The Low Country Healthy Start Program

The health of a nation plays an integral part in the overall success and economic well being of a particular country. The United Stated, while pouring more money into the healthcare system than any other country, still stands as a broken system with inadequate care for many citizens. One of the most marginalized groups of people, African American women, continually score alarmingly low on basic measures of overall health. The healthcare discrepancies between white and black women in the United States are alarming, and they reveal flaws in the American health care system as a whole.

Infant mortality rate constitutes the death of a baby before their first birthday. Mortality rates around the world differ tremendously with America leading the first world countries at an alarming rate of 6.1 deaths per 1,000 births. Conversely, Finland and Japan secure the last, most desirable position, with deaths totaling 2.3 per 1,000 births, as of 2010. (Ovaska-Few, 2015) In 2014, over 23,000 babies died in the United States. (CDC, 2016) Exploring the mortality rates in America brings light to a dire need for additional interventions and research as to why this developing nation has the highest rate of infant deaths before the age of 1 year old. African Americans face the worst outcomes of infant death compared to whites, Latino, and their Native American peers in North Carolina. (Ovaska-Few, 2015) This paper will explore why African American are the leading race for infant mortality and the steps that health communities need to take to address this devastating occurrence.

Why do African Americans have a higher rate of infant mortality, low birth weights and preterm delivery? Evidence

It should be noted that these services vary according to population needs, with some studies even indicating that services vary based on the racial background of the participants (Evans, Labbok, & Abrahams 2011). This should be a cause for concern, and discrepancies in services provided must be avoided to limit further disparities. Data from the Centers for Disease Control (2016) found that in 2010, the rates for breastfeeding initiation was 74% for Native American women, which was lower than other groups. In order to better combat breastfeeding disparities, the WIC program continues to tailor their breastfeeding support services to achieve the Healthy People 2020 goals by increasing the number of trained staff, holding community involvement sessions, and constructing additional educational components.

The United States is a melting pot of cultural diversity. For a country that was founded by individuals fleeing persecution, it has taken us many years to grant African-Americans equal rights, and even longer for those rights to be recognized. Despite all the effort to eliminate inequality in this country, health disparity among this minority group remains a significant issue. Research in this area has pointed to several key reasons for this gap that center on differences in culture, socioeconomics, and lack of health literacy.

Major disparities continue to exist in spite of America’s “Affordable Care Act”, Although minorities suffer disease five times greater than the rest of the nation, minorities represent the majority of the disparity. Infant Mortality has always been America’s indicator as to the state of the countries health status. America is one of the wealthiest and most powerful nations in the world, However, America ranks number 24th in the world for infant mortality. Puerto Rican and Indian women rank highest among ethnic classes with low infant mortality rates. Some researchers have found lack of prenatal access as the key contributing factor to low mortality and birth weights among these two ethnic classes.

Death and illnesses among women, infant, and child are preventable. In pregnancy, existing health risks can distinguish or prevent any future health problems for women and their children. According to U.S. Department of Health and Human Services (2016), some high-risk factors that may consider are the following: hypertension, heart disease, diabetes, depression, genetic conditions, sexually transmitted diseases, tobacco and alcohol abuse, inadequate nutrition and unhealthy weight. By having this government Healthy 2020 initiative, factors that can affect the pregnancy and childbirth such as poverty,

Currently, Community Prevention Partnership of Berks County, Nurse Family Partnership, home visitation Program, provides services to first time low income expectant mothers. The organization has been delivering the program for many years. Successfully, the program serves 250 families. The Berks county, Nurse Family Partnership program has served 1600 first time poor mothers, and 1250 children since it began. Most NFP clients by the time of referral are 18 years of age. Accordingly, the thirty-one percent of this first-time mothers receives Supplemental Nutritional Assistance Program (SNAP) and about fifty five percent are receiving Medicaid assistance. In fact, the household income average is 16, 000 and fifty two percent of mothers have not obtained a high school or GED diploma. Indeed, NFP outcomes involves maternal and child’s development education, referral and follow ups. Also, the program encourages breastfeeding, immunization updates developmental screenings. It has reduced smoking during pregnancy by 16.9% as well as prematurity rate by 4.5 %. (Michalopoulos, Lee, Duggan, Lundquist, Tso, Crowne, Burrell, Somers, Filene, & Knox, 2015).

