As Unplanned Pregnancy Rates Drop, Births Improve
Unplanned pregnancies often result in delayed prenatal care, which can increase health risks for both mother and baby. They’re also associated with higher numbers of premature births and lower birth weights, which affect children’s health outcomes. Simply put, fewer unplanned pregnancies means more healthy moms and babies. It’s a fact that has ignited efforts to address unplanned pregnancies as a strategy to improve infant mortality rates.
With the rate of unplanned pregnancies dropping by six percent in recent years, these efforts are proving successful and can be used to motivate future improvement efforts. Nearly half of U.S. pregnancies are still unplanned and accompanied by significant disparities. Seventy-five percent of teenage pregnancies are unintended and black and Hispanic women have far higher rates of unintended pregnancies than white mothers. Much of these disparities are a result of less education, lower income and other social determinants of health that can further exasperate a pregnancy’s risk.
“We can change these numbers,” says Zhandra Levesque, MPH, project director for the NICHQ-led Collaborative Improvement and Innovation Network to Reduce Infant Mortality (Infant Mortality CoIIN). “We need to keep investing in strategies that empower women to protect and take pride in their sexual and reproductive health.”
Long-acting reversible contraceptives (LARCs) are one of those strategies. LARCS, which include IUDs and birth control implants, are more effective than any other form of birth control, in large part because they require minimum maintenance, which leaves little room for user error. Yet, despite their effectiveness, they’re only used by 10 percent of women.
“If we’re thinking about strategies to spread and scale, there’s a clear opportunity here,” says Levesque. “Especially when we consider the bright spots we uncovered during the Infant Mortality CoIIN; each success provides a foundation for states across the country to build on.”
Incorporate LARCs into Postpartum Care
During the postpartum care that immediately follows delivery, providers are already engaging mothers in conversations about healthy birth spacing. These conversations offer a seamless opportunity to discuss the effectiveness of LARCs as a contraception choice and, if the mother chooses, perform immediate insertion.
They’re also an opportunity to reach mothers who might not be able to return for their follow-up appointments, which may account for more than half of mothers on Medicaid. Finding transportation, getting time off from jobs, accessing affordable childcare—each can make it more difficult for a new mother to get back to a clinical setting. Helping all mothers return for follow-up care should always be the highest priority; but providing these services immediately guarantees all mothers immediate options.
“Postpartum insertion is a strategy that can promote healthy birth spacing, and in return improved birth outcomes for women and infants,” affirms Levesque. “This means it deserves our attention. We want to give mothers every chance to make informed decisions about their future pregnancy habits, especially since they’re already under the many stresses imposed by the social determinants of health that regularly affect their lives.”
LARCs have steep upfront costs though, which can overshadow their long term economic benefit. Because of this, hospitals are less likely to stock them and have them on hand for postpartum insertion. As a result, many mothers are still forced to wait until their follow-up visit. Recognizing the inherent risks in this approach, South Carolina implemented a policy through Medicaid that offered hospitals full reimbursement if they inserted LARCs postpartum and prior to discharge.
For policy improvements to be successful they don’t just need to be feasible; they also need buy-in from stakeholders across the hospital. Clinicians need to know how to insert the devices and all caregivers should be educated on LARCs’ effectiveness and ease of use. Knowing this, South Carolina’s team worked to identify champions at every stage of the mother’s journey. From prenatal care providers, to physicians and nurses, to lactation consultants, each are potential resources for pregnant mothers and each received appropriate training. Thanks to these efforts, more new mothers better understand their reproductive choices and have the freedom to take immediate advantage of LARCs.
Leverage Women as Stakeholders
LARCs come with many misconceptions: they’re only available for women who have had children, they have unmanageable side effects, they cause abortions. These misconceptions, among others, mean that too many women are making reproductive choices based on faulty information.
Understanding the social, cultural and historic perspective on LARCs can help states address those misconceptions. North Carolina used surveys to reach out to women directly, asking them what they knew, heard and believed about LARCs. By working with community based programs, like Healthy Start, and making the survey available in both English and Spanish, they identified 100 diverse participants from different communities across the state.
