Maternal health is a significant public health issue in the United States. “Women in the U.S. are more likely to die from childbirth than women living in other developed countries” (U.S. Department of Health and Human Services, n.d.). Unfortunately, mortality is just a small part of the issue. For every maternal death, there are up to 100 occurrences of Severe Maternal Morbidity. Severe Maternal Morbidity or SMM refers to complications and health conditions attributed to pregnancy, such as hypertension, heart disease, diabetes, infections, and blood clots (Wheelock et al., 2020). Prenatal care is one of the best tools to prevent maternal mortality and SMM. However, the U.S. Department of Health and Human Services (n.d.) report the number of pregnant women who received early and adequate prenatal care decreased from 2018 to 2021. Adolescents, women of color, and residents of rural areas are disproportionately affected by maternal mortality and SMM in the United States (Trotman et al., 2015; Hoyert, 2023; Wallace et al., 2020).
For my intervention I am focusing on Hispanic/Latina adolescent, expectant mothers in Chautauqua County, New York. I selected this population because there are more instances of adolescent pregnancy in Chautauqua County than in New York State and the rates of adolescent pregnancy in Chautauqua County are higher among Hispanic/Latina women than any other race group (Faulk et al., 2022).
Chautauqua County is one of the least healthy counties in New York State in terms of longevity and quality of life (County Health Rankings & Roadmaps, n.d.). Compliance with prenatal care is low in Chautauqua County. Within their race group 66.7% of Hispanic women in Chautauqua County received adequate prenatal care, compared to 72% of white women and 75.7% of Black women (New York State Department of Health, n.d.., Race/Ethnicity). Chautauqua County also sees high rates of maternal morbidity. Data is not available for rates of Severe Maternal Morbidity in Chautauqua County, however, the rates of SMM in New York State have historically exceeded the national average (Wheelock et al., 2020, p. 2).
My theme is “el futuro comienza con mamá” (the future starts with mama). Not only does life begin in a mother’s body, but that mother has the power to shape the future – both her future and her child’s – by taking an active role in her own healthcare. Primero juntas (First, together) is group prenatal care that empowers the expectant mother to participate in her medical care and creates a support system for her and other expectant mothers at a similar gestational age. The marketing plan focuses on organizations that work closely with the Hispanic community. Marketing materials would include posters, available in Spanish and English, radio advertising spots, and social media campaigns.
At the Individual Level, Marsiglia et al. (2010) found one of the greatest barriers to seeking care is the Hispanic/Latino cultural belief of “power of faith over illness” and the “supernatural roots of illness” (p. 120). The expectant mother’s one-on-one appointment with her provider is an important opportunity to provide a new way of thinking about medical care. By tracking and recording her own vital signs at each visit, she sees firsthand how these lifestyle changes can impact the health measurements and physical wellbeing. Group discussions help demystify healthcare by finding commonality in shared experiences. The history of unconsented medical experimentation in minority groups has led to a general distrust of doctors (Golden, 2023). Language barriers also create reluctance to receive care. Building trust helps counterbalance the target population’s perceived risks to medical care. Primero Juntas allows the expectant adolescent significantly more time with her provider to ask questions and ensure she understands her health. The patient-led group discussions allow the expectant mothers to raise topics they would like to cover. Services offered in English and Spanish ensure clear communication.
At the Relationship Level, the Hispanic/Latino population place importance on social support from family and friends (Marsiglia et al., 2010). This cultural belief is at odds with the reality that pregnant adolescents often lack social support (Trotman et al., 2015). Primero Juntas helps cultivate local community. Expectant mothers experience the pleasure in forging close relationships with other expectant mothers. They may feel a sense of accountability to their new friends, therefore encouraging them to attend appointments. Primero Juntas also promotes healthy relationships between the expectant mother and her support person. They learn together about pregnancy and topics discussed in group sessions. By having the same education, expectant mothers and their support people will “speak a common language” when the baby arrives, making for a smoother transition into parenthood.
At the Community Level, lack of transportation is a barrier to receiving care. The 2016-2020 American Community Survey found 12.1% of Chautauqua County households do not have access to a vehicle. (Faulk et al., 2022). Short-term car rentals, ride share services, and a partnership with the County's public transit system can make possible for expectant mothers to attend appointments. One-on-one appointments allow the provider develop a close relationship with the patient, and to get a better understanding of her family structures, social networks, employment or school, and physical home environment. This may help reduce racial biases in care (Chen et al., 2017). Providers can improve access to prenatal care by connecting with other obstetric providers to offer additional prenatal group care to expectant women. Providers could also gauge interest in new programs tailored to the county’s Asian and Amish minority populations.
At the Societal Level, cost is one of the greatest barriers to receiving group prenatal care. Grants funded the first Primero Juntas program, but, in order to continue and expand throughout the county, there must be systemic changes. All participants of Primero Juntas – patients, providers, and support people – will write letters to insurance providers advocating for value-based care, an alternative payment structure that bases the amount healthcare providers earn on the results of the care they deliver to their patients (Centering Health Institute, 2019). In the interim, insurance companies must cover group care. The World Health Organization attributes low instances of prenatal care to a “lack of knowledge of when and where to seek care” (Chandra-Mouli et al., 2013). Sexual education provides an ideal opportunity to gain these resources and knowledge. But, recent legislation has made sexual education more restrictive and therefore limits the opportunity. Providers can start a social media campaign promoting comprehensive sexuality education. This approach to sexual education includes the physical, mental, emotional, and social aspects of sexual health (Shapiro & Brown, 2018). By teaching students about pregnancy, the many changes that take place during gestation, possible negative health outcomes and the subgroups most impacted, students can understand why early prenatal care is so important and then seek it when and if needed (Wiemann et al., 1997).
References
Centering Health Institute. (2019, April 5). Aligning value-based payment with the centeringpregnancy group prenatal care model: strategies to sustain a successful model of prenatal care. https://www.centeringhealthcar...nteringPregnancy.pdf
Chandra-Mouli, V., Camacho, A. V., & Michaud, P. A. (2013). WHO guidelines on preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 52(5), 517–522. https://doi.org/10.1016/j.jadohealth.2013.03.002
Chen, L., Crockett, A.H., Covington-Kolb, S. Heberlein, E., Zhang, L., & Sun, X. (2017). Centering and racial disparities (CRADLE study): rationale and design of a randomized controlled trial of centeringpregnancy and birth outcomes. BMC Pregnancy Childbirth, 17(118) 1-13. https://doi.org/10.1186/s12884-017-1295-7
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Marsiglia, F.F., Bermudez-Parsai, M., & Coonrod, D. (2010). Familias Sanas: An Intervention Designed to Increase Rates of Postpartum Visits among Latinas. Journal of Health Care for the Poor and Underserved, 21(3), 119-131. https://doi.org/10.1353/hpu.0.0355
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Wiemann, C. M., Berenson, A. B., Pino, L. G., & McCombs, S. L. (1997). Factors associated with adolescents' risk for late entry into prenatal care. Family planning perspectives, 29(6), 273–276..
Wheelock, S., Zezza, M., & Athens, J. (2020). Complications of Childbirth: Racial & Ethnic Disparities in Severe Maternal Morbidity in New York State. New York State Health Foundation. https://nyhealthfoundation.org...ternal-morbidity.pdf
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