February Health Equity Spotlight
The following entry in our monthly health equity spotlight is from Kelsey Petrie, a medical student and WSMA member at the University of Washington School of Medicine, as well as co-chair of the WSMA Health Equity Task Force.
During my OB/GYN clerkship, a young woman came in with severe abdominal pain and fever. She was several weeks preterm and had received no prenatal care. Given the severity of the initial fetal heart tracing, she was rushed back for an emergency C-section soon after arrival. The baby was small with suboptimal Apgar scores, but after receiving treatment for a perinatal infection and scheduling a follow-up visit, both mother and baby were free to leave. After this experience, I was left wondering not only what social and structural obstacles may have prevented this new mother from receiving or utilizing prenatal care, but also what the next year would hold for the two.
In Washington state, infant mortality rates are not evenly distributed, with American Indians having more than twice the rate of infant death in the first year of life1-3. Further, while the overall infant mortality rate in Washington has declined, it continues to increase among American Indians1-3. Statistics regarding the cause of death are similarly striking. Babies born to American Indian mothers are three times as likely to die from SIDS or from an infectious disease, five times as likely to die from an injury, 1 ½ times as likely to die from a complication of pregnancy and delivery or from a cause attributed to prematurity and low birth weight, and 1.3 times as likely to die from a birth defect2. Risk factors associated with poor pregnancy outcomes among American Indians in Washington are often socially or structurally rooted—a mental health diagnosis, alcohol or other substance abuse, smoking, threatened pre-term birth, history of pre-term birth or fetal death, and obesity prior to pregnancy with weight gain beyond what is recommended2.
These statistics have prompted efforts to improve birth outcomes across Washington state in recent years. Notable examples include the American Indian Health Commission’s Tribal Maternal-Infant Health Strategic Plan, which focuses on identifying risk factors causing poor outcomes and developing measurable objectives for improvement, and the First Steps Program, which helps low-income pregnant women access medical services through Medicaid. Last year, the Governor’s Interagency Council on Health Disparities convened an Adverse Birth Outcomes Disparities Advisory Committee meeting with community-based organizations, providers and state agencies1. The committee recently issued three recommendations, rooted in evidence-based medicine, for reducing disparities1:
Let’s support the excellent work being done to reduce infant mortality across the board in Washington. Familiarize yourself with the community programs in your area and utilize them. Lobby for increased funding for the First Steps Program. And make an effort to incorporate cultural sensitivity into your daily practice.
- Support community-driven approaches.
- Enhance the First Steps Program.
- Promote equity in state government.
What do you think? How can physicians help to reduce disparities in maternal and birth outcomes? Leave your comments below.
- Governor’s Interagency Council on Health Disparities. (June 2015) Update State Action Plan to Eliminate Health Disparities. Retrieved from http://healthequity.wa.gov/Portals/9/Doc/Publications/Reports/HDC-ActionPlan-June2015-Final.pdf.
- American Indian Health Commission for Washington State. (2010). Executive Summary Healthy Communities: A Tribal Maternal-Infant Health Strategic Plan. Retrieved from http://www.aihc-wa.com/files/2011/09/MIH-Ex-Sum-web-FINAL-030811.pdf
- Washington State Department of Health. (March 2013). Infant Mortality. Retrieved from http://www.doh.wa.gov/portals/1/documents/5500/mch-im2013.pdf
- Washington State Healthcare Authority. (2015). First Steps. Retrieved from http://www.hca.wa.gov/medicaid/firststeps/Pages/index.aspx