An innovative program, Moms2B, is helping to reduce the infant mortality rate in babies born to mothers with low socioeconomic status in the Weinland Park area of Ohio. The infant mortality rate of babies born to mothers who participate in this free community based support group that runs throughout pregnancy and the child's first year experience was lower than before the program was implemented. Additional maternal infant health benefits were also observed. The results of the study: Improving Maternal and Infant Child Health Outcomes withCommunity-Based Pregnancy Support Groups: Outcomes from Moms2B Ohio were published this month inThe Journal of Maternal Child Health.
Infant mortality rate (IMR) is the number of live born infants dying in the first year of life per 1000 live births. This rate can often be reflective of the overall health of a community, region or country as it reflects both maternal and infant health. In the USA, the IMR has been consistently declining over the years and reached an all-time low of 5.87 per 1,000 in 2015. (Matthews et al, 2015). Despite the decline, infant mortality rates for African American babies is twice as high as for White babies in the USA. This current rate is also higher than rates in less developed countries. (March of Dimes, 2016)
Medical and social conditions are interconnected and both have an impact on the health of pregnant people and babies. Poverty, food insecurity, housing insecurity, domestic violence, short intervals between pregnancies, absent parents, lack of reliable transportation, drugs, alcohol, racism, untreated mental illness, previous childhood and sexual abuse history and other conditions all impact the health of the parent during pregnancy, the birth outcomes and the health and safety of the child. African American infants experience lower breastfeeding rates, are at higher risk of infections and sleep-related deaths compared to their White counterparts. Early and consistent access to prenatal care, especially in a group setting, additional support and home nurse visits amongst other things, all reduce the incidence of preterm birth and improve infant health. The effectiveness of the program in reducing IMR was assessed by examining the IMR before initiation and after the program ran for four years.
Faced with striking and disturbing infant mortality rates among these populations, the Ohio Collaborative to Prevent Infant Mortality was formed and one of the programs to come out of that effort was the Mom2B community intervention program. Mom2B is a weekly program focused on nutrition along with social and medical support. In addition to the support group, weekly meals are offered. Centered in Weinland Park, this area had the highest rates of violent crime in the Columbus, Ohio area. This area also suffered from circumstances that foster conditions that have a major impact on maternal infant health.
Once a pregnant person joined Mom2B, they met with the program facilitators and other program participants weekly for two hours. Nutrition, pregnancy and parenting topics were covered along with assistance in connecting people to needed medical and social services. A healthy meal was also available. Breastfeeding support was provided from a lactation consultant. Follow up text messages and telephone calls were sent/made during the week between in-person meetings to create positive relationships between participants and Moms2B staff. The rotating six-month curriculum, (which is available by request from the study authors), covered: nutrition, mental health, pregnancy, reproductive health, parenting, and infant safety topics. Onsite childcare was provided if parents needed support in order to participate. Emergency food bags were also supplied and a local food bank truck stopped by regularly. Program participants were visited in the hospital after birthing by a Mom2B facilitator and then once returning home were provided home nurse visits.
The entire Mom2B team was made up of social workers, dietitian, pediatrician, obstetricians, community educators, family advocates and more. The program has had a high retention rate as relationships were developed from continued attendance and both emotional and logistical support that was provided along with relevant education. The relationships and connection were also strong between participants who supported each other as well in peer to peer relationships.
Program costs have run about $2200 per person served per year. While this cost might seem high, the cost should examined in the context of the societal cost of preterm birth. A premature infant incurs much higher medical expenses than a full term infant, partly because of the initial period of hospitalization and the increased medical utilization costs that continue into childhood as well (Petrou et al. 2011). The majority of the participants were Medicaid recipients. Medical care costs alone from birth through age five for preterm children are estimated to be $31,290 per case (2005 dollars) (Behrman and Butler 2007). Furthermore, preterm birth has other direct and indirect costs associated with it such as lost parental wages, increased use of social services, and a greater need for educational interventions when the children born prematurely are in school.
The Mom2B participants were at high risk of adverse maternal and infant health outcomes due to previous stillbirths, existing medical conditions, socioeconomic conditions and other known risk factors.
In the four years (2007-2010) before the Mom2B program started in Weiland Park, there were 442 births and six infant deaths (IMR of 14.2 per 1000 births). In the four years (2011-2014) since Moms2B was initiated, there have been 328 births and only one infant death. (IMR of 2.9 per 1000 births.) The one death was of a child who's mother did not participate in the Mom2B program. This is not a statistically significant decrease but is certainly worth noting.
Other results to be noted include seven repeat pregnancies of participants, and all the intervals between deliveries were a healthy 18 months or more. There was not a statistically significant difference in low birthweight infants, or in prematurity, which is believed to be the result of the large number of multiple births and also, the authors feel, is due to the overrepresentation of African American parents in the program. Breastfeeding rates at hospital discharge nearly doubled among program participants.
In post program surveys - most women agreed or strongly agreed that the program gave them a better understanding about their health, available health care services, and their medical care. Most of the women said they learned to eat healthier, to be more physically active, and to follow their health care provider’s recommendations.
The authors believe that a major strength of the Moms2B program includes the success of recruiting and retaining pregnant women living in poverty and providing a multidisciplinary model to address the social determinants of health extending through the infants’ first year of life. There was an additional benefit of including health science undergraduate and graduate students in the model. They both learn from and mentor the pregnant and parenting women. This provides an opportunity to improve empathy and reduce racism among future health care providers when they participate in such community-based programs.
The study authors summarize the overall results:
"In summary, we have found that the introduction of a community-based interdisciplinary model aimed at addressing the social determinants of health was associated with important improvements in maternal and infant health outcomes, most notably a decline in infant mortality from 14.2 to 2.9 per 1000. While these findings await confirmation, the preliminary success of this program suggests that this model could offer promise to other similar communities at high risk of adverse maternal and infant health outcomes."
When I read the study for this review, I couldn't help but think how replicable and affordable the program is when compared to the health and cost savings for both babies and parents. I also consider the valuable role that a childbirth educator could play as a member of the coordinated team. Do you have a program like this in your community? Would you be interested in bringing or working on such a program? The authors have stated that they are happy to share resources for those interested in offering a Mom2B program in other communities. Check out the Mom2B website for more information or contact lead investigator Patricia T. Gabbe.
Behrman, R. E., & Butler, A. S. (2007). Preterm birth: Causes, con- sequences, and prevention. Washington DC: National Academies Press.
Gabbe, P.T., Reno, R., Clutter, C. et al. Matern Child Health J (2017). doi:10.1007/s10995-016-2211-x
March of Dimes. (2016). PeriStats. White Plains, NY. Retrieved, from http://www.marchofdimes.org/peristats/Peristats.aspx.
Matthews T. J., MacDorman, M. F., & Thoma, M. E. (2015). Infant mortality statistics from the 2013 period linked birth/infant death data set. National Vital Statistics Report, 64(9), 1–30.
Petrou, S., Eddama, O., & Mangham, L. (2011). A structured review of the recent literature on the economic consequences of preterm birth. Archives of Disease in Childhood – Fetal and Neonatal Edition, 96(3), F225–F232. doi:10.1136/adc.2009.161117.`