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Executive
Summary
The
rate of infant mortality in the United States
declined by 74 percent between 1960 and 2000,
but the degree of decline has slowed in the
past decade. Experts believe that eliminating
racial/ethnic disparities in birth outcomes
is key to the continued reduction in the overall
rate of infant mortality in the United States.
Blacks, American Indian/ Alaska Natives, and
Puerto Ricans, in descending order, have notably
higher rates of infant mortality than other
races/ethnicities. Several programs have been
implemented to address racial/ethnic disparities
in birth outcomes. Healthy Start, a national
initiative begun in 1991 by the Health Resources
and Services Administration, Maternal and Child
Health Bureau, is the largest of these programs.
Healthy Start is a community-based program targeted
to eliminating or reducing racial/ ethnic disparities
in birth outcomes in high-risk communities.
The goals of Healthy Start are to improve the
quality of the local perinatal system of care,
to enhance the cultural competence of providers
who work within the system, and to improve women’s
access to the system of care. These objectives
are accomplished through outreach, health education,
case management, and enhanced community collaboration
within the local perinatal health system. The
activities of the Healthy Start program are
designed to encourage pregnant and interconceptional
women, providers, and other community stakeholders
to address the risk factors associated with
poor perinatal health outcomes.
In this paper, an evidence base is provided
to support the targeted interventions implemented
by the national Healthy Start program and other
perinatal health initiatives to reduce racial/ethnic
disparities in birth outcomes. In light of this
objective, the racial/ethnic disparities in
birth outcomes are described and the evidence
on behavioral, biological, and social risk factors
for poor perinatal outcomes in the context of
such racial/ethnic disparities is reviewed.
The risk factors reviewed are prenatal care,
folic acid use, periodontal care, infant sleep
position, breastfeeding, well-child care, interconceptional
care, maternal smoking, alcohol and other drug
use, adolescent pregnancy, perinatal depression,
stress, bacterial vaginosis, domestic violence,
and maternal birthweight. Key findings are:
Compared
to women of other races/ethnicities, Black women
have the lowest rates of preventive behaviors
associated with improved birth outcomes. These
behaviors include entering prenatal care during
the first or second trimester, using folic acid,
receiving periodontal care, putting infants
to sleep on their back, breastfeeding, completing
child vaccinations, and spacing births a year
or more apart. Black women also have higher
rates of adolescent pregnancies, stress, bacterial
vaginosis, and domestic violence during pregnancy.
These risk factors are recognized as being associated
with preterm birth/low birthweight, the cause
of infant mortality for which Blacks are at
highest risk.
Compared
to other races/ethnicities, American Indian/Alaska
Natives have the highest prevalence for risk
factors associated with sudden infant death
syndrome, such as smoking and alcohol use during
pregnancy, and putting infants to sleep in the
prone position. These findings provide an evidence
base for designing and evaluating initiatives
– such as Healthy Start – that are
intended to reduce or eliminate disparities
in maternal and infant health outcomes.
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