Pregnancy Risk Assessment Monitoring System (PRAMS): Examples of
Translation of PRAMS Data |
|
Back to PRAMS
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
- allow affected women the opportunity to choose if and when to have
children,
- provide comprehensive reproductive health care for low-income women
and men who otherwise do not have access to such services, and
- 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.
* |
Links to non-Federal organizations found at this site are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organization Web pages found at these links.
|
Page last reviewed: 2/4/09
Page last modified: 10/5/07
Content source: Division
of Reproductive Health,
National Center for Chronic
Disease Prevention and Health Promotion |