Premature birth is an important public health priority in terms of health of women and infants. Every year an estimated 15 million preterm babies are born and this number is still rising (WHO, 2015).In 2014, 1 of every 10 babies born in United States were premature and black infants were 50% more likely to be born premature than white, Hispanic and Asian/Pacific islander infants (CDC,2015). Almost 1 million children die each year due to complications of premature birth (WHO, 2015). Major survivors face lifelong disabilities like learning disabilities, hearing, visual, feeding, digestive, breathing and respiratory problems (CDC, 2015) and low birth weight (March of Dimes, 2014). A major challenge in decreasing the rate of preterm birth is

Receiving good prenatal care is extremely important for an expecting mother. The prenatal period has a great impact on the newborn's health. Low birth weight is a problem among a certain population of newborns. It is crucial to understand the conditions in poverty and its

Reduced infant disparities; patients have lower rates of low birth rate (U.S. low income low birth rate percentage 8.2% vs Health Centers 7.5%).

In the United States, there are disparities between the different racial groups when it comes to low birth weights and premature births. Evidence of this can be seen with information collected Reichman (2005). She found that African Americans have the highest rate with this accounting for 13.0%. While whites are reporting 6.5% and Hispanics are seeing figures of 6.5%. However, inside the Hispanic demographic there are differences in these numbers as Puerto Ricans have 9.4%. These disparities are not tied to economic status with many educated African American women having children of low birth weight. Whereas, there are differences between select segments of the Hispanic population in contrast with other sub groups. (Reichman, 2005)

Healthy People 2020 is a promotion to help raise public awareness by providing measureable objectives and goals for individuals to obtain higher qualities of lives, decrease premature deaths, and promote a higher quality of life (US Department of Health and Human Services, 2014). Healthy People 2020 has monitored its progress for over three decades between communities over the nation to understand where prevention measures are needed most. Fielding, Teutsch, & Koh (2012) projected that Healthy People 2020 will project a greater emphasis on social needs when it comes to health care disparities and will focus on education and income across the reform. One strength I noticed, when navigating through U.S. Department of Health and Human Services

David and Messer (2011) reported on a study by the National Institutes of Health that revealed the rate of infant mortality among African American women living within walking distance of the Capitol was 23.9 per 1,000 live births in 1989 1991 slightly worse than rates during the same time period in Panama and Sri Lanka. Access to prenatal care, the norm for the middle and upper classes, was lacking for this group. Family support, a non-medical factor, was also shown to be generally lacking for the lowest socioeconomic group. Studies have shown that there is a higher rate of obesity among the lower socioeconomic classes (Kanaya, Santoyo-Olsosson, Gregorich, Grossman, Moore, and Stewart, 2012).. Obesity can lead to debilitating or even deadly conditions such as diabetes, heart disease and stroke. Overweight children with poor eating habits are likely to grow into overweight adults with poor eating habits; without education, they do not know how to make positive changes. In addition to the often higher costs of healthier food choices, it also costs money to join a gym or even play school

While some women who received no prenatal care had normal, uncomplicated births, others did not. Most of the women who did not receive adequate prenatal care gave birth to an underweight and underdeveloped infant. Among the benefits of early, comprehensive prenatal care are decreased risk of preterm deliveries and low birth weight (LBW)-both major predictors of infant morbidity and mortality. (Dixon, Cobb, Clarke, 2000). Preterm deliveries, deliveries prior to 37 weeks of gestation, have risen. Since the studies in 1987, which showed the rate of preterm deliveries as 6.9% of births, the 1997 rate shows an increase to 7.5%. Low birth weight, defined as an infant weighing less than 2500 grams (5lbs. 5oz) is often preceded by preterm delivery. Low