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 MeetingApril 2 & 3, 2014Washington, 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 Women’s 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

Men’s program (HV, groups, barbers)

Community education

Percent of Women Who Experienced a Rapid Repeat Pregnancy (Less than 18 months from birth to conception)

46

28.3

7.2

01020304050

All Kent CountyMedicaid-eligibleAfrican American

women

All African Americanwomen in Kent

County

Strong Beginningswomen who were

engaged in theprogram for at least

18 months

Per

cent

Infant Mortality Rate (IMR)Moving average per 1000 live births

Strong Beginnings and Grand Rapids Black IMR

18.3 17.9 17.6 16.7

9.8 9.1 9.5 8.57.1

0

10

20

30

40

50

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

Rat

e pe

r 1,0

00 li

ve b

irths

Grand Rapids Black IMRStrong Beginnins

-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