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ALABAMA
PRAMS data for 1995 showed that 28.1% of mothers smoked shortly before pregnancy, 16.2% during pregnancy, and 23.6% shortly after pregnancy. The data also demonstrated higher smoking rates among pregnant women receiving Medicaid than among pregnant women not receiving Medicaid. Using the PRAMS data, the Alabama Department of Public Health, in collaboration with the University of Alabama-Birmingham, received $2.5 million as part of a grant from the National Heart, Lung, and Blood Institute in 1996 aimed at stopping or reducing smoking among pregnant women who receive prenatal care in county health department clinics in 8 counties. The intervention, SCRIPT (Smoking Cessation-Reduction in Pregnancy Trial), is a 5-year project consisting of a patient education program using a self-help guide and video, guided by trained staff. Initial results from the intervention indicate that SCRIPT participants are more than two times as likely to quit smoking as the control group.

COLORADO
Undocumented women in Colorado could not receive prenatal care through Medicaid but could receive emergency care for labor and delivery. A study using PRAMS data from 1997 and 1998 examined the level of prenatal care and birth outcomes among documented and undocumented women in the state. The data described the lack of prenatal care and the higher prevalence of negative birth outcomes among undocumented women. These data were included as part of a larger report to the state legislature. As a result, the CO state legislature in the 2000 session passed a bill that allows undocumented women to enroll in a Medicaid HMO and receive prenatal care services at any time during pregnancy. Although no funds were allocated in the legislation to provide services, Medicaid health care providers can now provide prenatal care to undocumented women through a pilot project that will be monitored and evaluated by the CO Department of Health Care Policy and Financing.

MAINE
The state Breastfeeding Coalition, made up of representatives from the five regional breastfeeding task forces, is charged with coordinating breastfeeding promotion efforts of professionals statewide. Maine PRAMS is a member of this state coalition and regularly provides data to the group. The Coalition disseminates breastfeeding literature and participates in a variety of health promotion activities focused on increasing the rate and duration of breastfeeding through provider education and systems change. The Coalition, in conjunction with the Division of Community and Family Health, convened a breastfeeding conference in 1997; the conference "Latching On: State and Local Partnerships in Breastfeeding Promotion" gathered together lactation consultants, nutritionists, and other health professionals who developed action plans for the state. PRAMS data provided information about the level of breastfeeding and the characteristics of women who breastfeed.

Having PRAMS data available enabled the Coalition to establish breastfeeding goals for Maine. Two new health objectives were added to the Healthy Maine Year 2000 Objectives aimed at increasing breastfeeding rates at one week or more and at 13 weeks or longer. PRAMS data for 1995 established the baseline of 58% of women breastfeeding one week or more; by 1998, this had increased to 69%.

The availability of PRAMS data on breastfeeding has brought about other changes, including increased understanding and support for public health nurses and lactation consultants in their roles as breastfeeding educators. In recognition of the important role of lactation consultants, each public health nursing unit of the state health department is now required to have lactation counselors available. In addition, the WIC program is now training lactation counselors and plans to work with public health nurses to create a stronger network for supporting breastfeeding in Maine.

Maryland
Examples of Translation of PRAMS Data

Maryland PRAMS analyzed data for 2001–2003 births, which indicated that 20% (1 of 5) new mothers reported feeling at least moderately depressed during the postpartum period.

Data were used to inform legislators who sponsored House Bill 844 (in 2004) to educate all mothers about postpartum depression (PPD) before hospital discharge. The bill was not successful; however, it lead to a strong recommendation from the General Assembly to provide educational materials to mothers before leaving the hospital. Maryland PRAMS published a booklet, About Postpartum Depression and disseminated it among all hospitals in the state. It has been translated into several languages.

PRAMS data were also included in the grant application to the Maternal and Child Health Bureau (MCHB) from the Mental Health Association of Maryland. Maryland PRAMS received a grant award of $250,000 for educating providers, women, and families in Maryland about perinatal depression. A Web site was created (http://www.healthynewmoms.org) and helpline, as well as public service announcements, grand rounds, presentations, and webcasts, etc. — both statewide and nationally. After the federal grant was issued, the Maryland Medical Society received $30,000 from Aetna to work on provider training in postpartum depression.

