Perinatal and Infant Health Domain

Annual Report Year 2022

 

Priority Area: Decreasing perinatal and infant health disparities

Improving Perinatal and Infant Health outcomes continues to be a priority within the District of Columbia and DC Health. Following a life course perspective, the health and wellbeing of pregnant mothers and their infants have a significant impact on the health status of the overall population. The health of society has long been measured by the health of its mothers and children. Infant mortality is a key indicator of population health as healthy mothers tend to give birth to healthy babies and are best positioned to fully nurture them.  Health during infancy and early childhood establishes a positive trajectory for health throughout the life course. In the District, adverse birth outcomes including preterm births, low birth weight, and infant deaths continue to disproportionately affect non-Hispanic Black mothers and residents in Wards 5, 7, and 8. As described in the 2022 DC Health Perinatal and Infant Mortality Report, the District’s infant mortality rate (IMR) nearly halved from 7.4 to 4.5 per 1,000 live births from 2011 to 2020. Yet, progress on addressing disparities has been stagnant in recent years and geographic areas of the city (Wards 5, 7, and 8), as well as racial groups (African Americans) continue to face higher mortality rates compared to the rest of the District.  Across the eight wards, infant mortality rates during 2016-2020 were significantly higher in Wards 5, 7, and 8 at 6.0,9.9, and 12.9 per 1000 live births, respectively compared to Wards 2 and 3 at 2.1 and 3.0 per 1000 live births, respectively.  In 2016–2020, the infant mortality rate was three to five times higher among non-Hispanic Black infants compared to Hispanic and non-Hispanic White infants, respectively. In 2019-2020 preterm births were significantly higher among non-Hispanic Black mothers (13.1%) compared to non-Hispanic White mothers (7.2%). In addition, sociodemographic and pre-pregnancy characteristics play an integral role in perinatal birth outcomes. Medicaid financed births reported more than triple the rate of infant mortality compared to those births financed by private insurance. More than half of all infant deaths (59%) occurred during the neonatal period. Reducing infant mortality depends in large part on promoting the health of women of childbearing age, promoting the health of women during pregnancy, reducing preterm birth, and reducing low birth weight [1].

Focus Area 1: Breastfeeding

Breastfeeding has many health benefits for both babies and mothers. Breast milk provides the ideal nutrition for infants and can help protect baby and mother against certain illnesses and diseases[2]. According to survey data from DC’s Pregnancy Risk Assessment Monitoring System (DCPRAMS), 96.4% of women ever breastfed during their current pregnancy and 83.2% of women breastfed for 8 or more weeks in 2021. However, once stratified by race there are clear disparities in breastfeeding rates among non-Hispanic Black women and non-Hispanic White women. DC Health strategically targets and supports pregnant women and new moms with breastfeeding through intentional programs and activities aimed at addressing the barriers that impact mothers’ intent to breastfeeding, ability to initiate and maintain breastfeeding and/or continuing breastfeeding exclusively.

Performance Measures:

• National Performance Measure (NPM) 4A: Percent of infants who are ever breastfed.
• NPM 4B: Percent of infants breastfed exclusively through six months. 
• Evidence- Based or- Informed Strategy Measure (ESM) 4.1: Percent of women provided with in-person or telephonic breastfeeding consults/support services.
• ESM 4.2: Percent of women referred for breastfeeding peer counseling support.
• ESM 4.3: Increase the percent of staff that completed breastfeeding education training.

 

Objective 1: Increase rates of breastfeeding initiation among African American women from 63% to 75% by 2026.

 

Strategies:

• Educate pregnant women about the benefits and management of breastfeeding, with priority given to subpopulations with lower rates of breastfeeding initiation and duration.
• Incorporate breastfeeding-friendly policies and training staff in the handling of breast milk at health centers, schools, and early childhood centers.
• Refer and track referral completion of women to breastfeeding services.
• Determine placement for lactation support personnel based on identified needs within the District.

 

Activities:

 

In FY22 Title V continued to fund and provide technical assistance and program evaluation support to the DC Breastfeeding Coalition (DCBFC). DCBFC was established to increase breastfeeding initiation and continuation rates for all infants in the District of Columbia. Working in partnership with maternal and child health professionals, community health organizations, and mother-to-mother support groups, DCBFC seeks to promote, protect and support culturally sensitive programs and activities that build awareness and understanding of the preventive health benefits of breastfeeding. Through its breastfeeding research, advocacy, and educational activities, the Coalition seeks to reduce health disparities, particularly among racialized families living in DC communities with fewer resources.[3] Creating a Breastfeeding-Friendly District of Columbia, a project led by the DCBFC, aims to maintain access to culturally congruent peer and professional support for breastfeeding at the East of the River Lactation Support Center located in Anacostia (Ward 8) while expanding this capacity through evidence-based and evidence-informed strategies that have a high likelihood of sustainability. The target population for this project was WIC-eligible women in Wards 5, 7, and 8 in the District, with a special focus on Black, teens, and populations with historically lower rates of breastfeeding. DCBFC focuses on the following key objectives:

• To increase basic breastfeeding knowledge and provision of supportive breastfeeding care by home visiting staff;
• To facilitate prenatal breastfeeding education classes for Mary’s Center’s Home Visiting Program, Community of Hope’s Home Visiting Program, and the United Planning Organization’s Early Learning Program and;
• To increase breastfeeding support in the District; and
• To increase the number of International Board-Certified Lactation Consultant (IBCLC) candidates from underrepresented groups.

The DC Breastfeeding Coalition improves the capacity of home visitors and childcare staff to provide breastfeeding education and support to families. DCBFC hosted a series of breastfeeding trainings for the three designated community partners: Community of Hope, Mary’s Center, and United Planning Organization. The training focused on: Breastfeeding Basics, Hand Expression, Breastfeeding Positions and Latch, and Breastfeeding Barriers and Solutions. Enhancing breastfeeding training and education gave staff confidence and skills to better educate and support breastfeeding families. DCBFC also assists with virtual breastfeeding classes for families served by the three community partner organizations in both Spanish and English.

 

The DCBFC also leads professional development sessions for lactation professionals to become IBCLC’s. The Coalition improves access to professional lactation support, particularly among Black residents with low household incomes. DCBFC organized and led two cohorts of lactation support training (Lactation Certification Preparation Course, LCPC) in FY22. Lactation Certification Prep Course (LCPC) is taught by a team of International Board-Certified Lactation Consultants (IBCLC) deeply rooted in the DC metro area. These practitioners provide professional breastfeeding support to some of the most underserved communities in DC. All the instructors are from underrepresented groups in the field of lactation; combined they have 34 years of certified lactation consultant experience. In keeping with their goal, at least half of the class participants self-identified as a member of one of the following groups that is underrepresented in the lactation profession: Indigenous Peoples, People of Color, Men, Deaf, Hard of Hearing, Developing Countries, LGBTQI Community, Low Socio-Economic Individuals/Communities, Adolescents, Generation Z, and People with Differing Abilities. For the first and second cohorts, this percentage was 86% and 100%, respectively.

