Moving towards measurable outcomes in maternal and child health Yhenneko J. Taylor, MStat State of the Science Congress on Nursing Research September 14, 2012

Acknowledgments Co-author Paper Mary A. Nies, PhD, RN Maternal and Child Health Journal (Epub June 2012)

Overview MCH Issues Study Objectives Research Methods Results of Evaluation Studies Conclusions & Implications

Issues in maternal and child health Healthy People 2020 Goal Infant mortality 6.0 deaths per 1,000 live births Early and adequate prenatal care 77.6% percent of pregnant women Maternal mortality 11.4 deaths per 100,000 live births Low birth weight 7.8% of live births Preterm births 11.4% of live births Preconception health 26.2% women taking folic acid

Strategies to address MCH issues Holistic approaches Social determinants Preconception care Community building Father involvement

Federal efforts around MCH Program Target Benefit Head Start Children ≤5yo Education, medical, and dental Healthy Start Pregnant women and infants <2yo Funds community projects to reduce infant mortality disparities WIC Pregnant women and children <5yo Supplemental food packages Medicaid Pregnant women Prenatal, delivery, and postnatal care

Objectives Examine impact of programs that aim to improve the health of mothers and children under age five Focus on health status and healthcare outcomes Identify gaps in knowledge

Methods for literature review Searched Medline, Academic Search Premier, CINAHL and PsycInfo Inclusion criteria: Published during 2006 to 2011 Assessed program impact on a health status or health care outcome

Four categories of studies Twenty peer-reviewed studies met inclusion criteria

Evaluations of birth outcomes Measures Infant mortality Birth weight Preterm birth Small for gestational age Length of stay Healthy Start 5 studies Mixed results Medicaid 4 studies Lower LBW and PTB WIC 2 studies

Breastfeeding and nutrition WIC (4 studies) Increased breastfeeding initiation Decreased food insecurity No change in exclusive breastfeeding Measures Breastfeeding initiation Food insecurity Exclusive breastfeeding

Maternal health outcomes Measures Depression Family well-being Length of hospital stay Head Start 1 study Reduced maternal depression Medicaid Decreased LOS for disadvantaged women Healthy Start No change in depression

Unintended pregnancy Medicaid Demonstrations Measures Unintended pregnancy rates Cost savings Medicaid Demonstrations 2 studies $2.76 to $4.02 saved per Medicaid dollar 24% fewer unintended pregnancies

Limitations Findings from peer-reviewed studies only Variations in study quality Included only recent studies

Conclusions Large focus on infant and child health in comparison to maternal health Studies are local and utilize large computerized databases Variation in methodological rigor Program benefits may vary by location and setting

Implications for Practice Further research to increase our understanding of what works and help target resources More well-planned evaluation studies are needed Program data can help identify benefits for maternal health

Thank You Yhenneko Taylor ytaylor5@uncc.edu