD, the state’s commissioner of health, about the program.

Today marks the start of the regional Infant Mortality Summit, kicking off a collaborative, multi-State initiative to improve infant health outcomes. NewPublicHealth will feature some innovative programs and initiatives to support healthy babies this week.

NewPublicHealth: What are key initiatives that make up Healthy Babies Minnesota?

Dr. Ehlinger: We have a lot of activities related to pregnancy, prenatal care, preconception care and early childhood care; and so we’re collaborating on all of those. We also have a Children’s Cabinet that’s focusing on early childhood growth and development. We’re also really focusing on adverse childhood experiences. We’re collecting information across the state on what’s happening to babies in the first year of life, adverse childhood experiences, to make sure that we prevent those or can intervene quickly. And we’re also really focusing on preconception care. Trying to make sure that women who are anticipating becoming pregnant will focus on all of the important issues—make sure their weight is normal, their blood sugars are under control, if necessary, that they’re not smoking, they’re not drinking.

NPH: And what is the next set of ideas for 2012?

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Healthy Babies are Worth the Wait

Jan 11, 2012, 4:32 PM, Posted by Jennifer L. Howse, NewPublicHealth

Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today, Jennifer L. Howse, PhD, president of the March of Dimes, comments on efforts to give more babies a healthier start in life. This week, a regional Infant Mortality Summit will kick off a collaborative, multi-State initiative to improve infant health outcomes.

A baby born in the United States today faces a one out of eight chance of being born too soon. Prematurity is a common, costly, serious and a largely silent health epidemic. The good news is that national, state and local health officials are addressing this problem with historic public health initiatives to give more babies a healthy start in life.

On Nov. 1, the United States received a grade of “C” on the March of Dimes 2011 Premature Birth Report Card. Preterm birth is the leading cause of newborn death. Babies who survive an early birth face an increased risk of serious life-long health challenges, such as breathing problems, cerebral palsy, or learning disabilities. Even babies born just a few weeks early have higher rates of hospitalization and illness than “full-term” infants (39-40 weeks of pregnancy). We’ve developed an educational campaign and a hospital-based toolkit to help parents and professionals better understand the critical importance of those last weeks of pregnancy to a baby’s health.

Although the U.S. preterm birth rate has improved slightly in recent years, nearly half a million infants still are born too soon. Each early birth places a terrible emotional toll on families and a financial burden on the health system. In fact, the first year health and medical costs of one preterm birth are nearly ten times more than a full term birth.

But, the problem hasn’t gone unheeded.

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ASTHO 2011-2012 President's Challenge: Healthy Babies

Oct 21, 2011, 8:18 PM, Posted by NewPublicHealth

For the last few years, each annual meeting of the Association of State and Territorial Health Officials has kicked off a yearlong President’s Challenge that focuses on a particular health issue impacting all states. Judith Monroe, MD, now the director of the Office for State, Tribal, Local and Territorial Support at the Centers for Disease Control and Prevention used her Presidential Challenge in 2008 to highlight the need to “walk the talk” by promoting wellness in health department worksites.

In 2010 Paul Halverson, director of the Arkansas Department of Health, devoted his President’s Challenge to injury prevention, a topic prominent at this year’s ASTHO annual meeting as well. And last year John Auerbach, state health commissioner in Massachusetts and ASTHO’s outgoing president, made health equity his cornerstone initiative. The focus on these health issues has extended well beyond the challenge year and health officials continue to make them a priority.

For the 2011-2012 President’s Challenge, incoming president David Lakey, MD, commissioner of the Texas Department of Health, is focusing on healthy babies because too many are born too soon, often resulting in developmental and health issues that impact their entire lives.

NewPublicHealth spoke with Lakey about his President’s Challenge, why preventing preterm birth is such a critical issue and key partners across the country to help accomplish his goal to reduce prematurity in United States by 8 percent by 2014.

NPH: How did you come to focus on healthy babies for your President’s Challenge this year?

Lakey: About a year and a half ago when we were discussing the challenges that all of us were facing in the southern part of the United States, Regions 4 and 6, all of us brought up the challenge that we have with prematurity and infant mortality.

I guess the other part of my interest is my background. I’m an infectious disease physician but I did pediatric training and spent time helping to care for premature babies and the consequences that come with that, whether it was intellectual disability or problems with the lungs or other abnormalities.

So we saw this as an issue that we needed to put some focus on. It is also an area that has significant ethnic disparities. If you look at the rates in the African American community, they’re about twice as high as in other populations. And we also started to understand not only the human aspect but also the economic aspect that prematurity is a driver of our Medicaid budgets in our states. We can not only improve health outcomes and improve people’s lives but also do it in a way that saves money for the states and helps us drive our health costs in our system down.

NPH: What are some of the proven strategies for improving these health outcomes?

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