The Low Country Healthy Start Program

Currently, Community Prevention Partnership of Berks County, Nurse Family Partnership, home visitation Program, provides services to first time low income expectant mothers. The organization has been delivering the program for many years. Successfully, the program serves 250 families. The Berks county, Nurse Family Partnership program has served 1600 first time poor mothers, and 1250 children since it began. Most NFP clients by the time of referral are 18 years of age. Accordingly, the thirty-one percent of this first-time mothers receives Supplemental Nutritional Assistance Program (SNAP) and about fifty five percent are receiving Medicaid assistance. In fact, the household income average is 16, 000 and fifty two percent of mothers have not obtained a high school or GED diploma. Indeed, NFP outcomes involves maternal and child’s development education, referral and follow ups. Also, the program encourages breastfeeding, immunization updates developmental screenings. It has reduced smoking during pregnancy by 16.9% as well as prematurity rate by 4.5 %. (Michalopoulos, Lee, Duggan, Lundquist, Tso, Crowne, Burrell, Somers, Filene, & Knox, 2015).

Reduced infant disparities; patients have lower rates of low birth rate (U.S. low income low birth rate percentage 8.2% vs Health Centers 7.5%).

As with the environment, this health factor is also a great indicator of the health status of a population, because if babies are not being born or are dying prematurely, this can have long-term economic consequences and population decline. Therefore, it is paramount that much efforts are put into lowering infant mortality rates According to State of Health Report, Clayton County ranked high in infant mortality in the State of Georgia. In addition, it ranked highly in premature births and low birth weight. The most current data show the infant mortality rate to be 9.2, premature birth at 11.0 percent, and low birth weight at 10.4 percent among all ages and races.6 These disparities are much greater among the various age group and race. Because the issue of maternal and child health is such a major factor in the overall health of the population of Clayton County, the focus will be centered on the issues of infant mortality and the magnitude of the problem confronting the population of this

Healthy People 2020 is a promotion to help raise public awareness by providing measureable objectives and goals for individuals to obtain higher qualities of lives, decrease premature deaths, and promote a higher quality of life (US Department of Health and Human Services, 2014). Healthy People 2020 has monitored its progress for over three decades between communities over the nation to understand where prevention measures are needed most. Fielding, Teutsch, & Koh (2012) projected that Healthy People 2020 will project a greater emphasis on social needs when it comes to health care disparities and will focus on education and income across the reform. One strength I noticed, when navigating through U.S. Department of Health and Human Services

It should be noted that these services vary according to population needs, with some studies even indicating that services vary based on the racial background of the participants (Evans, Labbok, & Abrahams 2011). This should be a cause for concern, and discrepancies in services provided must be avoided to limit further disparities. Data from the Centers for Disease Control (2016) found that in 2010, the rates for breastfeeding initiation was 74% for Native American women, which was lower than other groups. In order to better combat breastfeeding disparities, the WIC program continues to tailor their breastfeeding support services to achieve the Healthy People 2020 goals by increasing the number of trained staff, holding community involvement sessions, and constructing additional educational components.

The Low Country Healthy Start program was designed to eliminate disparities in perinatal health, improve birth outcomes, and quality of life in African American women and infants living in Allendale, Bamberg, Hampton, and Orangeburg counties. This process evaluation sought to determine whether the services provided by LCHS were effective in changing the birth outcomes associated with chronic disease in African American women. Data collected from the initial risk screening and assessment survey along with attendance data from services provided by LCHS was utilized. Case summaries and frequencies were ran on all data linked with chronic disease to determine the risk factors, recognize who was at risk, and what services were provided. Findings suggest that Asthma was the most common chronic disease amongst its participants with smoking tobacco, poor coping skills, negative feelings, and inadequate housing being the risk factors associated with asthma. The services provided by LCHS were found to be insufficient in reaching participants with chronic disease. The program in general proves to be useful and beneficial in addressing the major issues associated with low birthweight infants, however the data collected for this particular study is all self-reported which leaves gaps and unanswered questions due to inconsistency in the data received.

