Remarks to the 8th Annual Spring Conference of the National Healthy Start Association

by HRSA Administrator Elizabeth M. Duke

March 20, 2007
Washington, D.C.

I’m delighted to have this opportunity to speak to all of you at this 8th annual meeting of the National Healthy Start Association. On behalf of Secretary Leavitt and the entire HRSA family, I want to tell you how much we appreciate your efforts to ensure quality health care for all of America’s mothers and children. I also want to congratulate the Healthy Start Association’s first Chief Executive Officer -- Peggy Sanchez Mills. Peggy, we look forward to working with you and your staff.

I also want to recognize Peter van Dyck, Maribeth Badura, Karen Hench, Beverly Wright, David de la Cruz and the rest of the dedicated staff of HRSA’s Maternal and Child Health Bureau, I thank you for your commitment to and concern for mothers and their families.

Today, Healthy Start projects reach into 97 communities in 37 states, plus the District of Columbia and Puerto Rico. Through the years, hundreds of thousands of women and their children have benefited from your work in promoting mothers’ health and in fighting infant mortality in communities that dearly need our help and intervention.

HRSA is proud of its strong and enduring partnership with all of you. Working together, we have accomplished a great deal.

In the United States each year, about 6 million women become pregnant.

Most of them, thankfully, have safe pregnancies and deliver healthy infants.

Other women give birth too early, or see their babies die during or soon after birth, or die themselves in pregnancy-related deaths. These difficulties continue to occur too often – especially among women who are members of racial and ethnic minorities.

We know that some interventions will improve birth outcomes. Increasing a woman’s access to prenatal care in her first trimester of pregnancy is so important. That’s why Healthy Start programs emphasize it.

A community committed to working together in new and innovative ways to lower infant mortality can improve birth outcomes. That’s why Healthy Start emphasizes the community-based approach.

Greater acceptance of personal responsibility by expectant parents can improve birth outcomes. That’s why Healthy Start emphasizes it.

Education works. Outreach works. Case management works. That’s why all these activities are part of Healthy Start and that’s why it works to improve health outcomes for the women and children who are part of your programs.

At the national level, Healthy Start has made a big impact on earlier entry into prenatal care for pregnant women.

In Healthy Start projects in 1998, first trimester entry into prenatal care by project participants was only 41.8 percent. By 2004, the most recent year for which we have data, first-trimester entry into prenatal care had increased to 70 percent – a remarkable increase in six short years.

Of course, Healthy Start’s most dramatic impact is in neighborhoods and communities.

From 2002-2005, 13 Healthy Start communities reported no infant deaths among program participants! For example, in 2001 the Jacksonville (Fla.) Healthy Start program reported an infant mortality rate of 15.6 per 1,000 live births. By 2004, there was dramatic improvement: no infant deaths among the program participants.

The Worcester (Mass.) Healthy Start project’s infant mortality rate of 3.2 infant deaths per 1,000 live births is significantly lower than the 7.1 rate for the whole city.

And in Central Harlem, the infant mortality rate was 27.7 infant deaths per 1,000 live births when the Healthy Start program began in 1991. By 2004, the infant mortality rate had dropped to 5.1 infant deaths per 1,000 births.

Healthy Start is also making great strides along the U.S.-Mexico border, which is an area of special interest and focus to us at HRSA.

Currently, we fund four border projects – Luna County Healthy Start and La Clinica de Familia in New Mexico, and Valley Primary Care Network Healthy Start and Baptist Children’s Home Ministries in Texas. These projects do exciting work that was featured in a special video shown at last fall’s Healthy Start grantee meeting.

Two of these Healthy Start border projects – La Clinica de Familia in Las Cruces and Valley Primary Network in Brownsville – reported no infant deaths among program participants for the past four years.

These examples are just a few of the dozens I could have cited. Healthy Start is making its mark all across the nation. Now I want to give you a brief update on some other exciting news in the area of maternal and child health.

Among our many priorities at HRSA, mental health is right at the top, because in co-presents with so many other problems.

For far too long in this country, mental health has been just a side issue – viewed as separate and apart from our broader efforts to improve public health. We want to change that view! We want mental health fully integrated into the primary care system. With this approach, we all benefit. Mental health is particularly relevant in any discussion about the overall well-being of the nation’s mothers and mothers-to-be.

Depression is a serious societal problem and, even in its milder forms, can result in significant health-related issues. In women of childbearing age, the consequences can be enormous.

Not only do some pregnant and postpartum women suffer emotional distress, but studies also tell us that maternal depression can negatively impact the social, emotional and cognitive development of their children. Estimates are that some 70-80 percent of new moms suffer from what is called postpartum blues.

While these depressive symptoms typically last a few hours or up to 14 days after delivery, for some women a crippling postpartum depression remains. It can last up to a year, impairing family relationships and causing potential attachment disorders between moms and their infants. If diagnosed and treated in time, postpartum depression and its often devastating consequences can be lessened or prevented.

To shed more light on this important topic, HRSA will soon publish a new booklet titled Depression During and After Pregnancy: A Resource for Women, Their Partners, Families and Friends. Designed for the consumer and general public, it provides information in understandable language for the pregnant or postpartum woman and gives her and family members tips on recognizing the signs of postpartum blues and more serious cases of depression or psychosis. I urge you all to make great use of this new resource in the coming weeks when it becomes available.

Before I close, I also want to bring to your attention the February supplement of Pediatrics which contains 15 articles based on data collected by the HRSA-supported National Survey of Children’s Health. This survey, conducted during 2003 and 2004, is one of the largest ever done on the health of U.S. children. It used a sample size of parents or guardians of more than 102,000 children in all 50 states and the District of Columbia.

The articles in the supplement focus on timely issues at the national level as well as state-specific analyses that highlight elements of children’s health in three states: Alabama, Florida and Rhode Island.

Included in the supplement are studies examining a variety of subjects including the health and well-being of adopted children, the prevalence of violent disagreements in families, disparities in dental insurance coverage among children, the impact of immigrants on breastfeeding practices, and the effect of inadequate sleep on children.

A limited number of paper copies of the journal supplement are available through the HRSA Information Center on-line at: www.ask.hrsa.gov or by phone at 1-888-Ask-HRSA.

Let me close by telling you that we at HRSA are very proud of the work our agency does in partnership with all of you. We believe that together we can improve health care for mothers and their children and through that work we will together eliminate health disparities.

Your work is an enormous asset to our nation and I am delighted to play a supporting role in it.

Thanks for listening, thanks for coming to this important meeting, and thanks especially for committing your careers to improving the health of all of America’s mothers and children.

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