AMCHP 2005 ANNUAL CONFERENCE
DELIVERING RESULTS, IMPROVING PREGNANCY & BIRTH
February 19-23, 2005
JEANNINE SMALLS: Good afternoon. As Elizabeth stated, I am Reverend Jeannine Smalls. I'm also working with the South Carolina Department of Health and Environmental Control, the Office of Minority Health.
Somebody said once that it is a dangerous thing to put a podium and mic in front of a black preacher, so I will try to restrain myself today and try not to take a text and preach a sermon, and I'll try to stay within the time limited that is allotted for us today.
We are very excited about the project that the Southland Department of Health and Environmental Control has implemented with one of the largest African Methodist Episcopal churches to address the issues of infant mortality. What I want to do is to run quickly through some data sheets and get into the actual implementation of the project and tell you a little about how it came to be. The South Carolina Department of Health and Environmental Control believes that infant mortality is more than a number, but that infant mortality is a critical indicator on the health of a society. It's overall state of reproductive aged women fell in accessibility of primary healthcare, predictor of the health of the next generation.
South Carolina's live birth by race of mother from 1977 to 2002 shows a slight increase around 1987 to 1993. Compared to the United States, South Carolina infant death rate shows a decline from 1987 with a substantial dip in 1997 to 1998, and an increase again in 1999. Clearly, black infant mortality rates is a concern for South Carolina, as you can see in the chart.
When we look at the leading causes for black's short gestational age and low birth weight and maternal complications are prevalent in South Carolina. Neonatal death rates by race, South Carolina death rates compared to the US black death rates are higher. Post neonatal death rates by race, blacks and others still need improvement. Very low birth weight groups comprise of 59 percent of South Carolina residents in 2001 and 2002.
Low birth weight infants in South Carolina by race. Data on women in South Carolina entering perinatal care in the first trimester. And here is information on infant mortality rates for multiple birth in South Carolina, all races from 1998 to 2002. And a percentage of unintended pregnancies in South Carolina from 1993 20 2001.
One of the ways that South Carolina addresses these disparities is through perinatal regionalization which is a system for organizing and maximizing the resources. There are levels of care established for in-patient obstetrical and neonatal services. Most high risk mothers of infants cared for in regional perinatal centers and it ensures education and provides surveillance of population.
South Carolina is divided into four perinatal regions, the Midlands, the Piedmont, the Pee Dee and the Low country area .
Fetal infant mortality review is another effort involving communities to better understand and develop local strategies to avoid infant death in South Carolina.
Other traditional strategies that are used are early and adequate prenatal care programs, the WIC enrollment program, Caring for Tomorrow's Children Program, and the Healthy Start program which there are three grants active in South Carolina.
In partnership with the South Carolina Department of Environmental Control and the March of Dimes, the African Methodist Episcopal Church was made aware of the infant mortality program and vowed to step forward and to help. How did the AME Church come to address this issue? First I want to say that in the African Methodist Episcopal church, it was difficult to share and talk about infant death and to talk about other social ills in the church. And in the beginning, it was really kind of taboo, so it look a lot of education and work for us to get our foot into the door and into the church in order for us to address these particular disparities. Some of the issues or concerns we have with getting a program started was first of all in the church, we have the traditional moms, the older women in the church that comes with a lot of myths about how to take care of babies and how pregnant women should take care of themselves.
The second issue we had with building this partnership was the fact that in the church, it was primarily dominated with male pastors, so male pastors were not very sensitive to the needs of infants until we have had an opportunity to engage some of the female pastors as well as the ministers' wives. And you will see as we go through the slides that the ministers' wives and Widows Alliances picked up the infant mortality project next and ran with it, and that's primarily how we were able to get this effort thrust into the church.
Now, someone asked why partner with the AME church, with the African Methodist Episcopal church as opposed to another denomination? Well, in the African Methodist Episcopal church, we felt we had the structure that was necessary in order to make sure that the program was successful. In the beginning of the project, the presiding bishop of the church who presides over all of the AME churches in South Carolina, and that was about 609 churches and more than 246 congregates made a vow that we will address the issues of health, particularly with children in South Carolina.
So under the bishop in South Carolina, there is six conferences. The South Carolina Conference, the Columbia Conference, the Piedmont, Northeast, Palmetto and Central conference. Under each one of those conferences, there is three districts. The three districts are presided over by our presiding elders or senior pastors. And then for each of the districts, the local church reports to each presiding elder district, and each district comprises of at least 30 to 35 local churches. So within the local church, the information activities of infant mortality or the issue of infant mortality will go strictly up to the presiding elder's district which they will report to conference and eventually reported to the bishop of the African Methodist Episcopal church. So the input and feedback on the local efforts were easily transferable.