 

To conduct individual face-to-face or telephonic breastfeeding consults, East of the River Lactation Support Center (ERLSC) continues to operate within the Children’s National Anacostia primary care pediatric clinic. Breastfeeding families are provided education and lactation support during their pediatric visit which is an optimal standard of care. This model of lactation care allows breastfeeding families the opportunity to receive services without having to travel outside their medical home. Breastfeeding families from all Children’s National primary care locations, DC WIC clinics, and the DC community at large are seen at the ERLSC. Breastfeeding families seeking lactation support find ERLSC through various points of contact, including the DC Breastfeeding Coalition website, social media outlets, their WIC clinic, and by word of mouth. To facilitate the provision of IBCLC support to DC WIC families during FY22, five DC WIC clinics (Unity-Parkside, Unity-East of the River, Unity-Anacostia, Unity-Upper Cardozo and Children’s Health Center- MLK), were served by two DCBFC IBCLCs. IBCLCs assisted WIC breastfeeding mothers with high-risk breastfeeding issues (e.g., mastitis) that are outside the scope of a WIC Peer Counselor. Lactation consults continued primarily by telephone with several in-person visits.

A range of data points are reviewed by DC Health and the DCBFC referenced in Table 1.

 Table 1: DCBFC Indicators

 

In FY22 Title V continued to provide Subject Matter expertise (SME) and program evaluation guidance to DC Women, Infants, and Children (DCWIC). WIC aims to improve birth outcomes, breastfeeding rates, infant feeding practices, immunization rates, and more [4]. The mission of WIC is to safeguard the health of low-income (185% of the federal poverty line or below) women, infants, and children up to age 5 who are at nutrition risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care [5]. DC WIC provides District families access to free, healthy food, breastfeeding resources and support, nutrition education, referrals to community organizations, and immunization screening. Four Local Agency organizations (Children’s National Hospital, Unity Health Care Inc., Mary’s Center, and Community of Hope) provide WIC services in the District, and DC Health serves as the State Agency.

DC WIC’s target population includes income-eligible pregnant women, post-partum women up to one year, infants, and children up to age 5 years. DC WIC helps improve access to prenatal care, household food security, infant and child development, inter-conception care, and breastfeeding rates. Table 2 below shows DC WIC participant data. Data informs locations of new clinics, target populations not being reached, outreach and marketing efforts, staffing and training needs at WIC clinics and partnership development.

 Table 2: DCWIC Participation Data

 

DC Health aims to increase the District’s WIC coverage rate from 48% to 65% by 2026 and increase the percentage of mothers who breastfeed their infant. To simplify the enrollment process and reach all eligible families, DC Health and the DC Department of Human Services executed a data sharing agreement to share client level Temporary Assistance for Needy Families (TANF) and WIC data in FY22. Next steps for FY2023 included finalizing a data matching protocol to identify TANF families eligible for WIC but not participating and carrying out quarterly WIC outreach for enrollment. DC WIC uses multiple strategies to increase the percent of participants who breastfeed. DC WIC partners with Pacify to provide access to live and on-demand breastfeeding support services. Pacify performs services via an app that allows participants to video chat with an International Board-Certified Lactation Consultant (IBCLC). This partnership contributes towards achieving DC WIC’s FY2022 breastfeeding goal of increasing breastfeeding initiation and duration rates by implementing evidence and practice-based breastfeeding promotion and support activities. In FY22, 354 WIC participants enrolled in Pacify. Pacify IBCLC’s made 299 contacts with WIC participants, providing breastfeeding support. In addition, DC WIC works with the DCBFC through the East of the River Lactation Center to provide access to IBCLCs for WIC families mostly residing in Wards 7 and 8. Assisted by funding from Title V, DCBFC was able to employ two part-time International Board-Certified Lactation Consultants (IBCLC) to assist mothers at DC WIC service sites in Wards 7 and 8. These WIC sites were chosen based on the high enrollment of Black women and disparate breastfeeding rates seen at these sites.

 

In April 2022, DC WIC completed a two-year, statewide project to implement a new management information system and transition from paper checks to an electronic benefit transfer (EBT) system. DC WIC supported 52 retail food stores to upgrade their point-of-sale systems; led a 6-month training for 50+ WIC clinic staff on the new system; and piloted and rolled out the new system across 13 WIC clinics, 52 stores, and DC Health. A mass media campaign to recruit new WIC families and promote eWIC was also conducted in FY22.

 

The DC Workplace Breastfeeding Support Toolkit was developed through a partnership between Title V grantee DCBFC and DC WIC. The Toolkit aims to build capacity across District employers to create breastfeeding-friendly workplace environments and support chest/breastfeeding employees. The Workplace Breastfeeding Support Toolkit is a policy, system, and environmental (PSE) breastfeeding approach applied to workplace settings and intended for use by small and large businesses, District agencies, other MCH programs, community-based organizations serving chest/breastfeeding individuals, and the community.

 

In FY22, DC WIC leveraged federal waivers, data, strategic communication, cross-agency collaboration, and community partnerships to support DC families during the infant formula shortage. Beginning in February 2022, when the FDA announced a recall of infant formula manufactured by Abbott Laboratories, DC WIC applied for all federal waivers to give families and WIC staff maximum flexibility in responding to the recall and purchasing additional infant formula brands, sizes, and forms (e.g., powder, concentrate, and ready-to-use). DC WIC provided constant communication with WIC families from the beginning of the recall. DC WIC sent text messages to families advising them to visit Abbott’s website and check if their formula was affected and return it to stores for exchange or refund.  Text messages also featured a link to an easy-to-read Formula Substitution Chart, in English and Spanish, guiding families to buy alternate formulas. DC WIC continually updated authorized retailers and WIC grantees with all the changing information related to the formula recall via emails, memos, and regular meetings. DC WIC regularly updated its website (dcwic.org) with up-to-date infant formula information, provided frequent updates to managed care organizations for dissemination to their members, and drafted two informational memos for healthcare providers - disseminated by the DC Chapter of the American Academy of Pediatrics, DC Hospital Association, DC Primary Care Association, and DC Chapter of the American College of Obstetricians and Gynecologists.  