Receiving good prenatal care is extremely important for an expecting mother. The prenatal period has a great impact on the newborn's health. Low birth weight is a problem among a certain population of newborns. It is crucial to understand the conditions in poverty and its

Infant mortality rate constitutes the death of a baby before their first birthday. Mortality rates around the world differ tremendously with America leading the first world countries at an alarming rate of 6.1 deaths per 1,000 births. Conversely, Finland and Japan secure the last, most desirable position, with deaths totaling 2.3 per 1,000 births, as of 2010. (Ovaska-Few, 2015) In 2014, over 23,000 babies died in the United States. (CDC, 2016) Exploring the mortality rates in America brings light to a dire need for additional interventions and research as to why this developing nation has the highest rate of infant deaths before the age of 1 year old. African Americans face the worst outcomes of infant death compared to whites, Latino, and their Native American peers in North Carolina. (Ovaska-Few, 2015) This paper will explore why African American are the leading race for infant mortality and the steps that health communities need to take to address this devastating occurrence.

In the United States, there are disparities between the different racial groups when it comes to low birth weights and premature births. Evidence of this can be seen with information collected Reichman (2005). She found that African Americans have the highest rate with this accounting for 13.0%. While whites are reporting 6.5% and Hispanics are seeing figures of 6.5%. However, inside the Hispanic demographic there are differences in these numbers as Puerto Ricans have 9.4%. These disparities are not tied to economic status with many educated African American women having children of low birth weight. Whereas, there are differences between select segments of the Hispanic population in contrast with other sub groups. (Reichman, 2005)

Why do African Americans have a higher rate of infant mortality, low birth weights and preterm delivery? Evidence

Death and illnesses among women, infant, and child are preventable. In pregnancy, existing health risks can distinguish or prevent any future health problems for women and their children. According to U.S. Department of Health and Human Services (2016), some high-risk factors that may consider are the following: hypertension, heart disease, diabetes, depression, genetic conditions, sexually transmitted diseases, tobacco and alcohol abuse, inadequate nutrition and unhealthy weight. By having this government Healthy 2020 initiative, factors that can affect the pregnancy and childbirth such as poverty,

The health of a nation plays an integral part in the overall success and economic well being of a particular country. The United Stated, while pouring more money into the healthcare system than any other country, still stands as a broken system with inadequate care for many citizens. One of the most marginalized groups of people, African American women, continually score alarmingly low on basic measures of overall health. The healthcare discrepancies between white and black women in the United States are alarming, and they reveal flaws in the American health care system as a whole.

The United States is a melting pot of cultural diversity. For a country that was founded by individuals fleeing persecution, it has taken us many years to grant African-Americans equal rights, and even longer for those rights to be recognized. Despite all the effort to eliminate inequality in this country, health disparity among this minority group remains a significant issue. Research in this area has pointed to several key reasons for this gap that center on differences in culture, socioeconomics, and lack of health literacy.

These are defined as the conditions in which people work, play, grow, live that affect wide range of health and quality of life. The determinants like socio-economic status, race, ethnicity, social capital, behavioral factors (e.g., tobacco use, maternal smoking), biological and psychosocial factors (e.g., family and peer social support) which greatly affects the inequalities among minorities in infant mortality and birth outcomes (Kim, 2013). In order to understand the social determinants impacting infant mortality and birth outcomes, it is important to understand the conceptual framework of societal to individual level determinants of infant mortality and birth outcomes. Conceptual framework includes identifying social determinants at mirco, meso and macro levels. This in turn will help in interpreting patterns of disparities in infant mortality and birth outcomes among blacks. Social conditions consists of where people work, play, age, born, live etc. which depends on their race, ethnicity, gender, social capital, socio-economic status. Macroeconomic determinants include income inequality, which directly affect the infant mortality rates. Income inequality means household income and unemployment for women. In order to reduce the incidences of infant mortality, reducing the income inequalities and generating employment and increasing economic growth among women of childbearing age will help to achieve the desired outcome. Access to prenatal care also influenced by social

While some women who received no prenatal care had normal, uncomplicated births, others did not. Most of the women who did not receive adequate prenatal care gave birth to an underweight and underdeveloped infant. Among the benefits of early, comprehensive prenatal care are decreased risk of preterm deliveries and low birth weight (LBW)-both major predictors of infant morbidity and mortality. (Dixon, Cobb, Clarke, 2000). Preterm deliveries, deliveries prior to 37 weeks of gestation, have risen. Since the studies in 1987, which showed the rate of preterm deliveries as 6.9% of births, the 1997 rate shows an increase to 7.5%. Low birth weight, defined as an infant weighing less than 2500 grams (5lbs. 5oz) is often preceded by preterm delivery. Low