As a result, through 609 congregations statewide and more than 246,000 persons received information toward reducing infant mortality in South Carolina.
Prior to that effort, the bishop of the African Methodist Episcopal church came to the South Carolina Department of Health and asked for assistance in developing a statewide strategic health plan that will help to address not only the infant formality problem but the other problem of HIV and AIDS and also high blood pressure and stroke problems within the State. So we went into summits and actually came out of those summits with a development of the African Methodist Episcopal church strategic health plan. What you see here, it says draft but we have completed the plan and the plan was unvailed in 2002. It is a five-year plan that encompasses four long-term goals and 16 strategic goals and more than 80 strategic strategies and actions for addressing each one of those goals. This plan was developed in partnership with the Department of Health and the Office of Rural Health Services.
More specifically, strategy goal Number 2 is one of the priority areas and that is to develop an AME health agenda targeting children. Under that particular strategy, there were short term outcomes and a number of -- and for evaluation purposes, we want to list the number of congregation members who can identify two ways to prevent infant mortality.
This is a -- the plan parted all the AME churches in the State. We were able to use the GIS mapping to plot the AME churches in the state. This is a sample of one of the conferences we used in order to identify the issues and the problems in that particular conferences so that the conferences and local churches will have an idea of what particular issue they need to address.
This particular slide shows the disparity area under infant mortality, but there are other areas under high blood pressure, heart disease, stroke, diabetes, that look just like this where the churches are plotted on the map. And therefore, each area on the State can see exactly where the prevalence is and can identify what particular disparity they may want to work on in that area. For example, we see in the Columbia conference area, the infant mortality, the darker area, is really a concern and where the red triangles are, they represent a AME church in that area.
So we have more AME churches concentrated in an area where the infant mortality was higher, and so what we did, that particular conference focused on reducing infant mortality.
Now in other conferences like the Palmetto conference, for example, which encompasses the Low country area of our state, the highest incidents of diabetes and stroke was in that area, so that conference focused on diabetes and stroke. Now, all of the conferences in the State through the Ministers' Wives and Widows Alliances did focus on infant mortality in order to bring the statewide rate down.
As a result of the AME Ministers' Wives and Widows Alliances adoption, the initiative was addressed to address this issue began. Now, someone asked why the Ministers' Wives alliances. Well, I mentioned earlier most of the ministers in our church were male and they had no idea what infant mortality was about, they had no idea why babies were dying and their wives got upset because they were not talking about it from the pulpit. And the Ministers' Wives got into a meeting and decided they will adopt this issue of addressing the disparity of infant mortality death in South Carolina. So they developed a project called the Skiing Project, Supporting Kids and Infants Into a New Generation. Through grants from the March of Dimes, we developed an infant mortality curriculum which is here. And this-- curriculum is used by the women in the church. They are trained on this curriculum idea. It's a table top curriculum. They can go through it. There's writing on the back of each sheet. They would read from each sheet while you're sitting out here looking at the front of it. This has been very useful and very helpful in the church, because the ladies started out and said I don't know anything about infant death rates and how to explain it, but using this table top curriculum has been very easy for them in smaller groups as well as larger groups to explain and to share information about why babies are dying and what we can do to prevent the low birth rate.
JEANNINE SMALLS: --of folic acid vitamins. There's also other little -- there's a first aide kit in here, fingernail files and other little trinkets that the women would put in this kit along with brochures about infant death, prenatal care where you can go and find it and some other information that they put in here, information about Back to Sleep, other information they could stuff in this kit, they would stuff it in and the pastor, when he finishes the premarital counseling, he presents the couple with this kit.
There's also information we place in here telling the men that men can be fathers -- men are fathers, men give birth to babies, too. So there's information for the man as well. So these have been very, very helpful.
The other initiative they did was the baby showers and basket for expecting parent. And with the baskets, the ministers' wives bought baskets and gave a certain number of baskets to each local church, and they were to identify the pregnant women in those churches and they had a massive baby shower either in the local church or the presiding elder's district where there is 30 or 35 churches together. All the women would come in on Saturday morning and they would have a little breakfast or brunch and they would bring a baby item and throw it into the big tub of gifts. And if there is one women that is pregnant in the group, then that one women gets all of the information, all of the gifts along with information about what to do in terms of signs and symptoms of preterm labor, what to do about -- information about Back to Sleep and a lot of other information that is provided for them in that basket. Sometimes they had as many as 12 to 13 women in one baby shower in a district, and so the baskets has been very, very helpful.