 

The goal of the DC Healthy Start (DCHS) Program is to improve health outcomes before, during, and after pregnancy, and reduce racial/ethnic differences in rates of infant death and adverse perinatal outcomes within the District of Columbia. The Healthy Start Program supports the Title V objective of increasing the rate of breastfeeding among women by 2026 by adopting and implementing set breastfeeding support strategies at program enrollment and throughout the perinatal period, including support breastfeeding policies and training for staff. These strategies include introducing and educating participants about breastfeeding at program enrollment. To improve perinatal health outcomes and close the disparity gaps based on race and place in the District, DCHS leverages patient-centered medical homes in areas with disparate perinatal health outcomes to implement the enhanced case management program. Community of Hope and Mary’s Center are community health centers that serve as medical homes for program participants, while also providing comprehensive case management and care coordination through DCHS. Additionally, to work toward more equitable birth outcomes and target women who are at high risk for adverse perinatal outcomes, DCHS increases social supports in the perinatal period by using group prenatal care (Centering Pregnancy) and community-based doula models.  

 

During enrollment into Mary Center’s Healthy Start program, participants are asked about their intent to breastfeed in addition to receiving breastfeeding education and resources to support their decision to breastfeed. Community of Hope offers a monthly “Making Milk 101” group education class to provide anticipatory guidance to pregnant patients about lactation and infant feeding. The groups are open to the community and foster a safe environment for pregnant people to feel empowered, supported, and enlightened as they learn about feeding in the first 24 hours, myths, benefits of skin-to-skin, the art of breastfeeding, positioning, latching, and how partners can help provide support.

 

Overall DCHS  provides Women’s Health Consultation as a telehealth appointment, that includes breastfeeding consultation and during the postpartum, DCHS tracks participants’ initiation of breastfeeding, participants who breastfed at least once, and participants who breastfed until 6 months.

DCHS works to increase participants’ access to lactation services in the postpartum period. These lactation services include continued home visits, where Community Health Workers (CHW) provide support through breastfeeding education and access to lactation services. In addition, DCHS’s participants are connected to Pacify, an app that offers 24/7 teleconference-style pediatric and breastfeeding consultation and connects families to a nationwide pool of experts—including lactation consultants, registered nurses, and doulas. Following enrollment to Pacify, the CHWs support families to ensure ease of future use by running a “test call” where they are connected to an expert on the other end. The Healthy Start Program also promotes WIC breastfeeding support groups and encourages engagement with WIC Breastfeeding Peer Counselors. Healthy Start ensures the coverage of breastfeeding education as part of Centering sessions. In FY22, DCHS held virtual Centering group care sessions in Spanish hosted by the Healthy Start clinical provider and facilitated by two CHWs. In these sessions, the prenatal groups can ask about breastfeeding, debunk myths and misconceptions, and seek the Centering community’s support in making decisions about breastfeeding. Healthy Start offers integrated doula services in its program model. In FY22, Mary Center was awarded the Supplemental Doula Program to provide contracted doula support to participants during the prenatal and postpartum periods. With this addition, Healthy Start participants can opt-in to receive support from a doula. A doula conducts a postpartum visit 4-10 days after birth to process the birth story, ensure normal recovery, and offer support for breastfeeding. Community of Hope also offers the Meet the Doulas program, a 6 session education series facilitated by the Healthy Start Doula Team focusing on perinatal education. Healthy Start also works to increase access to breast pumps by connecting participants to a breast pump through their insurance services. In addition, the Mary’s Center clinic offers breast pumps directly as an initiative to reduce the administrative burden on participants and make the device readily available. DCHS ensures the training of staff to offer breastfeeding support. As part of their education, our Healthy Start CHWs are trained as Certified Lactation Counselors (CLC). As CLCs, DCHS CHWs can provide direct lactation support services when issues or concerns regarding breastfeeding arise.

 

Focus Area 2: Risk Appropriate Perinatal Care

Perinatal health is the health and well-being of mothers and babies before, during, and after childbirth[6]. During the prenatal period, early initiation to care during the first trimester is imperative. Several studies have suggested that poor prenatal care utilization is associated with poor birth outcomes including but not limited to infant mortality, low-birth-weight babies, and prematurity, especially for Black women[7]. Compared with infants born to mothers who received prenatal care, infants whose mothers did not receive prenatal care are three times more likely to have a low birth weight and are five times more likely to die in infancy[8]. Women who do not receive prenatal care are also three to four times more likely to die from pregnancy-related complications than those who do receive care[9]. Establishing early prenatal care and continuation until the time of delivery is one of the most effective interventions to improve birth outcomes due to the three major components of prenatal care: risk identification, treatment of medical conditions/risk reduction, and education[10]. Quality prenatal care adequately and promptly identifies women who are at high risk for preterm birth and coordinates access to high-risk providers to address preventable pregnancy-related complications.

 

Data shows the District’s maternal mortality rate between 2014 and 2018 at 23.1 deaths per 100,000 live births and pregnancy-related mortality at 44.0 deaths per 100,000 live births which was higher than the U.S. maternal mortality rate of 20.7 deaths per 100,000 live births and pregnancy-related mortality rate at 28.4 deaths per 100,000 live births. Black women constitute about half of all births in the District but account for 90% of all pregnancy-related death. In contrast, White women in the District represent 30% of all births experience and no pregnancy-related deaths. Geographically, a large portion of pregnancy-associated deaths occur in Wards 7 and 8 of the District with a predominantly Black population and a shortage of birthing hospitals[11]. Recognizing the importance of the health of mothers and children to the District of Columbia, DC Health developed and is implementing a focused strategy to improve and eliminate disparities in perinatal health outcomes. DC Health is driven to implement effective strategies to improve perinatal care quality and increase early initiation into prenatal care among all DC residents to improve birth outcomes.

 

Performance Measures:

• State Performance Measure (SPM) 6: Risk appropriate perinatal care – Decrease the proportion of Medicaid beneficiaries who deliver a low-birthweight infant.

 

Objective 2: Increase percent of pregnant women who initiate prenatal care in the first trimester from 68% to 75% by 2026.

Strategies:

• Enhance the capacity to provide a space for women to engage in early and continuous prenatal care to prevent maternal complications.
• Develop and standardize screening tools and/or procedures to help identify, monitor, and track women at risk for preterm birth.
• Improve linkages to care, including prenatal care, labor and delivery options, social services, and community programs.
• Increase early initiation of perinatal care by pregnant mothers in the first trimester.

Activities:

 

In FY22, DC Health’s Community Health Administration (CHA) Preterm Birth Pilot Program was concluded. Four organizations (Community of Hope, Medstar Washington Hospital Center, Howard University Hospital, and Unity Healthcare, Inc.) were selected through a formal Request For Application (RFA) process, to implement evidence-based strategies to reduce the occurrence of preterm birth and improve health outcomes. As described in DC Health’s Framework to Improve Community Health, the Preterm Birth Pilot Program supports the Maternal and Reproductive Health Services objective to reduce preterm births among Black women from 13.6% to 11.4% by 2026. Programmatic efforts targeted pregnant women at risk for preterm birth, prioritizing women with Medicaid and residing in Wards 5, 7, and 8.

