maternal and infant health assessment (miha)
TRANSCRIPT
Maternal and Infant Health Assessment (MIHA)
Christine Rinki and Mike Curtis
Surveillance, Assessment and Program Development Section Maternal, Child and Adolescent Health Program
Kristen Marchi
Center on Social Disparities in Health University of California, San Francisco
MCAH Action
May 20, 2015
• Collaborative effort of
– Maternal, Child and Adolescent Health (MCAH) Program
– California Women, Infants and Children (WIC) Program
– The University of California, San Francisco (UCSF)
– Genetic Disease Screening Program (GDSP)
Partners
• Annual population-based survey of women with recent live births
• Addresses maternal and infant social and economic conditions, health behaviors, health status and access to care before, during and after a recent pregnancy
• Provides information not available from other sources to develop, target and evaluate public health efforts
• Modeled after the Pregnancy Risk Assessment Monitoring System (PRAMS) conducted by the Centers for Disease Control and Prevention in 40 states
What is the MIHA survey?
• Health status • Chronic conditions • Mental health • Nutrition and food security • Weight • Health insurance • Service utilization • Breastfeeding • Infant sleep
• Pregnancy intention • Family planning • Childhood hardships • Hardships in pregnancy • Intimate partner violence • Social support • Substance use • Income • Demographics
Topics
• Sample from birth certificates for Feb - May births, excluding: – Non-residents – Women < 15 years old – Multiple births > 3
• Designed to represent all women giving birth in calendar year who meet inclusion criteria
• Questionnaire mailed in English and Spanish with telephone follow-up to non-respondents
• ~6,800 women have participated per year since 2010, with a response rate of 69-70%
• Most women complete survey 2 – 7 months postpartum
MIHA methods
• Additional WIC funding expanded the sample to include selected counties and populations in California
– Counties with the most births (2010-2015)
– Women eligible but not enrolled in WIC (2010-2015)
– American Indians/Alaska Natives (2012-2015)
– African Americans (since 1999)
• Increased sample size improved our ability to report local data for counties with the most births
• MIHA includes enough women from each group to report their information separately
Sample design
MIHA regions, before 2010
MIHA data availability, 2010-2012 births
Top 20 Birthing Counties % of resident women with a live birth in 2011
• Los Angeles ………………….. • San Diego …………………….. • Orange ………………………… • Riverside ……………………… • San Bernardino………………. • Santa Clara …………………… • Sacramento …………………... • Alameda ………………………. • Fresno ………………………… • Kern ……………………………
• Contra Costa …………………. • San Joaquin ………………… • Ventura ………………….…….. • San Mateo ……………………. • San Francisco ……………….. • Tulare …………………………. • Stanislaus …………………….. • Monterey ……………………… • Santa Barbara ……………….. • Sonoma ……………………….
26.0% 8.7% 7.6% 6.1% 6.1% 4.7% 4.0% 3.8% 3.2% 2.9%
2.4% 2.1% 2.1% 1.8% 1.7% 1.6% 1.5% 1.4% 1.2% 1.0%
MIHA data availability, 2013-2015 births
Top Delivery Counties
• 35 counties with largest number of births
• 98% of California births
• In 2010, WIC began funding a portion of MIHA to:
– examine eligible women not enrolled in WIC
– evaluate WIC impact
– examine reasons for not enrolling
• Results inform outreach efforts to increase coverage of populations that need services, at state and local levels
Collaboration with WIC
Collaboration with CDC on Healthy People 2020
Partnership to provide national estimates for 10 Healthy People 2020 Maternal, Infant and Child Health Objectives using PRAMS/MIHA data
16.1 Discussed preconception health with a health care worker prior to pregnancy
16.2 Took multivitamins/folic acid prior to pregnancy
16.3 Did not smoke prior to pregnancy
16.4 Did not drink alcohol prior to pregnancy
16.5 Had a healthy weight prior to pregnancy
16.6 Used contraception postpartum to plan subsequent pregnancy
18 Reduce postpartum relapse of smoking among women who quit smoking during pregnancy
19 Increase the proportion of women giving birth who attend a postpartum care visit with a health worker
20 Increase the proportion of infants put to sleep on their backs
NEW Reduce the proportion of women with postpartum depressive symptoms
Include survey items to address public health priorities
• Tdap and flu vaccination (Immunization Branch)
• Receipt of birth defects screening, reasons for no screening (Genetic Disease)
Analyze existing data to measure health status and access to care
• Oral health problems and access to dental care (Oral Health Unit)
• Maternal smoking before, during, and after pregnancy (Tobacco Control Prog.)
