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Improving Child Spacing Among Healthy Start Participants

Peggy Vander Meulen, RN, MSN Throughout the Reproductive Life Course: Opportunities and Challenges Empowering Girls and Women Global Technical Meeting April 2 & 3, 2014 Washington, D.C.

Objectives
Today will discuss:
Barriers to accessing and utilizing family planning services Methods to overcome barriers Importance of Racial Equity

Background
Michigan high Black infant mortality

2003 Kent County highest Black IMR Black : White disparity ratio = 4 : 1 Two-thirds from LBW / PTB
Close ICP = 3 to 4 x more likely LBW

46% low-income African American women pregnant within 18 months

Background
Enroll 450 pregnant & IC women / year

Outreach, case management, education


Mental health services, Fatherhood

85-member coalition for systems work


Local, state & national advocacy

Community engagement

Barriers - Systems
Conservative attitudes towards FP

Teach abstinence-only in schools


Funding cuts to Title X provider

No urban FP clinics in GR
Limited public transportation Racism (individual, systemic, internal)

Barriers - Personal
Fear racial discrimination / mistrust

Myths & misinformation


Lack of alternative life goals

Fatalism, apathy, embarrassment


Partner opposes use of birth control Lack transportation, insurance, time

Interventions - Systems
Advocacy

Annual FP Conference
FP Toolkit & EC-friendly pharmacies Healthy Womens Resource Guide Preconception kits & counseling Racial Equity workshops & toolkits

Interventions - Services
Extensive staff training

Reproductive Live Plans


Bi-weekly home visits

Address associated factors (DV, SA)


System navigation, enhanced services

Mens program (HV, groups, barbers)


Community education

Percent of Women Who Experienced a Rapid Repeat Pregnancy


(Less than 18 months from birth to conception) 50 40 30 20 10 0 46 28.3 7.2 All Kent County Medicaid-eligible African American women All African American Strong Beginnings women in Kent women who were County engaged in the program for at least 18 months

Percent

Infant Mortality Rate (IMR)


Moving average per 1000 live births Strong Beginnings and Grand Rapids Black IMR
50

40

Rate per 1,000 live births

30 Grand Rapids Black IMR Strong Beginnins 20 18.3 17.9 17.6 16.7

10

9.8

9.1

9.5

8.5

7.1

0 2005-2008 2005-2009 2005-2010 2005-2011 2005-2012

-Strong Beginnings 2011 2013 IMR: 0 / 1000)

Conclusions Implications for Practice


Invest in staff training

RN / SW: Professional expertise, technical competence, credibility CHW (peer mentor): Personal expertise, cultural competence, trust
Talk early, talk often about FP and reproductive health

Conclusions Implications for Practice Address clients attitudes and motivation (not only give information) Build on clients strengths & life goals Include partners Use culturally appropriate education Overcome practical barriers, and Address racism & discrimination

in order to give women the support they need to access and utilize family planning services and delay subsequent pregnancies for the minimum 18 months recommended

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