 

Initially, the purpose of the pilot was to collaborate with healthcare providers and payors to ensure women at high-risk preterm birth were offered high-quality care, including the use of 17P and aspirin. Birthing facilities were to adopt successful strategies that have been implemented in other states and jurisdictions to increase the use of 17P and aspirin to reduce the occurrence of preterm deliveries. The medication had been shown to reduce the recurrence of preterm birth by 33% and was considered a clinical standard of care. However, in 2020, the Federal Drug Administration (FDA) proposed the medication be withdrawn, as results did not further demonstrate a clinical benefit in reducing preterm birth. This recommendation shifted provider perspectives on the usage of the medication. As recommendations shifted away from the use of 17P, the goals and objectives of the pilot were adjusted to focus on implementing other evidence-based strategies and interventions, such as Centering Pregnancy, chronic disease management (i.e., blood pressure monitoring), patient education and screening and connection to Maternal Fetal Medicine specialists. The Preterm Birth Pilot program ended in September 2022.

 

 

 

 

 

 

 

 

 

 

*Number of individuals served include patients who received prenatal care services and direct intervention services (including antepartum and postpartum education, navigation services, and 17P) in FY22.  

** Number of individuals served include patients who received direct intervention services as part of the pilot program (including antepartum and postpartum education, navigation services, and 17P) in FY22. 

 

 

Each of the four grantees demonstrated success in implementing education on preterm birth, enhanced monitoring, and Centering Pregnancy. Grantees demonstrated success leveraging their health information systems to provide enhanced education, patient support and connectivity to outreach services. One grantee conducted a qualitative analysis to understand how women receive prenatal care services to further aid the development and enhancement of their programs and services. Recommendations from this analysis indicated a need for providing more patient education, use of technology-based methods for improved health communication, increased access to resources to support positive health behaviors, and provision of more health care resources to supplement provider-patient collaboration. Additional analysis from another grantee indicated the need for improvements in patient-level data collection, specifically around patient demographics and other related risk factors, which impacted the organization’s ability to effectively reach the target population and provide data related to program evaluation and overall effectiveness. Overall key lessons learned from the pilot indicated a need to ensure organizations’ health information systems, as well as their current clinical practices and workflows have the capability to effectively capture individuals at risk to ensure timely monitoring and tracking of health outcomes. In addition, a need was identified to ensure more effective collaboration among grantees to improve provider partnerships. 

 

Through implementation of the Preterm Birth Pilot Program, DC Health leveraged the lessons learned to develop the new Preterm Birth Reduction Initiative. The new initiative request for application was released on July 1, 2022. Goals include developing screening tools and/or procedures to help identify women at risk for preterm birth; management of associated risk factors for those at risk for preterm birth; and improving linkages to care, including prenatal care, labor and delivery options, social services, and community programs. Through this new initiative, DC Health is emphasizing grantee organizations’ abilities to leverage Health Information Exchange (HIE) technology to identify, monitor and track outcomes among women at risk for preterm birth. The Community Health Administration as well as the Title V team will continue to support the Preterm Birth Reduction Initiative to increase risk-appropriate perinatal care and create equitable birth outcomes in the District.

 

In FY22 the District’s Title V program continued to fund two Well Woman Projects: Unity Healthcare, Well Woman Project (Unity), and La Clinica del Pueblo’s Mujeres Saludables (Well-Women) Project (La Clinica) which are discussed in further detail in the Women/Maternal Health Domain. Both grantees implemented evidence-based well-woman promotion strategies to expand access to interception care, preconception care, quality prenatal care, and health care over the life course to improve equity of birth outcomes in the District. While both projects focus primarily on well-woman interventions, they also implement strategies directly aligned with Title V’s goal of improving risk-appropriate perinatal care. Their objectives focus on increasing the percentage of pregnant women who initiate prenatal care in the first trimester from 68% to 75% by 2026.

 

Unity’s serves a majority Black population. It is incredibly important to support the efforts to improve their workflow and ability to improve early entry into prenatal care. Unity reported in FY22 using the Uniform Data System (UDS) clinical quality measure showing that 61% of pregnant women entered prenatal care during the first trimester. To engage women in early prenatal care, Unity aimed to hire a Registered Nurse Obstetric Intake Coordinator to coordinate efforts in increasing early entry into prenatal care rates. However, their efforts were not successful due to ongoing, nationwide staffing challenges in healthcare and required a pivot in approach. Care coordinators and other providers at Unity helped to bridge the gap by continuing to triage their pregnant patients based on risk and gestational age of pregnancy to support efforts in decreasing the time between pregnancy diagnosis and entry into prenatal care. In FY22 Unity was able to conduct 2,304 obstetric intake visits. While staffing and data system limitations hindered the tracking of success for Unity, strategic plans and technical assistance meetings were conducted throughout the fiscal year by the Title V team to address these issues.

 

One of La Clinica’s project goals is to enhance access and quality of comprehensive prenatal care for immigrant and low-income Latina pregnant women.  The key indicator to measure the success of the project is ensuring at least 65% of prenatal patients entered prenatal care during their first trimester. To achieve this goal, La Clinica enhanced its capacity to provide prenatal care through quality improvement activities such as its Prenatal Clinical Champions program. The Prenatal Clinical Champions program brings together healthcare professionals with clinical expertise, leadership skills, and passion to improve their overall prenatal care capacity, staff training in Spanish provided by Planned Parenthood covering Women’s Sexual and Reproductive Rights and Family Planning Methods, group-based health education sessions, individual health educations sessions, and community health promotion activities to engage the community. In FY22, La Clinica provided prenatal care to fifteen (15) unique patients, of which fourteen (14) of those patients (93%) were engaged in care in the first trimester, surpassing their goal of 65%. Engaging Latina women into early prenatal care has been a huge success in FY22 by the unique ability La Clinica has to offer culturally and linguistically appropriate care to their patients.

