Promoting Healthy Birth Outcomes
Although New York has made tremendous strides in improving birth outcomes, key perinatal indicators have remained stagnant or have worsened. These poor outcomes result from complex medical, psychological, social and environmental factors that can present significant public health challenges to a state as diverse as New York. Some of the most significant factors that influence birth outcomes occur before pregnancy, such as nutritional status and other health behaviors. Taking a life course approach which involves encouraging healthy behaviors from early childhood through adulthood may be key in improving birth outcomes.
While nearly three-quarters (74.7%) of women giving birth in NYS in 2013 received early prenatal care, the rate was significantly below the Healthy People 2020 goal of 90%. Although there has been little change in low birthweight rates for the past decade, in 2013, the prevalence of low birthweight was 7.9% of all births, slightly higher than the Healthy People 2020 goal of 7.8 % of all births. The infant mortality rate has steadily declined, with the 2013 rate of 4.9 deaths per 1,000 births falling below the Healthy People 2020 goal of 6.0 deaths per 1,000 births. Data also show that disparities in birth outcomes are often significant. For example, in 2013, only 63.7% of black women received early prenatal care and 12.0% of black infants were born low birthweight.
Poor pregnancy outcomes, including low birthweight, preterm births and infant mortality, are associated with late or no prenatal care, unplanned pregnancy, cigarette smoking, alcohol and other drug use, being HIV positive, short interpregnancy spacing, chronic diseases, obesity, maternal age, poor nutrition and low socioeconomic status. Recent studies point to associations between oral infection, particularly gum disease, and preterm, low-weight births. Pregnant women with periodontal (gum) disease may be seven times more likely to have babies born too early and too small.2 The exact connection between poor oral health and adverse birth outcomes is still being studied. The cost of preterm births in the United States was estimated to be $26.2 billion in 2005.
- Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Divison of Oral Health. Links Between Oral and General Health. U.S. Department of Health and Human Services. Office of the Surgeon General. October 4, 2004.
- American Academy of Periodontology. Baby Steps to Healthy Pregnancy and On-Time Delivery. AAP Oral Health Tips. March 10, 2008.
- By the year 2013, increase the percentage of women in New York who have received prenatal care in the first trimester to at least 90 percent. (Baseline: 74.6%, Vital Statistics, 2006)
- By the year 2013, reduce the percent of New York births that are low birthweight (<2,500 grams) to no more than 5%. (Baseline: 8.3%, Vital Statistics, 2006)
- By the year 2013, reduce New York's rate of infant deaths to no more than 4.5 deaths per 1,000 births. (Baseline: 5.8/1,000, Vital Statistics, 2006)
- By the year 2013, reduce the percent of late preterm births (34-36 weeks gestation) to no more than 6.4%. (Baseline: 8.3%, Vital Statistics, 2006)
Indicators for Tracking Public Health Priority Areas
Each community's progress towards reaching these Prevention Agenda Objectives will be tracked so members can see how close each community is to meeting the objectives.
Data and Statistics
- New York State Community Health Data Set: Maternal and infant outcomes organized by county of residence
- County Health Assessment Indicators (CHAI): Maternal and infant related statistics organized by topic and county of residence
- CPONDER—CDC's PRAMS On-line Data for Epidemiologic Research: CPONDER is a Web-based query system created to access data collected through Pregnancy Risk Assessment Monitoring System (PRAMS) surveys.
- Maternal and Child Health Services Block Grant (Title V) application: Report has maternal and child health data and service information.
- National Association for Public Health Statistics and Information Systems (NAPHSIS): Selected reports of public health data
- National Center for Health Statistics: Website has national and state-level birth and natality data including low birthweight and preterm births by county and subgroups, method of delivery, risk factors, prenatal care and trends.
- National March of Dimes: State-specific data on perinatal health
New York State Department of Health Programs
- Perinatal Health in New York State
- In NYS, a multi-pronged approach has been taken to provide perinatal services and improve maternal and infant outcomes. Improving outcomes requires both a hospital-based and community-based public health approach at many levels, including broad based outreach and regional approaches to identify gaps and barriers in the service system, as well as one-on-one direct services and outreach to the highest risk populations of the state. The system of clinical services also must fully support quality comprehensive care for all New Yorkers.
- Perinatal Regionalization Program
- The NYS system of regionalized perinatal services includes four levels of perinatal care provided by the hospitals within a region ranging from basic, uncomplicated deliveries (Level I hospitals), mothers and babies with the most complex, critical problems (Level III hospitals and Regional Perinatal Centers). The regional systems are led by Regional Perinatal Centers which, in addition to providing care to the highest risk mothers and babies, provide education and data support to their affiliate hospitals, and lead quality improvement activities in their regions.