The results were illuminating. Some women revealed that their providers did not offer LARCs as an option; and many women based their contraceptive choices on the advice and experiences of their friends.
These responses sparked North Carolina to change how they approached contraception education. They developed a pilot to test a series of life-planning questions that providers could use to improve conversations with patients. They also recruited young adults to join a community leadership council so that local voices are represented in future improvement efforts and spread through their communities. Each of these strategies helps elevate women as active stakeholders in decisions that directly affect their reproductive health.
“Reproductive choices are personal,” says Levesque. “That’s why each of these strategies, whether pre- or postpartum, involves building women’s self-efficacy. We want women to feel empowered in their choices and empowered in their pregnancies. Improving LARC education and access, ensuring it’s an option available to all women—it’s a step towards giving women the choices they deserve and ultimately improving children’s health.”
Ready to uncover more strategies to increase access to LARCs? Check out this issue brief, which provides a deeper dive into LARCs' current availability, barriers to prescribing it and potential Medicaid reimbursement models.Or learn more about a learning community developed by ASTHOS, dedicated to increasing immediate postpartum insertion.
NICHQ’s Next Steps: Update on the Equity Systems Continuum Initiative
The National Institute for Children’s Health Quality, with funding by the W.K. Kellogg Foundation, is building upon an evidence-informed conceptual framework known as the Equity Systems Continuum to describe and define the systems that individuals and organizations currently operate within: Supremist-Designed System, Savior-Designed Systems, Ally-Designed Systems, and Equity-Empowered Systems. The Global Infant Safe Sleep Center (GISS) developed the original framework and serves as an ongoing partner in the project.
3 Strategies to Leverage Community-Based Research in Maternal and Child Health
During Spring 2021 DARE conducted a series of community listening sessions for the National Action Partnership to Promote Safe Sleep Improvement and Innovation Network (NAPPSS-IIN). Listening session participants were asked about the resources and tools that help them promote safe sleep and breastfeeding/chestfeeding, and additional support needed to meet community safe sleep and breastfeeding/chestfeeding needs. While the analytic results are forthcoming, DARE is excited to share key lessons learned during NAPPSS-IIN community listening sessions.
A Physician’s Reflections on Racism and Treating Sickle Cell Disease
For NICHQ’s current and future work, I am motivated by wanting to be a better version of myself in service of others. Wondering whether my own implicit biases impacted my care of patients and families, I realize that I cannot redo past ER experiences. If I could go back, I would slow down to acknowledge and try to set my biases aside and approach patients from a personally more informed perspective. But now, I can use my past, present, and future experiences to ensure NICHQ is amplifying important lessons from this multi-year effort reflecting the compassion, care, and commitment of hundreds of dedicated professionals in pursuit of equitable, accessible, and quality healthcare for people living with sickle cell disease.
Navigating Well-Child Visits and Vaccinations during COVID-19
Well-child visits and recommended vaccinations are essential, ensuring children stay healthy and are protected from preventable diseases and illnesses such as measles, whooping cough, and seasonal flu. But, as the COVID-19 pandemic persists, data shows that fewer childhood vaccinations have been given and many children have fallen behind on their scheduled appointments. Healthcare professionals should utilize the following strategies to work with parents and caregivers to get their children caught up on missed appointments and recommended vaccinations.
Exploring a Nonbinary Approach to Health
NICHQ is not abandoning the traditional use of the terms “mother” and “maternal.” We are embracing the inclusive language of “birthing person/people” across our work. A move toward inclusive language does not force us to stop using language that so many people identify with; at its core, inclusion is about creating more space for one another. We are taking care to expand the use of these terms in our communications, on our website, in our resources, and eventually, in all our projects.
NICHQ Employee Spotlight: Olivia Giordano
Olivia Giordano, MPH, Project Manager shares how her work with NICHQ’s Supporting Healthy Start Performance Project (SHSPP) is supporting 101 Healthy Start community sites to harness lessons learned, implement innovative approaches to improvement, and ultimately start to close the disparity gap in maternal and child health.