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All pregnant women in Arkansas will experience a healthy pregnancy and deliver infants who have a great start in life. and 2 more... less...

Outcome measures data for Maternal and Infant Health Priority Area

Result - All mothers and infants in Arkansas are healthy

Number of children who died before their first birthday per 1,000 live births

Current Value

7.4 per 1,000

2018

Definition

The death of a baby is a tragedy for any family. High infant mortality also means that there are public health problems in the community that need to be addressed. So, it is important to see what problems cause a high infant mortality rate in a community so that people and organizations can work together to solve those problems and protect the health of the next generation.

In 2017, 304 babies died in Arkansas before their first birthdays. The infant mortality rate for that year was 8.1 deaths per 1,000 live births compared to the national infant mortality rate for the same year which was 5.8. Arkansas’s neonatal mortality rate was 4.6 per 1,000 live births. This was close to the United States neonatal mortality rate, which was 3.9. Arkansas’s post-neonatal mortality rate was 3.5 per 1,000 live births. This was much higher than the United States' post-neonatal mortality rate, which was 1.9.

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How are we doing on the data?

When asked how Arkansas adults are doing relative to the trendline data for the indicator, the stakeholders stated the following:

  • From 2013 through 2015 the rate remained relatively unchanged
  • The rate increased in 2016 and peaked in 2017 at 8.1 deaths per 1,000 births
  • The rate decreased from 8.1 in 2017 to 7.4 in 2018
  • Regardless of the reduced infant mortality rate in 2018, Arkansas still ranks 4th out of all 50 states

Story Behind the Curve

Stakeholders identified the following negative factors that may be contributing to infant mortality in Arkansas.

  • Access to care, overall and prenatal care
    • Health care coverage through employers or afffordable care options
  • Access to contraception
  • Age - births to women less than 20 years old or greater than 40 years old (35 years or older at the time of pregnancy strong correlation for mother and baby)
  • Availability to "good" insurance not helping
  • Access to OB/GYN - many providers not providing OB/GYN care in smaller communities/maternal care desserts, distance to provider and outcomes. Further they have to drive for appt, the worse they are
  • Perinatal deaths - surviving babies during neonatal care going home and lack of support at home
  • Black women have higher infant mortality when compared to whites or Latinos. In 2017, the infant mortality rate for blacks was 12.6, compared to 6.9 for whites, and 6.2 for Latinos.
    • Black babies die at greater rates than whites, in part because they have low birth weights twice as often.
  • Child abuse and neglect
  • Co-morbid conditions occurring in disadvantaged populations - preeclampsia, gestational diabetes, etc.
  • Educational attainment - Data suggests that women with less than a 12th grade education face higher risks for infant mortality
  • Genetic anomalies - leading cause of infant death
  • Health literacy, including understanding the importance of prenatal care
  • High stress environment - perhaps stress weathering, increases stress and negative outcomes
  • Housing insecurity
  • Pregnant women experiencing at least one health problem while pregnant
  • Mental health
  • Physical health of the mother during pregnancy, including health risks associated with obesity
  • Sexual violence leading to pregnancy
  • Substance abuse addiction, including smoking cigarettes
  • Teenage birth rate
  • Unintended pregnancy

Stakeholders identified the following positive factors that may be preventing or reducing infant mortality in Arkansas.

  • ACH - worked hard with NICHQ alliance and nurse alliance, working with hospitals
  • Decrease of elective deliveries
  • Good preventative care early/prenatal care.
  • Home visiting program efforts increasing awareness of the importance of prenatal care
  • Increased access to LARC
  • Increased access to Mirena and Nexplanon.  Dr. Manning secured funding for placing device immediately. Supreme Court issue - overall population has increased information with this issue/misinformation (example: Plan B is NOT illegal).  Governor and other efforts to improve education.  More people now trying to figure out where access is lcoated.
  • Mitigating risks posed from unintended pregnancy - elective deliveries and C-sections

Partners

Stakeholders identified the following potential partners to strengthen the positive factors or address the negative factors impacting the infant mortality rate in Arkanas.