• Hypertension before pregnancy (Chronic Disease / Injury Control)
• Disparities in infant feeding practices (Office of Health Equity; DHCS)
• Infant sleep environment and tobacco use during pregnancy (COIIN)
• Set federally mandated targets and monitor progress (Title V Block Grant)
Collaboration to support public health action
• County and MIHA Regional Statistics – Statistical comparison to the rest of California – By race/ethnicity, income, prenatal health insurance, maternal age, education
• Pooled years 2010-2012
County / Region Sub-group Snapshots have been posted!
• Statewide Statistics
– By race/ethnicity, income, prenatal health insurance, maternal age, education – Other potential subgroups, such as urban/rural, inter-birth interval, geographic
areas with concentrated poverty
2012 MIHA data have been posted!
MIHA publications
Snapshots available for selected counties and all MIHA Regions
Geographic Areas: County or region
compared with California
Statistical Information: Percent, 95% Confidence
Interval, Population Estimate
Symbols indicate statistically better or worse
than rest of state.
MIHA Snapshots by Maternal Characteristics, Selected counties and all MIHA Regions
- 2012
- 2012
Total column for
county/region
Maternal characteristic
columns
Statistical information:
percent, 95% confidence
interval
Public Health Action
Increased awareness of disparities through annual breastfeeding conference Convened CPSP “Lactation Leaders” workgroup to increase breastfeeding support services Developed grant proposal to strengthen lactation services in partnership with FQHCs Revised educational materials to ensure appropriate literacy level and Spanish translation
47 63 63 67
0 1 2 3 4 5
0
10
20
30
40
50
60
70
80
90
100
< High School Hispanic Income belowpoverty
Medi-CalPrenatal Ins
Sonoma County spotlight Disparities in intention to exclusively breastfeed
Sonoma 72
Per
cent
age
of w
omen
who
int
ende
d to
exc
lusi
vely
br
east
feed
(95
% C
I)
The Maternal and Infant Health Assessment (MIHA) Survey is an annual population-based survey of women with a live birth, with a sample size of 13,680 in 2010-11. Percentages and 95% confidence intervals are weighted to represent all women with a live birth in 2010-2011 in California.
Public Health Action • Engage hospitals and
FQHCs
• Identify modifiable risk factors for preterm birth
• Refine populations for intervention
• Set targets for improvement
Specific Initiatives
• MCAH Action Plan to
reduce postpartum depression among low income women
• Gates-Benioff Preterm Birth
37 20 21 18 11 4 3 6 0
10
20
30
40
50
No usualsource of
PREpreg care
No postpartumvisit
Prenataldepressive
sx
Postpartumdepressive
sx
Medi-Cal Private
San Francisco County spotlight Addressing disparities among low income women
Per
cent
age
of w
omen
wit
h in
dica
tor
(9
5% C
I)
The Maternal and Infant Health Assessment (MIHA) Survey is an annual population-based survey of women with a live birth, with a sample size of 13,680 in 2010-11. Percentages and 95% confidence intervals are weighted to represent all women with a live birth in 2010-2011 in California.
San Francisco County spotlight Addressing disparities among low income women
MIHA website
Information about MIHA
project Click tabs to download
MIHA products
MIHA website
www.cdph.ca.gov/MIHA
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More information about MIHA and our publications is available on the website:
www.cdph.ca.gov/MIHA
To be added to the MIHA distribution list or to contact the MIHA Team, email us at
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