The other initiative that they have in order to help prevent some of the low birth rate and the infant mortality program is oral health initiative for pregnant women. The oral health initiative for pregnant women involves just giving the pregnant women information about oral health, and I'll talk a little bit about that a little later on. Again, I mentioned that the Skiing, really stands for Supporting Kids and Infants Into the Next Generation and Skiing Project is aimed at reducing infant mortality in African American communities of South Carolina through the education of AME leaders, members and interdenominational partners.
Let me just explain for a minute here that the AME church was given the grant through the March of Dimes but the whole thrust of the effort was not to cater or address the issues within the AME church, but address the issues within the community and bring in other denominations as well in order to address the issues. Down in one of our counties in the lower part of our state, Hampton County, we have a list of maybe 12 interdenomination groups that are working on the oral health program to reduce the incidence of infant mortality, preterm labor, those kinds of things down in the Hampton County area. And in other parts of the state, there are other interdeminational groups that are working. It was very difficult getting that started because some of the other denominations say well, we want our own program. We want to do our own thing in our own church, but we were able to bring all the denominations together and let them know we are really stronger in numbers.
Again the infant mortality curriculum provides for ongoing training about infant mortality, its causes and ways to reduce risk with a table top binder with a curriculum designed in partnership with the South Carolina Department of Health and Environmental control.
The Vitamins for Brides an initiative of the Ministers' Wives and Widows' Alliance to increase intake of folic acid as a part of their premarital kit with information to educate and encourage women to consume folic acid every day.
The baskets for parents to be is an initiative of the Ministers' Wives and Widows' Alliances to educate parents to be about prematurity, the role of the father and about implementation of strategies in congregations to improve birth outcomes.
The oral health pregnancy program, now this program was adopted by the Women's Missionary Society of the church which was involved with the oral health program with funding from Robert Wood Johnson. The oral health, it's studies have shown that infections caused by periodontal disease and gum disease can raise a women's risk of having a baby too early and too small. So the Women's Missionary Society of the AME church adopted this initiative to educate women on the risk of periodontal disease. So you can see what is happening, the women of the church is taking control of his issue of -- of that one particular goal and strategic plan to address the issues of children in the state and they are thrusting forward with addressing those concerns.
The oral health initiative also took it a step further and in February which is oral health or dental health month, the bishop of the church declared an oral health Sunday, and for this month, it was the second Sunday in February for all AME churches statewide. In each AME church across the state, there was some activity going on with regard to oral health and pregnant women across the State.
On this past Saturday there was an oral health summit designed to educate the missionary ladies on the risks of oral health problems in pregnant women and to encourage additional interdenominational partnerships.
We also have district oral health initiatives developed by several of the districts to encourage and maintain adequate nutrition, encourage regular brushing and flossing, using a fluoride rinse daily, and maintain routine dental visits. We had one of the AME districts within the State that is pretty rural which is the Georgetown County area, and what they have done is pulled the churches together, the smaller churches that are close by, they pulled them together and developed regional initiatives within the Georgetown County because of the rurality of the county and there are several different initiatives that are working within that county to address oral health as well as infant mortality .
Other strategies for reducing infant mortality in South Carolina is to increase emphasis on preconceptual health with the providers as well as public awareness to decrease unintentional pregnancies and closing the health gap of African American focus reduction -- risk reduction.
South Carolina infant mortality rate, and this is an update from the previous slides I showed you, per 1,000 live births in 2003 for all races, 8.3 compared to 9.3 in 2002. Whites, 5.9 compared to 5.9 in 2002. And blacks and others 13.0 compared to 15.4 in 2002. And so the ladies in the African Methodist Episcopal Church now is really rejoicing and having a wonderful time because they told us at the Department of Health and Environmental Control that there is no proof that what they are doing did not contribute to the decrease in the infant mortality rate. So we do thank the African Methodist Episcopal Church for the work that they are doing.
And what I have here is just the six months report. The last six months report there were 33 training sessions conducted with 302 participants, and 138 kits were distributed to couples planning to marry and 153 baby showers were held with 3,586 participants. And during the shower, the March of Dimes Take Action Video has been shown to increase awareness of preteen preterm birth.
And so we are just excited about the work that we are doing with the faith community in South Carolina to address some of these disparate areas and we are looking forward to do more with other faith groups as we continue to work within the African American communities in order to address the disparities in our State. Thank you so much for your attention.