- The New York State Medicaid Services for Pregnant Women
- New York’s Medicaid program requires comprehensive prenatal care in both the managed care and fee-for-service delivery systems. Qualified clinics and practitioners in both systems offer complete pregnancy care and other health services to NYS women and teens who meet certain income guidelines. Find where to go to apply for prenatal care coverage.
- In areas of the state without prenatal clinics, eligible practitioners provide complete medical pregnancy services in private offices with other ancillary services provided by Health Supportive Services Providers (HSSP). Physicians are connected with HSSPs to ensure all women receive complete pregnancy care. The New York Medicaid program now offers other critical services for pregnant women and for certain other Medicaid eligible recipients:
- Smoking cessation counseling (effective January 1, 2009). See October 2008 Medicaid Update.
- Mental health counseling in Article 28 clinics provided by Licensed Social Workers for adolescents, children and pregnant and post-partum individuals.
- After-hours access (effective January 1, 2009) for hospital outpatient clinics and for diagnostic and treatment centers (effective March 1, 2009). An add-on payment is available for visits which are scheduled and occur on evenings, weekends and holidays as defined by the NYSDOH.
- Asthma and Diabetes Self Management Training (effective January 1, 2009 for physicians' offices and hospital outpatient departments and March 1, 2009 for Diagnostic and Treatment Centers). Medicaid reimbursement will be available for asthma and diabetes self management training services for Medicaid beneficiaries diagnosed with asthma and diabetes.
- Expanded and Streamlined Medicaid Eligibility for Pregnant Women
- The NYS Medicaid program offers pregnant women Medicaid coverage at the first prenatal visit based upon a brief presumptive eligibility determination by a qualified prenatal care provider, assistance with completion of a full Medicaid application with no resource documentation requirements, and expanded eligibility for pregnant women and infants younger than one year of age with family incomes at or below 200% of the federal poverty level. See Medicaid (Annual and Monthly) Income Levels for Pregnant
- Growing Up Healthy Hotline
- A toll-free hotline (1-800-522-5006) operates 24-hours per day, seven days per week and provides information and referral for individuals, including teens, about pregnancy care services, family planning, health care, nutrition and other health and human services. Information is available in English and Spanish with other languages available, as needed.
- The Nurse-Family Partnership
- The Nurse-Family Partnership (NFP) is a professional (nurse-led) home visiting program targeted to low-income, first-time mothers designed to improve pregnancy outcomes, children’s subsequent health and development, and parents’ economic self-sufficiency. The Department supports enhancement of existing programs through one-time TANF (Temporary Assistance to Needy Families) funding through a memorandum of understanding with the Office of Temporary and Disability Assistance. Nurse-Family Partnership programs are located in Chemung, Monroe and Onondaga counties, and throughout New York City.
- The Maternal and Infant Health Community Collaboratives
- The Maternal and Infant Health Community Collaboratives (MICHC) initiative uses a multi-dimensional community-wide systems approach to perinatal health, including early identification of women not enrolled in health insurance, not engaged in prenatal care, identification of risk factors, coordination of home visiting services and referrals. The initiative targets high-risk counties that work to improve specific maternal and infant health outcomes through implementation of evidence-based and/or best practice strategies across the reproductive life course, and supports programs with local health departments, community health centers and community-based non-profits that use community health workers (CHWs) to perform a combination of community outreach, home visiting, and community-based supportive services to provide a source of enhanced social support and create a bridge between at-risk populations and health care, social and other community services.
- The Maternal, Infant and Early Childhood Home Visiting Program
- The Patient Protection and Affordable Care Act (ACA) of 2010, created the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV), designed to improve health and development outcomes for at-risk children and families through evidence-based home visiting programs. The initiative targets communities in the state with concentrations of premature birth, low-birth weight infants and infant mortality and supports two evidenced-based home visiting programs that have demonstrated improvements in poor maternal and infant health outcomes: the Nurse-Family Partnership and Healthy Families New York. Programs are funded in Bronx, Chemung, Dutchess, Erie, Kings, Monroe, Nassau, Onondaga, and Schenectady counties.
- Comprehensive Family Planning and Reproductive Health Care Services
- The NYSDOH provides accessible reproductive health care services to women and men, especially low-income individuals and those without health insurance, through a network of statewide agencies. Services include contraceptive (birth control) education, counseling and methods to reduce unintended pregnancies and to improve birth spacing and outcomes; testing and treatment for sexually transmitted infections; routine screening for breast and cervical cancer; and health education in community settings to promote reproductive health, prevent unintended pregnancy and promote access to reproductive and preventive health services.
Strategies –The Evidence Base for Effective Interventions
- Folic Acid Supplementation and Fortification Reduces Number of Babies With Neural Tube Defects
- Folate taken before pregnancy and in the first two months of gestation can help prevent major birth defects of a baby's brain and spine. The Task Force on Community Preventive Services recommends community-wide campaigns to increase the use of supplements containing folic acid by women of childbearing age and folic acid fortification of food products.
- Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes
- Screening for depression, one of the most common perinatal complications, is feasible and fairly accurate.
- A Pocket Guide to Adult HIV/AIDS Treatment: Companion to A Guide to Primary Care of People with HIV/AIDS, August 2004 Edition
- The 58-page pocket guide is a resource for physicians and other health professionals in the appropriate treatment of patients with HIV/AIDS. A Guide to Primary Care of People with HIV/AIDS, 2004 Edition, has drug information tables, adult antiretroviral therapy tables, pregnancy tables, a three-step provider process for HIV prevention, and opportunistic infection tables focused on tuberculosis.
- Primary Care Interventions to Support Breastfeeding
- There is convincing evidence that breastfeeding provides substantial health benefits for children and adequate evidence that breastfeeding provides moderate health benefits for mothers. The promotion and support of breastfeeding may be accomplished through interventions over the course of pregnancy around the time of delivery, and after birth while breastfeeding is underway. Interventions may include breastfeeding education for mothers and families, direct support of mothers during breastfeeding observations, and the training of health professional staff about breastfeeding and techniques for breastfeeding support. Evidence suggests that interventions including both prenatal and postnatal components may be the most effective at increasing breastfeeding duration. Many successful programs include peer support, prenatal breastfeeding education, or both.
- Recommendations to Improve Preconception Health and Health Care
- Improving women’s health before pregnancy is essential to improve birth outcomes. The Centers for Disease Control and Prevention has outlined ten recommendations for improving women’s preconception health and thereby improving birth outcomes, including emphasizing the importance of personal responsibility; increasing public awareness, risk assessment, education and counseling on the importance of behaviors that impact preconception health; increasing interventions for women with identified risks; providing interconception interventions for women with adverse outcomes; expanding health insurance coverage; and increasing public health surveillance and research to monitor preconception health.
- Lee E, Mitchell-Hertzfeld SD, Lowenfels AA, Greene R, Dorabawila V, DuMont KA. Reducing low birth weight through home visitation: a randomized controlled trial. Am J Prev Med. 2009 Feb;36(2):154-60
- As part of a larger randomized control trial, this study examined the effects of home-visitation services on low birthweight (LBW) deliveries. The study found that the risk of delivering LBW babies was significantly lower for participants in the group receiving prenatal home visits with a focus on social support, health education, and better access to services, suggesting that this approach holds promise for reducing LBW deliveries among at-risk women and adolescents.
Reports and Resources
- Families and Children
- This U.S. Department of Health and Human Services website has a wealth of information on a broad range of topics related to families and children.
- March of Dimes
- Website contains information for professionals, researchers and community.
- Healthy People 2010/2020: Maternal, Infant and Child Health
- Information related to maternal, infant, and child health goals and objectives for Healthy People 2010/2020 is found throughout the MCH Library Web site.
Return on Investment
- Henderson JW. The cost effectiveness of prenatal care. Health Care Financ Rev. 1994 Summer;15(4):21-32.
- This study examined the association between prenatal care and birth outcomes and the implications for hospital costs for newborn infants. The net expected hospital cost savings for females who received prenatal care was over $1,000.
- Behrman RE, Butler AS ed. Preterm birth: causes, consequences and prevention. Washington, DC: National Academies Press, 2007
- The annual societal economic burden associated with preterm birth in the United States was, at a minimum, $26.2 billion in 2005, or $51,600 per infant born preterm. Nearly two-thirds of this cost was for medical care, including special education services and lost productivity costs for four disabling conditions: cerebral palsy, mental retardation, vision impairment, and hearing loss. It did not include the cost of medical care beyond early childhood or caretaker costs.
- Adams EK, Miller VP, Ernst C, Nishimura BK. Melvin C, Merritt R. Neonatal health care costs related to smoking during pregnancy. Health Economics. April 2002;11(3): 193-206.
- The study confirms the adverse effects of smoking. Among mothers who smoke, smoking adds over $700 per mother in neonatal costs. The smoking-attributable neonatal costs in the United States represent almost $367 million in 1996 dollars; these costs vary from less than a million dollars in smaller states to over $23 million in New York. These costs are highly preventable since the adverse effects of maternal smoking occur in the short-run and can be avoided by even a temporary cessation of maternal smoking. These cost estimates can be used by managed care plans, state and local public health officials and others to evaluate alternative smoking cessation programs.
- American College of Obstetricians and Gynecologists
- American Academy of Pediatrics - District II
- Association of Perinatal Networks of New York
- Family Planning Advocates of New York State
- March of Dimes
- New York State Perinatal Association (NYSPA)