# Presentation: 654573

## Giving Children a Level Playing Field: Perinatal Health Disparities

- Rev. Jeannine R. Smalls, MSW, M.Div.
- Planning & Development Consultant
- Faith-Based and Community Initiatives
- SC DHEC
- February 21, 2005

**Notes:**
I am very pleased to have the opportunity to talk with you today about infant mortality in SC.  On an average day in SC, 150  births will occur;  one infant death will occur; and one fetal death will occur.  These are significant infants for parents, families, providers of care, communities, and the welfare of our state.  
I want us to look first at SC’s birth rates, IM rate, and the leading causes of death.  Next, we’ll review some of the strategies that have been used in SC to reduce infant mortality and what some of the challenges are for the future.
Please ask questions or make comments as we go along.  I much prefer for this to be interactive.

## More than a number.....

- Infant mortality is a critical indicator of the health of a society.
- Overall state of reproductive age women’s health
- Quality and accessibility of primary health care
- Predictor of the health of the next generation

**Notes:**
Sometimes the numbers of an occurrence may seem small such as with IM and may be misleading about the implications of the event.  IM is widely held to be an important measure of a nation’s health and as a worldwide indicator of health status and social well-being.  The IM rate provides a thermometer, if you will, of the health of women, and the availability and access to health care.  It also provides us with an indicator of what the health of children will be and their health as adults.

## Live Births by Race of Mother:South Carolina, 1977 - 2002

**Notes:**
In 2002, 54,453 live births to SC residents were recorded.  As you can see, the highest number of births occurred in 1990 with over 58,000 live births.
In 2002, slightly less than half of all live births are paid for by Medicaid.  

## South Carolina and United States Infant Death Rates

**Notes:**
The rate of infant deaths is a major indicator of the health status of our population.  Over the past decade, the nation and SC have made steady progress in the number of babies who are living through their first year.  During 1986 - 1996, SC's infant death rate declined at a faster rate that the rate for the nation as a whole. 
However, in 1997, the long-standing improving trend seen by SC turned around while the trend for the nation continued downward and improving. “99 was 10.3
 A total of 507 infants died in our state in 2002, resulting in an infant death rate of 9.3 deaths per 1,000 live births.  US rate for 2001 was 6.8 down from 6.9.

## SC Infant Mortality Ratesby Race, Residence Data, 1984 - 2002

## Leading Causes of Infant Death, SC Residence Data, 2002

**Notes:**
Disorder relating to short gestation and low birthweight were leading cause of IM in SC in 2000.  Total 95, W 23, B 72.
Congenital anomalies T 89. W 42 b 47
SIDS  t 37, w 16, b 21
Maternal complications t 25, w 9, b 16  incompetent cervix, multiple pregnancies, PROM

## South Carolina and the United States Neonatal Death Rates by Race

**Notes:**
Neonatal mortality is the death rate for infants up to 28 days old; this is the most fragile period of a young life after birth.  In 2001, the US rate for white neonates was 3.8  per 1,000 live births and was 3.8 in SC.   For Black infants, the US rate per 1,000 live births was 9.2 and in SC was 10.1.  Total for US was 4.5 and for SC was 6.0.
The gap between the Black and White neonatal death has persisted through the years and has remained fairly stable.  
The leading causes of death during the neonatal period are low birthweight and conditions such as congenital anomalies, prematurity, respiratory complications, infections, maternal complications and hemorrhage.
We need to increase our focus on prevention issues the more directly affect neonatal mortality such as LBW and birth defects.

## South Carolina and the United States Postneonatal Death Rates by Race

**Notes:**
SC’s rate for all in 2001 was 2.9 deaths per 1,000 live births. US rate was 2.3
SC White rate was 2.0 and US white rate was 1.9
SC Black rate was 4.4  And US rate was 4.8 
 The leading causes of deaths in the postneonatal period include congenital anomalies, SIDS, septicemia, accidents and their adverse conditions.  Congenital anomalies appear to be a constant threat throughout the first year and the risk of death use to respiratory distress appears to diminish as the newborn survives past the neonatal period.

## Percentage of Infant Deaths by Birthweight GroupSC residence data, 2001 - 2002

**Notes:**
This chart reinforces that birthweight is a critical measure of risk for infant death.

## South Carolina Low Birth WeightInfants by Race

**Notes:**
The percentage of low birth weight babies is climbing.  These premature and smaller babies are at higher risk for dying, developing chronic illnesses and conditions, and experiencing developmental delays and learning problems.  LBW is a birth weight less than 2,500 gram or 5.5 pounds.  Very low birth weight babies, less that 1500 gram or 3.5 pounds are more than 200 times more likely to die in the first month of life than in infant weighing more than 5.5 pounds.
Although the increase is for all groups, the greatest increase can be observed among Blacks.  Black infants continue to be almost twice as likely to experience low weight at birth than white infants.  In the US preterm birth is much more common among Black than White women and is associated with 75 percent of newborn deaths not caused by congenital anomalies.

## South Carolina Women Entering Prenatal Care in the First Trimester

**Notes:**
Early prenatal care is important to help women recognize and discontinue behaviors that put their pregnancy in jeopardy and to get the early medical care they might need.
In 2002, 78 percent of pregnant women in SC started prenatal care during the first three months of pregnancy.  This represents a slight decline.
The trend appears to be leveling off.  

