Hani K. Atrash MD, MPH Director Division of Healthy Start and Perinatal Services (DHSPS) Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB)
Throughout the Reproductive Life Course: \Opportunities and Challenges for Empowering Girls and Women Washington, DC April 2-3, 2014
What to do How to do it
2
Year
35
Total
30 25 20 15 10 5 0 1982 1985 1988
White
Black
1991
1994
1997
2000
2003
2006
2009
Source: Singh GK. Maternal Mortality in the United States. A 75th Anniversary Title V Publication. HRSA 2010
Callaghan et al: Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol 120:1029-36, 2012
Risk factors for adverse pregnancy outcomes among women who recently delivered a live-born baby PRAMS 2004 Preconception health conditions and behaviors
Behavior /Condition Underweight (BMI < 19.8) Overweight (BMI 26 to 29) % 13.2 13.1 Behavior /Condition Previous Low Birthweight Previous preterm delivery % 11.6 11.9
21.9
1.8 6.9 2.2 1.2 10.2 Tobacco (3 months bef preg) Alcohol (3 months bef preg) Multivitamins (>=4/week) No contraception/not planning Pre-preg counseling 23.2 50.1 35.1 53.1 30.3
Heart Heart
Ear Ear
Missed Period
it is too late!
Working smarter
What we do - Work beyond the 9 months of pregnancy:
How we do it:
Comprehensive womens health Preconception / interconception Across the life span - Life-course approach Circles of influence COINs Collective impact
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Circles of Influence*
Transportation Infant
Health Program Directors
Infants Family
Infants School Community and faith agencies Police, Fire and Safety
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The Collaborative Innovation and Improvement Network to reduce infant mortality, and Healthy Start
Gloor PA. Swarm Creativity: Competitive Advantage through Collaborative Innovation Networks. New York: Oxford University Press, 2006.
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Uses the science of quality improvement and collaborative learning Team driven
o Phase 1: Regions IV and VI (13 states) o Phase 2: Region V (6 states) o Phase 3: National (31 states)
Part of a portfolio of efforts to improve birth outcomes and works in partnership with these initiatives
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Teams
5.
Data Dashboard
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25% total decline translating to ~50,000 early, elective deliveries averted since 2011 Q1
11%
9% 7%
Region VI Combined Region IV
5%
2011 2011 2011 2011 2012 2012 2012 2012 2013 2013 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2
* Based on provisional birth certificate data; excludes women with pre-existing conditions
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8% total decline translating to ~8,000 fewer women smoking in pregnancy since 2011 Q1
* Based on provisional birth certificate data reflecting smoking in any trimester; 3 States using unrevised birth certificate; 1 State excluded that did not report 2013 data
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Established in 1991 as a presidential initiatives Started as a 5-year demonstration project Targets communities with high infant mortality rates and other adverse perinatal outcomes Initially focused on community innovation and creativity Today, HRSA supports 105 grants in 196 counties, in 39 States, DC, Puerto Rico
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Low birth-weight rate =10% compared with 8.1% nationally, and 13.53% for African Americans Very low birth-weight rate 1.7% compared with 1.45% nationally, and 2.98%for African
Americans
A profile of Healthy Start: Findings from the Evaluation of the Federal Healthy Start Program 2012
and Evaluation
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