 

The District of Columbia Hospital Association (DCHA) established the District of Columbia Perinatal Quality Collaborative (DCPQC) in collaboration with DC Health. The DCPQC serves as the Healthy Start Community Action Network (CAN) for the District of Columbia and continued to be funded through the District’s Title V program. The DCPQC/CAN serves as the District’s champion for reducing maternal mortality, improving maternal and infant health outcomes, and narrowing racial and place-based disparities in maternal health. The DCPQC convenes a team of perinatal care providers from across the care continuum including a focus on DC birthing hospitals, public health professionals, and other multi-sectoral stakeholders, to improve health outcomes for women and newborns through continuous quality improvement. Initial infrastructure and development of the DCPQC began in FY 2020. However, the first full year of implementation began in October 2020 for FY 2021 and the initial AIM patient safety bundle (hypertension (HTN)) was launched in August 2021 with implementation proceeding through FY 2022. Based on AIM outcomes data, 3277 individuals (excluding ectopic pregnancies and miscarriages) experienced severe maternal morbidities (excluding blood transfusions) during their birth visit in 2021. Of these, 50% were non-Hispanic Black, 27% were non-Hispanic White, and the remaining 23% were in other categories. Black women constitute about half of all births but account for 90% of all pregnancy-related death. While non-Hispanic Black birthing people made up 90% of the city’s pregnancy-related deaths, White residents reported no pregnancy-related deaths, despite comprising 30% of all births in the city. Among all the District’s Wards, Wards 7 and 8 residents comprised 70% of pregnancy-associated deaths, while residents of Wards 2 and 3 reported no pregnancy-associated deaths in the reporting period.  Overarching programmatic goals are to reduce pregnancy-related morbidity and mortality among women in the District, reduce racial, geographic, and socio-economic disparities, and to work with participating hospitals to reduce impacts of national policies and practices that reflect systemic racism by January 2026.

In FY22, the DCPQC/CAN focused on the continued enhancing of alliance infrastructure including building the hospital teams, providing educational training, and inputting data into the AIM data system to ensure quality improvement projects were data-driven. The major focuses were DCPQC infrastructure, hospital team building, training, data, community engagement, and partnerships and collaborations. At the end of FY21 and into FY22, training was provided for hospital coders that work with maternal health data. The development of the hospital teams (formally named the Clinical Implementation Workgroups) took place; to include physician champions, nurse leaders, data leaders, technical leaders, quality improvement leaders, and additional teammates that would help to implement the team’s quality improvement projects. Patient advocate representation was also available during workgroup meetings to ensure that the patient voice was incorporated into the work of the teams. Monthly meetings were established, and hospitals were asked to use the AIM resources to develop a team charter and GAP analysis to help track the AIM bundle progress. Throughout the year, additional support in the form of resources and technical support was provided to the teams and this support will continue to assist the teams with their quality improvement projects. Several trainings were offered to ensure the hospitals had the necessary tools to implement the quality improvement work. This includes coding training for the hospital coders, a three-part racial equity and respectful care training for the hospital teams, and preeclampsia patient education training for all healthcare providers.

Two community members were engaged and attended the Full Committee meeting, the Advisory Board, and hospital team meetings. These community members also provided input on recruitment documents for inviting additional community members to the DCPQC. One of the community members (a Healthy Start mom) was connected to participate in the newly developed maternal health incubator developed by the American Association of Medical Colleges (AAMC). This opportunity allowed her to join a community member panel and share her maternal health experience. Additionally, a focus group was conducted with 10 Healthy Start participants to learn more from the community about their maternal health experiences in the District. The findings of this focus group will help to inform strategies that further support the work of the DC Perinatal Quality Collaborative. The District of Columbia has high rates of maternal mortality and severe maternal morbidity, characterized by racial and place-based disparities.

Clinical Implementation Workgroups were provided with patient education training and preeclampsia patient education resources by the Preeclampsia Foundation. Each patient education kit included 200 symptom tear sheets, 200 postpartum tear sheets, 25 symptom magnets, four clinic posters (two in English and two in Spanish), 100 subject-specific brochures, and 25 rubber bracelets. The workgroups added these resources to the patient's discharge packets and distributed them to all patients with severe hypertension/ preeclampsia. In FY22 the DCPQC/CAN, submitted hospital discharge data to the AIM data center, and hospitals registered to access the AIM data center.  Additional patient representatives were recruited, and racial equity and respectful care training was scheduled and implemented.  Hospitals inputted their data into the AIM data center and took part in Preeclampsia Foundation training and educational resources. Clinical Implementation Workgroups met monthly to discuss success, challenges, and barriers regarding AIM projects. Technical assistance is provided to the team to troubleshoot any issues that may arise. Looking forward, the DCPQC continues to explore ways to further engage patient and family representatives directly in the Clinical Implementation Workgroups and activities of the DCPQC/CAN. Enhancing the availability of data and data reports to support the work of the DCPQC will help to ensure that the members are able to make informed decisions and monitor progress effectively. In addition, developing mechanisms to engage Clinical Implementation Workgroups in improvement efforts as they work to meet staffing shortages will also be critical to enabling the DCPQC to successfully implement the current AIM bundle and expand the capacity of the DCPQC efforts to improve outcomes.

Performance Measures:

• SPM 6: Risk appropriate perinatal care – Decrease the proportion of Medicaid beneficiaries who deliver a low-birthweight infant.

 

Objective 3: Reduce the infant mortality disparity ratio among non-Hispanic Black infants from 3.5 to 2.6 by 2026.

Strategies:  

• Provide support to newborn screening programs to assist with early diagnosis and connection to intervention services. 
• Incorporate safe sleep education into hospital discharge regulations at birthing facilities in the District. 
• Support home visiting programs, pre-term birth reduction programs, and case management for high-risk women. 
• Preconception and prenatal nutrition education to help lower the risk of congenital malformations. 
• Refer and track referral completion of infants needing additional screening and specialty follow-up. 
• Support enrollment of infants in home visiting that are always placed to sleep on their backs, without bedsharing of soft bedding.
• Increase the percentage of infants with newborn screening test results outside normal limits for a newborn screening disorder that receive prompt and appropriate follow-up testing. 
• Increase early initiation of perinatal care by pregnant mothers in the first trimester. 

 

Activities:

 

DC Title V program continues to support the DC Health Safe Sleep Program (DC SSP) to educate and empower parents, caregivers, and partnering agencies with information on Sudden Infant Death Syndrome (SIDS) , Sudden Unexpected Infant Death (SUID), and safe sleep practices guided by the American Academy of Pediatrics Safe Infant Sleep recommendations. Unexpected deaths that cannot be explained are referred to as either sudden unexplained infant death, SIDS, or deaths of undetermined cause. Ensuring babies are sleeping safely greatly reduces a baby's risk of SIDS and other sleep-related causes of infant death. To lower the risk of sleep-related deaths, it is vital for all parents and caregivers of a baby to learn and understand infant-safe sleep practices. DC SSP has built and operationalized strong community capacity, by collaborating and sustaining robust working relationships with over 35 organizations (including local hospitals, daycare centers, short-term family shelters, and community organizations) that serve pregnant women and families in the District. Primarily using a “Train the Trainer Model”, the SSP Coordinator trains and provides technical assistance to staff at partner organizations, as well as providers at childcare settings, across the District that predominantly work in communities at higher risk for poor pregnancy outcomes. The program has also maintained an important relationship with the Office of the State Superintendent of Education (OSSE), providing training to licensed childcare center staff in the District, as well as groups with the DC Child and Family Services Agency, Child Protective Service (CPS). During the onset of the COVID pandemic, DC SSP shifted from in-person training to all virtual training. This approach has become the program’s new training model and continued to be a very effective and accommodating way of reaching more partners and their program staff. The program targets infants, birth to twelve months in all DC Wards, to ensure all neighborhoods have access to the program with a special emphasis on partner agencies serving families in Wards 5, 7 8, which historically have had the highest rates of infant mortality in the District.

