Racial Equity in Maternal and Child Health Case Studies on Practices and Strategies that Maternal and Child Health Organizations Use to Advance Racial Equity

Practitioners in maternal and child health (MCH) make it a priority to solve complex public health problems facing women, children, adolescents, and their families across the life course. The field of MCH has made significant advances in the past century, including the expansion of family planning methods and services, the eradication of once-common deadly diseases such as polio, and innovations in maternal and child health care that have significantly reduced the rates of maternal and infant deaths.Despite these investments, the health of women and children in the United States lags far behind that of other countries. The U.S. has one of the highest infant mortality rates among developed nations. Furthermore, nearly one in every ten babies born in the U.S. each year are born prematurely, and those who survive face an increased risk of lifelong health challenges. More troubling is the fact that there are extreme and persistent racial inequities in MCH outcomes and, in particular, birth outcomes. Babies born to non-Hispanic African American women are twice as likely to die in their first year of life as compared to babies born to non-Hispanic white women. In some places, inequities continue to grow. In New York City, African American mothers are twelve times more likely to die in the year after childbirth than white mothers, according to the most recent data; a decade ago, their rate of death was seven times higher.Most studies on birth outcomes that have accounted for differences in socioeconomic status among women continue to find racial inequities. Studies have also shown that African American women who abstain from risky behaviors during pregnancy (e.g., smoking, alcohol, or other drug use) still have higher rates of poor birth outcomes than non-Hispanic white women who engaged in some of those behaviors. Repeated exposure to structural, institutional, and interpersonal racism that many women of color experience throughout their lifetimes contribute to inequities in birth outcomes. Furthermore, the history of racial residential segregation, redlining, and systemic divestment in communities of color further compounds and concentrates disadvantage in specific geographic locations

Family, Maternal, and Child Health Through Photovoice

Objective : (1) To introduce photovoice, a participatory action research methodology, for use by MCH program managers to enhance community health assessments and program planning efforts, (2) to enable community people to use the photovoice methodology as a tool to record, reflect, and communicate their family, maternal, and child health assets and concerns, and (3) to educate community leaders about family, maternal, and child health issues from a grassroots perspective. Methods : Photovoice is based upon the theoretical literature on education for critical consciousness, feminist theory, and community-based approaches to documentary photography. Picture This Photovoice project took place in Contra Costa, an economically and ethnically diverse county in the San Francisco Bay area. Sixty county residents of ages 13–50 participated in 3 sessions during which they received training from the local health department in the techniques and process of photovoice. Residents were provided with disposable cameras and were encouraged to take photographs reflecting their views on family, maternal, and child health assets and concerns in their community, and then participated in group discussions about their photographs. Community events were held to enable participants to educate MCH staff and community leaders. Results : The photovoice project provided MCH staff with information to supplement existing quantitative perinatal data and contributed to an understanding of key MCH issues that participating community residents would like to see addressed. Participants' concerns centered on the need for safe places for children's recreation and for improvement in the broader community environment within county neighborhoods. Participants' definitions of family, maternal, and child health assets and concerns differed from those that MCH professionals may typically view as MCH issues (low birth weight, maternal mortality, teen pregnancy prevention), which helped MCH program staff to expand priorities and include residents' foremost concerns. Conclusions : MCH professionals can apply photovoice as an innovative participatory research methodology to engage community members in needs assessment, asset mapping, and program planning, and in reaching policy makers to advocate strategies promoting family, maternal, and child health as informed from a grassroots perspective.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45326/1/10995_2004_Article_486733.pd

Best Babies Zone Basics: A Step-by-Step Guide

BBZ Basics is a step-by-step guide to implementing the Best Babies Zone (BBZ) approach. It is intended for both public health and non-public health organizations looking to start or build upon a place-based, multi-sector, community-driven initiative to reduce racial inequities in infant mortality. The guide moves through the Six Foundational Phases of a BBZ, including how to select a Zone, how to collaborate with residents and build resident leadership, and how to plan for evaluation. The guide also includes a number of tools and resources to help you in the planning process. Use of this guide will enable you to adopt the BBZ approach and support your efforts in creating stronger, healthier neighborhoods where every baby has the best chance in life

