Oklahoma has the sixth highest infant mortality rate in the nation, with 8.5 infant deaths for every 1,000 live births; the rate of infant deaths for African Americans is more than twice the overall average. Oklahoma’s infant mortality rate could be reduced if women had better access to basic health services, more knowledge about healthy behaviors and habits, and more opportunities to put that knowledge into action. Healthy Women, Healthy Futures (HWHF) is a pilot program that has demonstrated tremendous success among the women fortunate enough to be able to participate over the past two years. Operated by the College of Nursing at OU-Tulsa for women with children enrolled at several of Community Action Project’s (CAP) early childhood education centers and at Educare I, HWHF seeks to improve the health of at-risk women living in poverty before they become pregnant again, thereby minimizing their risk of premature birth or infant death.
According to Tulsa County infant death data, women’s pre-pregnancy health contributes more than any other single factor (41 percent) to the likelihood of an infant death. Unfortunately, many low-income mothers have at least three strikes against them when it comes to good health:
- First, they do not have access to basic and preventive health services, since they often cannot access or afford health insurance and are eligible for Medicaid only once they become pregnant (unless they are under 19).
- Second, opportunities for exercise are few, as they are not likely to be able to afford gym memberships and they are likely to live in neighborhoods where it is not possible or safe to exercise outside.
- Third, access to healthy food is spotty, and their food budget is tight.
Healthy Women, Healthy Futures addresses all three issues by providing access to comprehensive preventive health services (including dental and vision care) as well as culturally relevant evidence-based health education, home visitation, assistance in navigating the health system, and the development of individualized health plans, which include reproductive life plans to promote healthy birth spacing and intended pregnancies. The program enrolls women who already have at least one child and are able to have another. It is an interconception health program; meaning, the time between pregnancies. Women may remain in the program if they become pregnant, but the goal is for them to become healthy first.
HWHF has seen measured changes in birth outcomes, participants’ health knowledge, lifestyles, and emotional and physical health. Participants have given birth to 13 full-term, normal birthweight infants despite various maternal risk factors. Two other infants were born prematurely, between 34-35 weeks gestation, to mothers with gestational diabetes; both are now doing well. One 34-year old who had experienced two previous miscarriages said, “I lost weight and was taking better care of myself. I felt more confident that my baby would be healthier. My delivery was easier.”
Other outcomes include: increased knowledge, which often spreads to other family members; better nutrition habits, such as a reduction in fat and sugar/carbohydrate intake and an increase in fruit and vegetable consumption; more regular exercise; and improved health, such as lower cholesterol, weight loss, improvement in BMI, and less difficulty in coping. The monetary savings of better health and healthier births cannot be ignored. During the pilot’s first two years, nearly $60,000 in health care costs was saved because participants were able to consult with HWHF staff prior to going to the ER, urgent care, or safety net health clinics for service. Had the 13 healthy births been premature and required intensive care, the cost to the health care system would have been over $600,000 based on estimates from the March of Dimes.
Healthy Women, Healthy Futures relies on partnerships with over 15 agencies and service providers in the community. The pilot period, which is in its final phase, has been generously funded by the George Kaiser Family Foundation. As the national conversation on maternal and child health has given more attention to the importance of interconception health, Tulsa has been lucky to be able to practice what national experts are preaching. The challenge now is to sustain and scale the program so we can turn around our unacceptable level of infant death.
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