The DC SSP program is one part of the District’s efforts to provide infant safe sleep education and contribute to the saturation of messaging from various angles and venues. The program aligns with Title V’s priority of decreasing perinatal and infant health disparities. In FY22, 1128 parents/caregivers were educated on infant-safe sleep practices, 197 partners and childcare providers were educated by the DC SSP on infant-safe sleep practices, and 1066 portable cribs distributed (Cribettes) portable cribs were distributed. To support the program’s long-term sustainability, the DC SSP continues to take steps to ensure partners are educated and infant-safe sleep resources are embedded within the community. Additionally, the DC SSP virtual training is reaching significantly more participants each year. This shift has increased convenience for District residents and allowed DC Health to provide more community partners with technical assistance and program oversight. Looking forward, the program will increase partner site visits to strengthen partnerships as well as ensure partners comply with program responsibilities and portable cribs are stored properly.

DC Title V program funds and provides evidence-based programmatic support to the District of Columbia’s Universal Newborn Hearing Screening Program, also known as the DC Early Hearing Detection and Intervention (DC EHDI) Program. Newborn hearing screening checks infants’ hearing shortly after birth. This screening process helps detect a possible hearing loss within the first months of an infant’s life. The overarching goal of the DC EHDI program is to ensure children who are deaf or hard of hearing (D/HH) are identified through appropriate newborn, infant, and early childhood hearing screenings for diagnosis and early intervention (EI). EI works to optimize language, literacy, and cognitive, social, and emotional development. DC EHDI adheres to the national hearing loss intervention guidelines of 1-3-6. Every newborn will receive a hearing screening by one month of age; every infant that does not pass the initial hearing screening and rescreening will have completed a diagnostic audiological exam by three months of age, and all infants confirmed as D/HH will be enrolled into EI services by six months of age. During FY22, 11,835 babies were born in the District of Columbia. Of those infants, 11,670 received a newborn hearing screening. The DC EHDI Program supports Title V goals by decreasing perinatal and infant health disparities by increasing the percentage of infants with newborn hearing screening test results outside normal limits that receive prompt and appropriate follow-up testing. The DC EHDI program continued to implement a multifaceted plan for addressing timely diagnosis, referrals to EI services, enrollment in EI services, and family support for the program. This plan focused on: (1) Collaborating with birthing hospitals, outpatient screening providers, and other health care professionals to ensure timely newborn screenings; (2) Engaging DC’s EHDI partners, stakeholders, and families in learning communities; (3) Developing and fostering collaborative partnerships with EI programs and (4) Addressing the importance and engagement of families within the EHDI system.

DC EHDI continued to work closely with and provide technical assistance to staff at the five District birthing hospitals, one birthing facility, Children’s National Hospital (CNH), Gallaudet Hearing and Speech Clinic, Kaiser Permanente, and other service providers to improve data quality, accuracy and timeliness of hearing screening and treatment/care plans reporting. The DC EHDI system continued to use the OZ e-SCREENERPLUS (eSP) Database to track newborn hearing screening results for all infants born in the District and District infants born in other jurisdictions. This system captures and documents initial and repeat screenings, referrals, and diagnoses. All providers (hospital providers and diagnostic audiologists) are required to maintain up-to-date records of all infants screened. Staff are required to adhere to the standard operating procedures for entry and management of all data entered in OZ eSP. All screening results are extracted on a continuous basis and reviewed for accuracy and completeness. When there were errors or incomplete information found in reporting, DC EHDI reached out to providers to obtain more information to ensure OZ is updated and accurate.

In addition, DC EHDI continued to contract services from Maryland/DC Hands and Voices (MD/DC Hands and Voices) to support families with children who are D/HH, without bias around communication modes or methodology. They provide parents with resources, networks, and information they need to improve communication access and educational outcomes for their children. MD/DC Hands and Voices operates a program called “Guide By Your Side”. The Guide By Your Side program provides support and mentorship to parents of children newly identified as D/HH through “guides.” The guides are parents of children that are D/HH and may also be D/HH. DC EHDI also continued to work in collaboration with the District’s neighboring states of Maryland (MD) and Virginia (VA) to ensure that infants receive appropriate care and follow-up. DC EHDI has established protocols with MD and VA’s EHDI Programs to securely exchange newborn hearing screening details for one another’s tracking systems. DC EHDI also collaborates with other state EHDI coordinators to learn about the successful implementation of evidence-based practices and novel approaches to improve the EHDI system and families’ interaction within the system.

DC EHDI also continued to fund an educational audiologist that collaborates with the Office of the State Superintendent of Education (OSSE) Part C/Early Intervention Strong Start Program. The educational audiologist assists the families that have been referred to Strong Start in their decision-making process regarding communication opportunities, hearing technology, early intervention, and additional services as needed until the child ages out of the program at the age of three.

In FY22, DC EHDI also continued to partner with the Office of the State Superintendent of Education (OSSE), Part C/Early Intervention (EI) agency and operator of the Strong Start (EI/Part C program) to ensure that children identified as D/HH were entered into EI services. DC EHDI worked with Strong Start to draft a data use agreement that will allow DC Health to have shared access to data, along with OSSE, to aid both entities in thoroughly following and tracking babies who are D/HH and qualify for EI services from the referral stage to the admission and participation stages. Currently, the drafted data use agreement will need to go through both legal teams for DC Health and OSSE prior to implementation. Throughout the project period, DC EHDI has focused on the entry of newborn hearing screening data by hospital/birth facility staff and additional outpatient screening and service providers. Inconsistent data reporting from the hospitals continues to be a challenge for the DC EHDI Program. Challenges with reporting included missed/no screen outcomes results for birth and OP screenings and little to no notes indicating status on transfers, referrals, newborn’s medical home, and/or notes on newborn’s case to aid follow-up. This reporting greatly impacted the program’s ability to accurately conduct surveillance. Duplication of profiles has also been problematic. In addition, this budget year revealed a continuous pattern of infants not receiving quality birth hearing screenings. Finding a solution is imperative to ensure accurate data is being reported in OZ eSP Database, including the number of profiles (aligning with an accurate number of births in DC) and infant profiles that have no follow-ups/listed as in process due to being a duplicate. DC EHDI continues to actively address reporting and other issues through a variety of Quality Improvement (QI) mechanisms, including the establishment of protocols around the timeliness of reporting screening results, recording of upcoming appointments and medical home information, providing updates on newborns (e.g., inpatient/NICU status, transfers to other hospitals, etc.), and on-going communication with birthing facilities and CNH to resolve issues that arise.

