1. Healthy Start Coalition of Jefferson, Madison & Taylor Counties, Inc. State of the Infant Madison County 2014

2. Madison County Birth Counts 205 babies born in 2013 (212 in 2012) –99 White (112 in 2012) –101 Black (97 in 2012) –5 Other (3 in 2012)

3. Population Estimates 2012

4. Infant Mortality – a volatile indicator No infant deaths 2013 Rolling three year averages 7.7 infant deaths per 1,000 2011-2013 FL is 6.2 From worst (2010-2012) in state 9 babies rate = 14.1

5. Volatility explained

6. Fetal Death Rate Improves 2 fetal deaths in 2013 Rolling three year average = 7.7 fetal deaths per 1,000 deliveries 2011-2013 FL is 7.2 second worst in state (2010-2012) 7 babies rate = 10.9

7. Low Birth Weight Currently, highest rate in the State of Florida 84 babies born below 2500g (5.5 lbs) Rate is 13 per 1,000 live births Was ALSO worst in state 2011-2012; 75 babies rate = 11.8 Why is it moving in the wrong direction?

8. Is it Obesity During Pregnancy ??

9. Is it Pregnancy Intervals? 35.4% of pregnancies in Madison County are not adequately spaced

10. Is it the support system? 61.1% of births in Madison County are to an unwed mother, 4 th highest in state

11. Worth Mention 23.8% of adults over the age of 25 (2011) in Madison County had NO high school diploma Gadsden tied Madison area has second highest positive screening rate for Healthy Start 47% (Gadsden 56%, State is 24%)

12. Healthy Start Prenatal Screening 163 of 205 pregnant women responded (screened) 2012-2013 Results

13. More results

14. Madison Healthy Start Of the total births in Madison County in FY 12/13, 79% were screened for Healthy Start (n=163) 77 were positive for risks for poor birth outcomes, another 18 were professionally referred 87 NEW pregnant women were reached by Healthy Start and funneled into care

15. More… A total of 158 pregnant women received a Healthy Start service in Madison County 17 of these were high-risk 87 infants (ages 0-3) received a Healthy Start service; 10 were highest risk 18 infants/families received Parents as Teachers

16. Good News/ Bad News Madison County has THE lowest rate of REPEAT births to teens ages 15-19 (7.7 per 1,000 2011- 2013) Gadsden is third highest at 22.4 Breastfeeding rates are going in the wrong direction Breastfeeding Initiation BlackWhite 2011-1337.8%68.1% 2010-1239.9%71.9% 2009-1144.6%71.5%

17. More good… Madison County traditionally has high rates of EARLY entry into prenatal care - 82.2% of pregnant women seek care in the first trimester (2011-13) Florida avg. is 80%, Gadsden is 78.4%

18. Root Causes Obesity contributing to preterm birth, low birth weight Access to care – Health Department is a SAFETY NET Health Literacy Perpetual Poverty Cyclical FASD

19. Fetal Alcohol Spectrum Disorder An underlying cause of poor school readiness rates An underlying cause of poor school performance An underlying cause of disproportionate rates of juvenile offenses, and subsequent D.O.C. involvement

20. Types of FASD Fetal Alcohol Syndrome (FAS): FAS represents the severe end of the FASD spectrum. Fetal death is the most extreme outcome from drinking alcohol during pregnancy. People with FAS might have abnormal facial features, growth problems, and central nervous system (CNS) problems. People with FAS can have problems with learning, memory, attention span, communication, vision, or hearing. They might have a mix of these problems. People with FAS often have a hard time in school and trouble getting along with others. Alcohol-Related Neurodevelopmental Disorder (ARND): People with ARND might have intellectual disabilities and problems with behavior and learning. They might do poorly in school and have difficulties with math, memory, attention, judgment, and poor impulse control. Alcohol-Related Birth Defects (ARBD): People with ARBD might have problems with the heart, kidneys, or bones or with hearing. They might have a mix of these.

21. Completely preventable

22. Why focus on minority health? Highlights of the Minority Health profile –Black infant death rate was 13.2, compared to 3.0 for whites (2011-13) –Fetal death rate was 6.5, compared to 6.0 for whites (2011-13) –Individuals below the poverty level 33.1% for blacks, 13.6% for whites (2006-10) –Births to unwed mothers 2.4:1 ratio (2010-12)

23. Why focus on minority health? -cont’d highlights –Births < 37weeks gestation 17.6% for blacks, compared to 11.5% for whites (2010-12) –Births to obese mothers 1.6:1 ratio (2010-12) –Death rate for coronary disease 1.9:1 (10-12) –Hospitalization rate for stroke 2.2:1(10-12) –Incidence rate for prostrate cancer 1.9:1(08- 10) –Death rate from diabetes 3.3:1 (10-12)

24. Food for thought

25. Solutions Whole Child Connection Medical Home Linkages for African American women Education to consumers on Medicaid Reform Advocate at state level for rural allocations Quality Programming Nutrition and Obesity prevention