Preventing Infant Mortality in Georgia February 2019 - Page 15

By Andrea Young Kellum, MPH, Senior Program Officer, and Gary D. Nelson, PhD, President, Healthcare Georgia Foundation ealthcare Georgia Foundation identified program sites, strategies, and outcomes based on evidence-based approaches to address adverse birth outcomes in Georgia. The implementation and evaluation of the Promising Approaches to Improved Infant Health demonstration program allowed the Foundation to identify the most promising approaches to improve infant health outcomes using the Perinatal Periods of Risk framework (PPOR) and directly informed the second iteration of grant support for the Taking Care of You (TCOY) Initiative. The PPOR framework defined and led to the selection of evidence-based practices and identified the need to move to a more upstream approach, by focusing on improving women’s health before, during and after a pregnancy. Ensuring that women achieve their optimal levels of health provides a “protective” effect to ensuring positive maternal and infant health outcomes. Here are a few thoughts as the Foundation reflects on the overall impact of TCOY and lessons learned: Was the investment in public health districts the right choice? To maximize the impact of our investment, the Foundation supported evidence-based strategies to reduce adverse birth outcomes in communities that were previously demonstrated to have high disparities. The three public health districts that were awarded funding are trusted community resources and were found to be a critical pathway to outreach and enrollment, especially considering they already had access to high-risk women (primarily African-Americans) through public health programs such as family planning and Women, Infant and Children (WIC). The TCOY grantees broadened the focus of their programs beyond prenatal care to also address preconception and interconception care. Reproductive life planning and providing education and access to contraception methods proved to be effective strategies in reaching women in the preconception period. Education on breastfeeding, appropriate child spacing, and safe sleep helped to reach women in the interconception period. Ultimately, focusing on overall women’s health allowed the public health agencies to reach a larger audience of women, partners, and families beyond those participating in the program interventions. Lessons learned from TCOY provides a framework for how other public health departments can implement evidence-based programs among the different sectors of public health departments (e.g. WIC, STD clinics, family planning, etc.) to ensure that women receive the right care at the right time and place. What is the significance of the data? No TCOY grantee sites experienced sleep-related infant deaths from 2014-2016. In Clayton, Lowndes and the Dougherty sites, there were infant deaths among the county comparator groups. The sample sizes were small; however, the grantees targeted higher risk African-American women at these sites, which further highlights the success of zero infant mortality. While there were improvements in the rates of preterm births during the grant period among the four grantee sites, some of the rates increased in 2016, which was similar to the national trend of rising preterm birth rates. The rising rates of preterm births are troubling and signal the importance of continued efforts to address women’s health. (Continued on page 16)