## Infant Mortality Rate for Multiple Births in SC, All Race, 1998 -2002

**Notes:**
2002 IMR highlights page 3

## Percent of Unintended PregnanciesSouth Carolina, 1993-2001

**Notes:**
Almost half of all babies born in SC are the result of an unintended pregnancy.  An unintended pregnancy increases the risk the that mother may fail to seek prenatal care, fail to take care of herself and the unborn baby by not eating the right foods, and fail to quit unhealthy behaviors such as smoking and drinking.  A baby born under these circumstances is more likely to be born at a low birth weight, develop chronic illnesses and condition or die before their  first birthday.
2001:  Unintended 48.2
Mistimed 37.5
Unwanted 10.8

## Perinatal Regionalization

- System for organizing and maximizing resources
- Levels of Care established for inpatient obstetrical and neonatal services
- Most high risk mothers and infants cared for in “Regional Perinatal Centers”
- Ensure education
- Provide surveillance of population

## South Carolina Perinatal Regions

**South Carolina Perinatal Regions**

**Spartanburg**

**Cherokee**

**Union**

**Greenville**

**Pickens**

**Oconee**

**Anderson**

**Abbeville**

**Greenwood**

**McCormick**

**Laurens**

**Saluda**

**York**

**Chester**

**Fairfield**

**Newberry**

**Edgefield**

**Lancaster**

**Kershaw**

**Richland**

**Lexington**

**Aiken**

**Orangeburg**

**Calhoun**

**Clarendon**

**Sumter**

**Lee**

**Barnwell**

**Bamberg**

**Allendale**

**Hampton**

**Horry**

**Colleton**

**Charleston**

**Dorchester**

**Berkeley**

**Georgetown**

**Jasper**

**Beaufort**

**Williamsburg**

**Chesterfield**

**Marlboro**

**Dillon**

**Darlington**

**Florence**

**Marion**

- Midlands Perinatal Region

- Palmetto Richland Memorial Hospital

- Pee Dee

- Perinatal Region

- McLeod Regional

- Medical Center

- Low Country

- Perinatal Region

- Medical University of South Carolina

- Piedmont

- Perinatal Region

- Greenville Hospital System

- (Greenville, Pickens, Anderson, Oconee,Abbeville, Laurens, Greenwood, Saluda, Edgefield, McCormick)

- Spartanburg Regional

- Medical Center

- (Spartanburg, Cherokee,

- Union, Chester)

## Fetal and Infant Mortality Reviews (FIMR)

- 	*Community-owned effort to better understand the pattern and occurrence of fetal and infant deaths and to develop local strategies to reduce these deaths.*

## Other traditional strategies

- Early & Adequate prenatal care
- WIC enrollment
- Caring for Tomorrow’s Children Program
- Healthy Start projects: 3 grants in SC

## The African Methodist Episcopal Church’s Response

*To Infant Mortality*

## Slide 19

## A Faith Based Structure for Success 

## AMEC Structure Continued:

- Therefore we have,
-  609 Congregations with more than
-  246,000 congregants statewide.
- Local Church pastors are accountable to the Presiding Elder of the districts, and the Presiding elders are accountable to the Conference and the Presiding Bishop.

## Slide 22

## Strategic Goal Number 2 is one of the Priority Area

- To Develop an AME Health Agenda targeting Children.
- Short-term Outcome:
- # of congregation members who can identify 2 ways to prevent infant mortality

## Slide 24

## Partnership with Faith Community

- AMEC Ministers’ Wives and Widows Alliance SKIING Initiative.
- Grant from March of Dimes
- Infant Mortality Curriculum
- “Vitamins for Brides” kits
- Baby Showers and Baskets for Expecting Parents
- Oral Health Initiative for Pregnant Women

## SKIING:    Supporting Kids and Infants Into the Next Generation

- SKIING is aimed at reducing infant mortality in the African American Communities of SC through the education of AME Leaders, members, and interdenominational partners.

## Infant Mortality Curriculum

- Provides for on-going training about infant mortality, it’s causes and ways to reduce risks, using a table top binder with a curriculum designed in partnership with SC DHEC.

## “Vitamins for Brides”

- An Initiative of the Ministers Wives and Widows Alliance to increase intake of folic acid.  As a part of their pre-marital counseling sessions, ministers will distribute a kit with information to educate and encourage women to consume folic acid every day.

## “Basket for Parents to Be”

- An Initiative of the Ministers Wives and Widows Alliance to educate “parents to be” about prematurity, the role of the fathers, and the implementation of strategies in congregations to improve birth outcomes.

## Oral Health & Pregnancy

- Studies have shown that infections caused by peridontal disease (gum disease) can raise a woman’s risk of having a baby too early and too small.
- The Women’s Missionary Society of the AMEC adopted this initiative to educate pregnant woman on the risk of peridontal disease.

## Oral Health Initiatives:

- In the month of February, the Bishop declares “_Oral Health Sunday_” for all AMEC statewide.
- _Oral Health Summit_ designed to educate Missionary Ladies on the risk of oral health problem in pregnant women and to encourage additional interdenominational partnerships.

## Continued.....

- District Oral Health Initiatives were developed by several of the districts to:
- 1. 	Encourage and maintain adequate        	nutrition
- 2.  Encourage regular brushing & 		flossing
- 3.  Use a fluoride rinse daily &
- 4.  Maintain routine dental visits.

## Other Strategies for Reducing Infant Mortality in SC

- Increase Emphasis on Preconceptional Health
- Providers
- Public Awareness
- Decrease Unintentional Pregnancies
- “Closing the Health Gap:  African American-Focused Risk Reduction”

## SC Infant Mortality Rates by Race (Updated)

- Per 1,000 live Births in 2003 for........
- All Races: 8.3 compared to 9.3 in 2002
- Whites:  5.9 compared to 5.9 in 2002
- Black & Other: _**13.0**_ compared to _**15.4**_ in 2002.

## “TOGETHER WE CAN MAKE A DIFFERENCE”

- Rev. Jeannine R. Smalls, M.S.W., M.Div.
- Office of Minority Health, SC DHEC.