Complex Calculations: How Drug Use During Pregnancy Becomes a Barrier to Prenatal Care

Pregnant women who use drugs are more likely to receive little or no prenatal care. This study sought to understand how drug use and factors associated with drug use influence women’s prenatal care use. A total of 20 semi-structured interviews and 2 focus groups were conducted with a racially/ethnically diverse sample of low-income women using alcohol and drugs in a California county. Women using drugs attend and avoid prenatal care for reasons not connected to their drug use: concern for the health of their baby, social support, and extrinsic barriers such as health insurance and transportation. Drug use itself is a barrier for a few women. In addition to drug use, women experience multiple simultaneous risk factors. Both the drug use and the multiple simultaneous risk factors make resolving extrinsic barriers more difficult. Women also fear the effects of drug use on their baby’s health and fear being reported to Child Protective Services, each of which influence women’s prenatal care use. Increasing the number of pregnant women who use drugs who receive prenatal care requires systems-level rather than only individual-level changes. These changes require a paradigm shift to viewing drug use in context of the person and society and acceptance of responsibility for unintended consequences of public health bureaucratic procedures and messages about effects of drug use during pregnancy

Developing an Anti-Racist Foundations Course in MCH for MPH Students.

IntroductionOver the past decade, foundational courses in MCH have been revised and revamped to integrate the life course perspective and social determinants of health in ways that bring these essential issues to the core of the learning experience. Yet the racial reckoning of 2020 and the racially disparate health impacts of the COVID-19 pandemic underscore that a deeper, more focused approach to anti-racist pedagogy is now imperative for MCH educators and others responsible for developing the MCH workforce.MethodsIn this paper, we discuss our experience of building a 'community of practice' of anti-racist MCH trainees through our course, 'Foundations of Maternal and Child Health Policy, Practice, and Science.'ResultsWe identify four principles which guided our course: (1) building on students' experience, knowledge, identities and social justice commitments; (2) creating a common purpose and shared vocabulary related to racism; (3) organizing classroom activities to reflect real-world problems and professional practices related to addressing structural racism as a root cause of health inequities; and (4) building students' skills and confidence to recognize and address structural racism as MCH professionals.DiscussionWe hope that this description of our principles, along with examples of how they were put into practice, will be useful to MCH educators who seek to build anti-racist frameworks to guide MCH workforce development

An ecological study to identify census blocks supporting a higher burden of disease: infant mortality in the Lille metropolitan area, France.

International audienceIn France, reducing social health inequalities has become an explicit goal of health policies over the past few years, one of its objectives is specifically the reduction of the perinatal mortality rate. This study investigates the association between infant mortality and social deprivation categories at a small area level in the Lille metropolitan area, in the north of France, to identify census blocks where public authorities should prioritize appropriate preventive actions. We used census data to establish a neighbourhood deprivation index whose multiple dimensions encompass socioeconomic characteristics. Infant mortality data were obtained from the Lille metropolitan area municipalities to estimate a death rate at the census tract level. We used Bayesian hierarchical models in order to reduce the extra variability when computing relative risks (RR) and to assess the associations between infant mortality and deprivation. Between 2000 and 2009, 668 cases of infant death occurred in the Lille metropolitan area (4.2 per 1,000 live births). The socioeconomic status is associated with infant mortality, with a clear gradient of risk from the most privileged census blocks to the most deprived ones (RR = 2.62, 95 % confidence interval [1.87; 3.70]). The latter have 24.6 % of families who were single parents and 29.9 % of unemployed people in the labor force versus 8.5 % and 7.7 % in the former. Our study reveals socio-spatial disparities in infant mortality in the Lille metropolitan area and highlights the census blocks most affected by the inequalities. Fine spatial analysis may help inform the design of preventive policies tailored to the characteristics of the local communities