Collaborative Works to Improve Maternal and Child Health in Greater Philadelphia

BY NATALIE COUGHLIN

“I never knew it could get so bad,” she said. Maria, a first-generation immigrant and new mom, describes her depression in a focus group after giving birth to her son during the coronavirus pandemic, who was born premature at 7 months old. Jane, a Black woman and new mom, then shares her painful postpartum recovery and the lack of care by doctors. Like thousands of women in the U.S. every year, Maria and Jane had high-risk pregnancies. The U.S. has the highest maternal and infant mortality rate of any other wealthy country in the world, with significant disparities. Here, Black infants are three times more likely than white infants to die within their first year of life and have a higher likelihood of experiencing long-term health problems (CDC National Vital Statistics Reports 2020). Pennsylvania ranks 29th in national infant mortality rates and although Chester County fares well in economics and health overall, county-level data does not draw attention to the pockets of poverty and barriers to health care for more than 30,000 people (CDC Linked Birth/Infant Death Files 2020; U.S. Census Bureau ACS 2015-2019). In Chester County, Black and Latinx individuals are more likely to be uninsured or underinsured and for women, prenatal health care access also shows racial and ethnic disparities. There is no shortage of research and lived experiences that point to systemic oppression as a main driver of inequity. At the same time, there is a shortage of investment in community-based services to address it. Unsurprisingly, the coronavirus has only elevated these problems. It’s what makes tackling maternal and child mortality one of the most significant and challenging issues of the day. “It takes a holistic approach,” said Milena Lanz, the Executive Director of Maternal and Child Health Consortium (MCHC), a health and social service nonprofit based in Greater Philadelphia. “Poverty is closely associated with adverse health outcomes and there are other factors that play into that. You have to look at the whole person and meet them where they are,” she said. MCHC has a 30-year history of doing just that, helping low-income families with children overcome barriers to good health and alleviating some of the pressures of high health care costs. MCHC helps caregivers access important resources like health insurance, food benefits, and school readiness programs. Their flagship home-visiting program, Healthy Start, focuses on the needs of high risk pregnant and parenting women and their children ages 0-18 months old. The program is guided by a dedicated team of bilingual, bicultural Community Health Workers who live and work in the communities that they serve.

Over 1-2 years, women enrolled in Healthy Start learn about their child’s development, healthy lifestyle practices, and healthy parent-child engagement, all the while having a support system in MCHC that is equipped to meet their needs. Women are screened for Adverse Childhood Experiences and postnatal depression to determine how much support they need. Families are also enrolled into state subsidized health insurance and food benefits programs to relieve the burden of high health care costs and keep healthy food on the table.

The organization sees about 5,000 families each year through its programs, 800 of whom are moms, babies, and participating family members in Healthy Start. The most significant and lasting success of the program has been the decrease in the prevalence of babies born at a low birth weight (< 5.8 lbs.), setting the foundation for healthy development and less likelihood of long-term health challenges.

To make improving maternal and child health a collective effort, last year MCHC launched the Perinatal Periods of Risk (PPOR) Project, also known as the Strategic Partnership Initiative to Reduce Infant Mortality Trends (SPIRIT), under Healthy Start. The project was first introduced by the Pennsylvania Department of Health to help communities use data to understand why babies die before their first birthday and come up with a plan to reduce infant mortality in areas with high rates.

The project calls for an organization with on-theground experience in working with high-risk populations to lead a collaborative of local hospitals, health providers, universities, and other organizations to improve pre and postnatal health services in their community.

So, is it helping? Yes, but steadily. Now well into the three-year project, MCHC is leading this collaborative in Chester County. So far, focus groups have confirmed common challenges that women from different ethnic and racial groups experience in their health care that contribute to disparities. The most common response being that they do not feel listened to when it comes to their health concerns and therefore are not properly treated, leaving them with sometimes severe, yet mostly preventable, health problems for mom and baby.

Focus group feedback, historical data, and county infant birth and death records all help identify the needs within four perinatal periods of risk: prematurity, maternal care, newborn care, and infant health. Over the next two years, the collaborative will identify and implement key prevention strategies, such as monitoring local health insurance coverage rates, clinical guidelines for well-woman visits, mental health support, and social support for caregivers.

At the end of the focus group, a participant thanked facilitators for what they do to help the community. Every day, entire communities rely on human service organizations to meet people’s needs that our system fails to address. For women like Maria and Jane, having a support system that understands their health risks and advocates for their needs can make all the difference. To learn more about these efforts, visit ccmchc.org.