Currently, all five DC birthing hospitals and CNH have either begun to explore and/or have completed implementation of the OZ NANI (Newborn Admission Notification Information) software that interfaces between a hospital’s EHR (Electronic Health Record) and OZ SP Database to create an automatic case entry from the birth file. NANI is a secure set of software tools that assist newborn screening programs in gathering timely, basic newborn admission information to establish an accurate denominator of hospital births and eliminate potential manual entry errors. It also helps to ensure OZ has demographic and other appropriate updates, including discharge and transfer information, and updated patient names, all in real-time. Four out of the five birthing hospitals have completed implementation and the last one is moving towards implementation. In FY22, DC EHDI discovered that NANI was not collecting accurate data elements to identify infants born in the District. DC EHDI will partner with OZ and birthing hospitals to identify why data elements such as race, and ethnicity are missing and not transferring over to OZ NANI seamlessly. There appears to be a disconnect when linking the hospital’s electronic health record to NANI. DC EHDI is working diligently with the DC OZ eSP Database HL7 Coordinator and hospital IT staff to determine where the connection is lost in the transfer of patient records and/or updates. DC EHDI will explore attending Interagency Coordinating Council (ICC) meetings in the future. The ICC advises and assists OSSE and the Division of Early Learning in the performance of its responsibilities, including the identification of fiscal and other supports specifically for early intervention programs; the promotion of methods for intra- and inter-agency collaboration regarding child find, monitoring, financial responsibility, and the provision of early intervention services; the transition of toddlers with disabilities to preschool and other appropriate services; and preparation and submission of annual report on the status of early intervention programs for infants and toddlers with disabilities and their families. DC EHDI aims to have a representative join their quarterly meetings as we work closely with the Part C Strong Start team for D/HH children in the District. DC EHDI hosts numerous meetings with the D/HH community in the District. The program has encountered barriers in accessing interpretive services through DC Health. Although the EHDI coordinator requests services promptly, interpreters are not typically assigned until the day before a scheduled meeting. In some instances, the quality of the interpreters has been poor due to timeliness, lightning, and proper translations. DC EHDI will work with leadership to determine the best ways to address this challenge and provide equitable language access for the District’s D/HH community.

The DC Newborn Metabolic Screening (DC NMS) Program, supported by Title V funding, ensures all newborn infants born in the District of Columbia receive timely metabolic and genetic screening for core and secondary health disorders that are treatable by diet, vitamins, and/or medication, or by anticipatory measures to prevent adverse reactions. The DC NMS Program collaborates with all the District’s pediatric providers, birthing hospitals and facilities to follow-up on abnormal screening results based on laboratory recommendations. This includes repeat screenings and referrals for genetic counseling and education, clinical evaluation and management, diagnostic (lab) testing, or other follow-up specialty care services as indicated. Metabolic and genetic disorders are rare, but can be serious, conditions that can lead to severe health and developmental problems or even result in death, if not identified and treated early. The overall goal of the DC NMS Program is to ensure that every infant born in the District is screened for 45 inherited disorders via a dried blood spot test prior to discharge. Our DC NMS Program aims to link every infant identified with abnormal screening results to a primary medical home and to ensure they receive timely and appropriate follow-up for medical referrals and connection to early intervention services. The DC NMS Program supports the achievement of Title V measures by decreasing perinatal and infant health disparities through the increase of the percentage of infants with newborn screening test results outside normal limits for a newborn screening disorder that receive prompt and appropriate follow-up testing.

 

In FY22, the DC NMS Program continued activities to enhance quality improvement and existing surveillance systems and Long-Term Follow-up (LTFU). The DC NMS Program maintained the program’s tracking systems and ensured appropriate follow-up information was shared regarding all abnormal labs and rescreening results for both immediate Short-Term Follow-up (STFU) and LTFU in coordination with key players involved in the program. This includes all the DC birthing facilities and hospitals, PerkinElmer Genetics Laboratory, primary care providers (PCPs), and specialty care providers. STFU regarding abnormal results begins immediately within the first days of an infant's life and continues as necessary to connect the newborn to additional testing and specialty follow-up if required. Once a diagnosis is made regarding a condition, a treatment plan regimen is generated and placed into action. DC NMS continued tracking the newborn in the LTFU phase along with both Primary Care Provider (PCP) at the newborn’s medical home and any specialists providing care to the newborn. This follow-through helps to ensure the coordination of care, delivery of treatment, and continuation of support services in place to provide the best clinical management for the newborn with a shared goal of healthy and therapeutic outcomes.

 

The DC NMS Program also continued to support the activities and partnerships with participation in the DC Fetus and Newborn Committee of the District of Columbia Chapter of the American Academy of Pediatrics. These engagements yielded valuable participant communication through stakeholder meetings and email interactions and discussions with essential health personnel from hospitals, clinics, government, and private entities. These collaborative efforts led to best practices in coordinating the inputs of stakeholders and partners into strategic planning for the program. There will also soon be a newly established Perinatal and Infant Health Advisory Committee that will house the District’s new Sub-Committee on Metabolic Disorders.

 

DC Health made great strides in FY22 by moving closer to the addition of a new disorder, Spinal Muscular Atrophy (SMA), to the DC Newborn Screening Panel. SMA was added to the Recommended Uniform Screening Panel (RUSP) in February 2018. In February 2019, the District’s past Committee on Metabolic Disorders voted “yes” to add SMA to the District panel. Since this point, DC NMS has been leading the effort to lead stakeholder engagement and communication and the development of the proposed rulemaking to add the disorder. Additionally, the Better Access for Babies to Integrated Equitable Services Act of 2020 (BABIES Bill) provided legislation to create updated DC hospital discharge regulations. It will standardize newborn screening procedures, including for metabolic and genetic disorders, at birth facilities and ensure the provision of comprehensive newborn education across birthing hospitals and facilities. The new regulations will be key in streamlining congruency and accuracy across all systems. The DC NMS and Perinatal and Infant Heath Division (PIHD) have been leading the effort in drafting the new regulations. The DC NMS Program encountered some recurring and new challenges in FY22, including access to updated contact information to assist with coordinating care between birthing hospitals, pediatricians, and families. Low staff capacity across birthing hospitals and delays in implementing evaluation and QA/QI activities has impacted these outcomes. Particularly related to the COVID-19 pandemic, there were occasional delays in families getting their newborns’ follow-up screenings when needed and expressed anxieties about being in medical settings for screenings post deliveries. Looking forward, the DC NMS Program will continue to focus on PCP's communication regarding follow-ups on repeat screenings and tests, referrals, and next steps in coordinating care for their patients, transition to a more expansive and streamlined data tracking system (OZ systems which house newborn hearing screening data), vital records collaboration with data sharing, quality assurance and quality improvement strategies, data utilization, and interoperability and overall providing seamless coordination across the newborn metabolic screening system.

