MCHB/EPI Miami Conference — December 7 - 9, 2005

Prenatal Care: Trials and Tribulations — Transcript

JAMIE SLAUGHTER: Good Morning. Okay. So my presentation is on the Perinatal Health Needs and Strategies in Louisana for the Title V Maternal and Child Health 2005 Needs Assessment. Just for a little bit of review for those of you that are not familiar with Title V Block Grant, it is a federal government grant that provides approximately 15 million dollars to fund MCH services throughout Louisiana . The Louisiana government provides the MCH program three dollars for every four dollars the federal government gives to the MCH program. Every five years the MCH Block Grant requires that the states that receive this funding perform a comprehensive needs assessment.

So one of the questions that we had was in the 2000 needs assessment prenatal care was considered a top priority for the state. One of the things that we wanted to know was, was availability and accessibility of prenatal care a priority health problem in Louisiana or whether new emerging needs that take a higher priority. So to assess the perinatal portion of our MCH population we developed a needs assessment template to be used by our Regional Fetal and Infant Mortality Reduction Initiatives around the state.

There are nine initiatives that were either had already been formed or in the process of forming. We chose to use these because they each have a community action team, which are made up of various community partners. So the template contains the following. A perinatal periods of risk approach. The methodology, how to calculate the excess rates, a worksheet and the perinatal periods of risk map labels to action. This is an example of the worksheet for each of the regions to kind of go through so that they can understand what peak POR is. This was the map labels to actions so each on the categories in POR is kind of related to; there are certain risk factors and preventive actions that are related to each one of both categories. The template also contains each regions fetal and infant mortality data which is shown there. It also provided the adequacy of prenatal care data and each group was provided with an MCH data book which tracks certain indicators through MCH indicators through out the year. They were provided data worksheets that would help them go through this data. A prioritizing perinatal needs worksheet to help them prioritize any of the needs that emerged from going through their data.

The prioritization looked at the extent, the trends in the issue, severity of consequences, was it a Healthy People 2010 resources available for addressing that issue is there were any and acceptability. How was this problem perceived in the community? It would rank one to five for each one of these issues. It also contained a possible solutions worksheet so once they prioritized their needs they would then list solutions or things that they thought would be solutions or activities for each issue and look at whether it was a short term or long term and if it was affective; they thought it was going to be effective or the resources available. The whole purpose of this was for them to look at whether or not, were there any solutions for their need and if there wasn't, should this be a priority need. You know you don't want to necessarily have something that is your number one need and not have any resources or way to address it so that you can correct whatever your problem is. So in the findings, in looking at the early (inaudible) of prenatal care, we found that the prenatal care rate for the state had increased since 2000. But it was mostly attributed to the prenatal care rates in the black community increasing. White rates, there was no significant difference between the years. Then when the different fetal and infant mortality regions, each of them had to I guess rate services, on their availability and accessibility throughout their region and their parish. If you look at the green square, that is just basic prenatal care. All of the regions say that they have prenatal care but not every single one of the regions, like Region Six and Region Seven don't have adequate prenatal care in every single one of their parishes.

In Region 9 they say that the access to prenatal care was poor. Then if you look at adequate high-risk prenatal care, all of the regions have it but it is not always easy to access. Then just is just kind of like a summary of all the needs that or the major, top needs that the regions; the different regions throughout the state had said were their top priority. You see that four regions said that early access to prenatal care was a top priority for them. Three regions said the adequate care was a top priority and then transporation of prenatal care and high-risk OB care was a priority for one region. So availability and accessibility of prenatal care was still considered a priority health problem throughout Louisiana . This even though the percent of pregnant women accessing early prenatal care had increased. The improvement in early prenatal care was largely due to the increase among the black population. I mean there is still a large racial disparity. I think the difference between whites and blacks is probably like 14 percent in accessing early prenatal care. What are the implications of this? This process allows for the regions to assess their needs and community readiness to take actions on addressing these needs. So not only do they know what their specific problems are to their region but they also have a framework to build from. To do strategic planning for their next couple of years in terms of addressing these problems. Then the needs assessment was also used as a roadmap for the overall state in our strategic planning. So just in terms of where is Louisanna now with Hurricane Katrina that did kind of change a lot of things. For the past three months, the state office has been having to go back out and sort of reassess what are the needs of our population because of the displacement of the New Orleans population to other cities in Louisanna. So that is all I have.