Other outcomes of Maryland PRAMS’ efforts to increase the visibility of PPD include formatting a state mortality review of suicides and the state maternal depression committee, PRAMS focus brief, and presentations at meetings.

NEW MEXICO
PRAMS data were first used to increase the visibility of the issue of access to emergency contraceptive pills (ECPs) and later to inform legislation allowing pharmacists to prescribe ECPs. PRAMS data showing population prevalence and numbers of unintended pregnancies, contraceptive use (or non-use) at time of conception, and rough costs of unwanted pregnancies to Medicaid were shared with the NM Dept. of Health, Planned Parenthood of NM, NM Pharmaceutical Association, NM Board of Pharmacy, and University of New Mexico. In early 2001, the NM Board of Pharmacy and NM Pharmaceutical Association requested that the NM legislature amend the Pharmacy Act to allow the Board of Pharmacy to develop protocols for prescribing by pharmacists. The law passed and was signed by the governor. Protocols for pharmacists to prescribe ECPs were approved by the Board of Pharmacy in late 2002 and by the NM Board of Nursing; implementation awaits approval, expected in May 2003, from the Board of Medical Examiners.

PRAMS data on unintended pregnancy were used for bill analysis of HB119, requiring hospitals to provide education and ECP treatment to rape survivors; this bill became law in 2003. A PRAMS newsletter discusses preconception issues and ECP initiatives, including the pharmacy protocols and HB119. The NM ECP Workgroup has used this newsletter to educate pharmacists, physicians, and other professionals across the state.


NORTH CAROLINA
PRAMS data were used as part of a campaign by the Medicaid Babylove Program to obtain a Family Planning waiver to extend Medicaid eligibility for men and women up to 185% of poverty and offer family planning and STD services.

PRAMS data for 1998 indicate that 44% of women report their pregnancy was unintended. In addition, NC has one of the highest infant mortality rates. By helping women to time and space their pregnancies, contraceptive use helps avoid adverse health, social and economic consequences associated with unintended pregnancies.

The waiver is a 1115(a) demonstration waiver that intends to reduce unintended pregnancies and improve the well being of children and families in NC. The waiver was prepared and presented to the NC State Legislature in 2000. The Legislature approved the proposal, pending approval from HCFA (Health Care Financing Administration). The waiver entails additional money to be appropriated for Medicaid's budget for the state match and it expands the Medicaid eligibility to a new group of people who otherwise would not have been eligible for Medicaid. The Division of Public Health will provide money for the state match.

The target population is women and men over age 18 and of reproductive age at or below 185% of the federal poverty level. The expanded Medicaid eligibility for family planning services to men and women will

1. allow affected women the opportunity to choose if and when to have children, 
2. provide comprehensive reproductive health care for low-income women and men who otherwise do not have access to such services, and 
3. provide education, screening, and early detection of STD's.

PRAMS data will continue to be used to monitor unintended pregnancy across the state and among various population groups (e.g., women on Medicaid).

UTAH
Utah’s prenatal care adequacy steadily declined from 1993 through 2000. United Health Foundation’s America’s Health: State Rankings Report ranked Utah at 49th in the nation for adequacy starting in 2000. Using 1999 PRAMS data, Utah conducted an analysis of the characteristics of women with inadequate prenatal care and found that 61% of women with inadequate prenatal care due to late entry stated that they received prenatal care as early as they wanted. Utah used PRAMS data to develop programs and raise awareness about prenatal care. The Utah Department of Health (UDOH) conducted six focus groups with women who received inadequate prenatal care. The UDOH concluded that women in Utah did not seem to value prenatal care and were unaware of the recommendations for prenatal care.

Utah’s "Baby Your Baby" program adopted this adequacy problem for its 2001 media campaign. Four commercial spots were developed to educate women on the importance of early and adequate prenatal care. The ads aired for 18 months on Utah’s CBS station. An evaluation of the campaign is currently being launched.

UT’s 2003 PRAMS data showed that the prenatal care adequacy rate increased to 81.6%, an increase of almost 20% from 2002. In looking at women who got inadequate care due to late entry, only 41% said they got care as early as they wanted, a decrease of about 20% from the 1999 analysis. The 2005 United Health Foundation’s America’s Health: State Rankings Report ranked Utah at 22nd in the nation for adequacy of prenatal care.
 

Page last reviewed: 10/5/07
Page last modified: 10/5/07
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion