About 700 women die each year in the U.S. as a result of pregnancy or delivery complications.1 This rate of pregnancy-related death is higher in the United States than the rates in other industrialized nations.
About 700 women die each year in the U.S. as a result of pregnancy or delivery complications.
Many of these deaths are preventable.1,2 Maternal pregnancy-related death and infant mortality rates reflect the health of the nation and communities in which these women live. Sadly, there are deep disparities in maternal and infant mortality in the U.S. depending on the race of the woman.3–6
The disparity in maternal pregnancy-related death and infant health outcomes, especially infant mortality rate (IMR, the death of an infant before his or her first birthday), among non-Hispanic black women is one of the greatest health inequities in the U.S. Non-Hispanic black women had a 3.4 times higher risk of dying from pregnancy complications compared to non-Hispanic white women.1,2 Infant mortality rate among non-Hispanic black women is more than double the rate among white women 5,7–9 (CDC, 2018- Infant mortality). In 2016, the overall IMR in the U.S. was 5.9 deaths per 1,000 live births, yet the IMR for non‐Hispanic blacks is 11.4 infant deaths per 1000 live births compared to 4.9 infant deaths per 1000 live births for white women.7
Infant mortality rate among non-Hispanic black women is more than double the rate among white women.
There are also significant disparities in other birth outcomes, like preterm birth rate and low birth weight.
There are many reasons for these disparities: maternal health behaviors, genetics, physical and social environments with lifelong exposure to stress, etc. 2,3,8,10 In addition, pregnancy-related maternal complications, including cardiovascular conditions, hypertension in pregnancy, gestational diabetes, access to quality care, health provider interactions, the health care system and policies, and insurance play clear roles.8,10,11
To eliminate the health inequities, especially those due to sociocultural differences, poor access to or quality of health care we need to prepare women and young girls before they become pregnant (ie. preconception care).8,10 It is important to promote healthy biological, social, cultural, and spiritual environments throughout the lifespan of a young girl to adulthood.
It is important to promote healthy biological, social, cultural, and spiritual environments throughout the lifespan of a young girl.
Preconception services are the medical care a woman receives from the doctor or other health professionals to increase the chances of having a healthy baby. This care is provided through screening, health promotion, and intervention services provided for women of childbearing age before or between pregnancies.13–16 Screening includes assessment of tobacco, alcohol, and drug use. Health promotion includes health counseling services on general health topics, and receipt of pregnancy-related counseling before pregnancy.
Some of the healthy habits that are part of preconception counselling include taking 400 micrograms of folic acid, being active, eating healthy foods, maintaining a healthy weight, avoiding smoking and alcohol use, avoiding use of “street” drugs, getting regular checkups, and managing and reducing stress.14–19
While women are interested in preconception health, many do not receive preconception care.
While women are interested in preconception health, many do not receive preconception care and many health care providers have yet to offer these services to women during clinic visits.15 Minorities and underserved populations are among the least likely to use preconception services effectively, and are disproportionately affected by adverse pregnancy outcomes.4
That’s one of the reasons I designed the HEALTH camp. Women’s health promotion program and the girls HEALTH (Health Education And Leadership Training for a Hopeful future) camp organized through the Calvin College Department of Nursing are designed to promote preconception health among women and girls, especially ethnic minority women and girls, with the goal of promoting healthy birth outcomes.
The camp was also established in response to the request from women in the nursing department partnering neighborhoods to teach their daughters about the reproductive health content in the women’s health promotion program.
That’s one of the reasons I designed the HEALTH camp.
The camp is free for girls between nine and 15 years old who mostly are from ethnic minority groups in partnering neighborhoods in Grand Rapids. It is an interdisciplinary program, involving more than ten Calvin College departments, with the goal of promoting a culture of health, educating girls about how their bodies work and how to keep themselves healthy, broadening their visions for their future, and helping them ponder what God might be calling them to in their part of building the kingdom.
The girls are introduced to basic health concepts related to nutrition, exercise, reproductive health, mental health, healthy behaviors, healthy communities and environments, genetics, and cancer education. The second goal of the annual summer camp is to introduce young girls to different health professions such as nursing, medicine, social work etc. with the goal of inspiring them to pursue a health profession for their future career.
The camp is free for girls between nine and 15 years old who mostly are from ethnic minority groups in partnering neighborhoods.
We ran the first HEALTH camp in the summer of 2016 and have continued to offer the camp every summer ever since. It has been a great joy to see over 100 girls every year and to see the commitment and dedication of Calvin College professors, students, and staff as they pour into the lives of these young girls to equip them for a better future.
Learn more about HEALTH camp on the Calvin College website.
References
1. Center for Disease Control and Prevention. Pregnancy-Related Deaths. Reproductive Health (2018). Available at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-re.... (Accessed: 18th January 2019)
2. Creanga, A. A., Syverson, C., Seed, K. & Callaghan, W. M. Pregnancy-Related Mortality in the United States, 2011–2013. Obstet. Gynecol. 130, 366–373 (2017).
3. BRYANT, A. S., WORJOLOH, A., CAUGHEY, A. B. & WASHINGTON, A. E. Racial/Ethnic Disparities in Obstetrical Outcomes and Care: Prevalence and Determinants. Am. J. Obstet. Gynecol. 202, 335–343 (2010).
4. Centers for Disease Control and Prevention. Eliminate disparities in infant mortality. U.S. Department of Health and Human Services Office of Minority Health and Health Disparities (2008). Available at: http://www.cdc.gov/omhd/AMH/factsheets/infant.htm.
5. Louis, J. M., Menard, M. K. & Gee, R. E. Racial and Ethnic Disparities in Maternal Morbidity and Mortality. Obstet. Gynecol. 125, 690 (2015).
6. Small, M. J., Allen, T. K. & Brown, H. L. Global disparities in maternal morbidity and mortality. Semin. Perinatol. 41, 318–322 (2017).
7. Center for Disease Control and Prevention. Infant Mortality. (2018). Available at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortal.... (Accessed: 19th January 2019)
8. Alhusen, J. L., Bower, K. M., Epstein, E. & Sharps, P. Racial Discrimination and Adverse Birth Outcomes: An Integrative Review. J. Midwifery Womens Health 61, 707–720 (2016).
9. Matthews, T. J., MacDorman, M. F. & Thoma, M. E. Infant Mortality Statistics From the 2013 Period Linked Birth/Infant Death Data Set. Natl. Vital Stat. Rep. Cent. Dis. Control Prev. Natl. Cent. Health Stat. Natl. Vital Stat. Syst. 64, 1–30 (2015).
10. Lu, M. C. & Halfon, N. Racial and Ethnic Disparities in Birth Outcomes: A Life-Course Perspective. Matern. Child Health J. 7, 13–30 (2003).
11. Park, J., Vincent, D. & Hastings-Tolsma, M. Disparity in prenatal care among women of colour in the USA. Midwifery 23, 28–37 (2007).
12. American College of Obstetricians and Gynecologists. Access to Women’s Health Care: Statement of Policy. (2013).
13. Johnson, K. et al. Recommendations to improve preconception health and health care--United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recomm. Rep. Morb. Mortal. Wkly. Rep. Recomm. Rep. Cent. Dis. Control 55, 1–23 (2006).
14. Hillemeier, M. M., Weisman, C. S., Chase, G. A., Dyer, A.-M. & Shaffer, M. L. Women’s preconceptional health and use of health services: implications for preconception care. Health Serv. Res. 43, 54–75 (2008).
15. Frey, K. A. & Files, J. A. Preconception Healthcare: What Women Know and Believe. Matern. Child Health J. 10, 73–77 (2006).
16. Moos, M.-K. From concept to practice: reflections on the preconception health agenda. J. Womens Health 2002 19, 561–567 (2010).
17. Berghella, V., Buchanan, E., Pereira, L. & Baxter, J. K. Preconception care. Obstet. Gynecol. Surv. 65, 119–131 (2010).
18. Centers for Disease Control and Prevention (CDC). Preconception Health. Centers for Disease Control and Prevention (2014). Available at: https://www.cdc.gov/preconception/overview.html. (Accessed: 30th January 2019)
19. Nypaver, C., Arbour, M. & Niederegger, E. Preconception Care: Improving the Health of Women and Families. J. Midwifery Womens Health 61, 356–364 (2016).
[Photo by Alex Nemo Hanse on Unsplash]
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