 

Performance Measures:

• SPM 6: Risk appropriate perinatal care – Decrease the proportion of Medicaid beneficiaries who deliver a low-birth weight infant.

Objective 4: Decrease the percentage of low-birth-weight infants with Medicaid Insurance from 60% to 40% by 2025  

Strategies:

• Enhance capacity to provide a space for women to engage in early and continuous prenatal care to prevent maternal complications.
• Implement communication campaigns focused on prenatal care, annual well-woman visits, and pre-conception health.
• Strengthen Community Health Workers (CHWs) role in providing service and support to families.
• Increase doula support to program participants during the perinatal period.
• Increase early initiation of prenatal care by pregnant mothers in the first trimester.

The percentage of low birthweight births in the District significantly decreased from 2011 to 2020 from 10.5% to 9.6%. The percentage of low birthweight births among all Medicaid financed births in the District was 12.6%, which was significantly higher than the percentage of low birthweight births financed by private insurance (7.2%) and CHAMPUS/TRICARE (4.8%). Mothers whose births were Medicaid financed were almost two times more likely than mothers with private insurance to have a low birthweight infant.

Activities:

As mentioned earlier in this domain narrative, the Preterm Birth Reduction Initiative aims to reduce the occurrence of preterm birth among at-risk District residents. The Preterm Birth Reduction Initiative supports the Title V objective of decreasing the percentage of low-birth-weight infants with Medicaid Insurance by ensuring that all subcontracted organizations (Medstar Washington Hospital Center, Unity Health Center, Community of Hope, and Howard University Hospital) provide services to at-risk communities serving high proportions of women with pre-term births, Medicaid-insured and residing in Wards 5,7, and 8. Organizations focus on developing screening tools and/or procedures to help identify women at risk for preterm birth; managing associated risk factors for those at risk for preterm birth; and improving linkages to care, including prenatal care, labor and delivery options, social services, and community programs.

 

The DC Healthy Start (DCHS) Program targets residents of Wards 5, 7, and 8 of the District of Columbia to ensure the identification and management of high-risk pregnancies. DCHS provides services and support for mothers, infants up to 18 months, and their families (fathers/partners) through comprehensive case management and care coordination to address health and social service needs. Two community health centers serve as medical homes for program participants. During the initial perinatal assessment and throughout the prenatal period, DCHS participants are assessed for medical risk factors that are indicative of a high-risk pregnancy, such as high blood pressure, history of smoking, history of opioid use, and domestic violence. Participants designated as high-risk pregnancies participate in more prenatal visits with their medical provider in addition to the increased in-person and remote home visits from DCHS community health workers (CHW). DCHS provides screening for risks to the fetus and newborn. Using the 4Ps Screening tool, CHWs assess participants in four domains: Partners, Parents, Past, and Pregnancy. With the screening tool, DCHS CHWs can detect drug and alcohol use and other factors that could pose a risk to the developing fetus and newborn. Positive screens are connected to the appropriate resources within the medical home.

DCHS supports the Title V objective of decreasing the percentage of low-birth-weight infants through programming and support, including referring participants to Women’s Health Consultation, Centering, and doula care, and providing clinical support to CHWs through the clinical provider. DCHS provides Women’s Health Consultation, offered by a Healthy Start Clinical Provider as a telehealth appointment. The Women’s Health Consultation visit was instituted as an adjunct to regular medical services and targets participants throughout the perinatal period. The Women’s Health Consultation covers various areas as needed, including (i) reproductive life planning, supporting participants with short and long-term reproductive goals, including preparing for pregnancy or accessing contraception; (ii) postpartum consultation, discussing and providing support related to postpartum recovery, postpartum depression, breastfeeding and more; (iii) inter-conception care, including linkage to primary care services for chronic illness, immunization support, mental health assessment, and risk assessment for STI prevention and interpersonal violence. This service aims to create a space for participants to engage in early and continued care to prevent complications and improve outcomes for mothers and their newborns and infants. In FY22, DCHS provided Women’s Health Consultation to 26 Healthy Start participants through a Clinical Provider. DCHS also offers the integration of supplemental doula services. DCHS began a supplemental doula program in FY22 that provides a contracted doula to birthing participants during the perinatal period and offers live or virtual support.

 

 

 

[1] D.C. Department of Health. (2022). District of Columbia department of health: Perinatal health and infant mortality report. Retrieved from. https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/2022-07-CPPE-PHIMreport-9-web.pdf

[2] Centers for Disease Control and Prevention(2021). Breastfeeding Benefits Both Baby and Mom. Retrieved form. https://www.cdc.gov/nccdphp/dnpao/features/breastfeeding-benefits/index.html#:~:text=Breastfeeding%20can%20help%20protect%20babies,ear%20infections%20and%20stomach%20bugs.

 

[3] http://www.dcbfc.org/mission.php

[4] https://www.fns.usda.gov/wic/about-wic-how-wic-helps

[5] https://www.fns.usda.gov/wic/about-wic-wics-mission

[6] D.C. Department of Health. (2022). District of Columbia department of health: Perinatal health and infant mortality report. Retrieved from. https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/2022-07-CPPE-PHIMreport-9-web.pdf

[7] Mazul, M. C., Salm Ward, T. C., & Ngui, E. M. (2017). Anatomy of good prenatal care: perspectives of low income African-American women on barriers and facilitators to prenatal care. Journal of racial and ethnic health disparities, 4(1), 79-86.

[8] U.S. Department of Health and Human Services Office on Women’s Health, “Prenatal care,” available at https://www.womenshealth.gov/a-z-topics/prenatal-care (last accessed January 2020); World Health Organization, “Global Nutrition Targets 2025: Low Birth Weight Policy Brief” (Geneva, Switzerland: 2014), available at https://www.who.int/nutrition/publications/globaltargets2025_policybrief_lbw/en.

[9] Association of Maternal & Child Health Programs, “Opportunities to Optimize Access to Prenatal Care through Health Transformation” (Washington: 2016), available at http://www.amchp.org/Policy-Advocacy/health-reform/resources/Documents/Pregnancy%20Issue%20Brief_Final%202016.pdf.

[10] ibid

[11] ibid