  • Arkansas Children's Hospital - operates the largest NICU in the state and also conducts Infant Death Review; working with local hospitals and communities
  • CHW - engage directly with women
  • Doulas - true grassroots in communities. example: church - gathering around the family. What is a doula - Where is a doula - Who is the right doula conversation.
  • Medicaid
  • Pharmacies - connection with provider, encouraging pharmacists to have discussion with providers - can I send this to you?
  • Schools
  • UAMS

What Works

Stakeholders proposed the following potential solutions to strengthen the positive factors or address the negative factors impacting the infant mortality rate in Arkanas.

  • Address the lack of physical health knowledge in school
  • Engage doulas especially on minority populations and on mental health
  • Expand Home Visiting programming as a cost effective way to address adverse childhood experiences (ACES) and other things going on in the home. 
  • Implement age appropriate educational tools to increase understanding about physical health for youg women
  • Nursery Alliance - work with hospitals to provide standard quality of care. Transition occurs sooner rather than later.
  • Offer lottery tickets as incentive to attend appointments
  • Preconception Health
  • Social determinant code that providers aren't using to bill for Medicaid (Z code 009 series?). Needs to be coded so as to know what to do next.
  • Southeast hospitals collaborate and designate one to provide obstetric and gynecological services with support from UAMS (example Stuttgart, DeWitt). Residents assigned a site on a rotating basis, proximity to complicated deliveries. Center provides the telehealth. ANGEL had something like this, but not resident program.  However, residents need to be trained full services.
  • Two pregnant women plans through Medicaid. Life360 program. Low income and high risk.
  • UAMS NICU - does follow-up care with nurses across the state.

Strategies

Stakeholders prioritized the following strategies because they ranked highest across four criteria: Impact, Feasibility, Specificity, and Value. 

  • Expand telehealth medicine specializing in maternal and infant care, especially in under-resourced parts of the state, that would engage trusted partners such as the AR Children’s Hospital Nursery Alliance or the University of Arkansas for Medical Sciences
  • Promote the use of doulas amongst women of color as a cost-effective and culturally responsible form of maternal care
  • Utilize and/or scale the use of Home Visiting Program models to increase awareness and understanding about the importance of maternal and infant health and how to access services, particularly in underserved communities

Work Plan for First Strategy

Strategy: Expand telehealth medicine specializing in maternal and infant care, especially in under-resourced parts of the state, that would engage trusted partners such as the AR Children’s Hospital Nursery Alliance or the University of Arkansas for Medical Science.

Action Step

Lead

Due

Identify drivers of SMM and associated risk factors that can be addressed via telehealth

 

 

Identify sites of care

 

 

Find qualified tele-presenters

 

 

Engage state perinatal collaborative around mortality and morbidity on data, partnership, and/or leveraging resources

   

Convene meeting between Drs. Manning/McElfish and ACH Nursery Alliance

SO

 

Locate legislative money to expand bandwidth for adequate connectivity (partnering with leg affairs folx from UAMS, BCBS, ADH, etc.)

SO

 

Target red counties with health equity focus

 

 

Work Plan for Second Strategy

Strategy: Promote the use of doulas amongst women of color as a cost-effective and culturally responsible form of maternal care.

Action Step

Lead

Due

Establish a shared definition for what a doula is and the work which they do

   

Identify physician champions

   

Initiate a pilot project in Northeastern AR

   

Increase partnerships

   

Increase education of HC providers

   

Increase education of consumers and communities

   

Increase supply of doula services and distribution

   

Determine payment source

   

Increase policy and advocacy

  fa

Work Plan for Third Strategy

Strategy: Utilize and/or scale the use of Home Visiting Program models to increase awareness and understanding about the importance of maternal and infant health and how to access services, particularly in underserved communities.

Action Step

Lead

Due

Develop partnership/resources: ADH, DHS, AHVN, birthing hospitals, CBOs, BCBS 

Sheena

6/23

Create an implementation plan for ARHOMES and potential expansion of MIECHV that strengthens the existing relationships and aligns their contributions

Tamara

12/23

Create awareness outreach campaign: AHA, AFMC

Amie

6/23

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