Improving Birth Outcomes for Black Babies in Orange County, Florida

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Despite substantial reductions in U.S. infant mortality during the past several decades, black-white disparities in infant mortality rates persist. One of the Healthy People 2010 national objectives for maternal and infant health is to reduce deaths among infants aged < 1 year to < 4.5 per 1,000 live births among all racial/ethnic groups. Important determinants of racial/ethnic differences in infant mortality are low birth weight (LBW), defined as < 2500 grams, and very low birth weight (VLBW), defined as < 1500 grams. Healthy People 2010 goals include reducing LBW to 5% and VLBW to 0.9% of live births (objectives 16-10a and 16-10b, respectively).

In Orange County, Florida, although there continues to be work to be done to achieve these goals for all races, the Black population’s maternal and child health outcomes are farthest from these goals. Please see the data below from the Department of Health, Florida CHARTS for 2003-2005:

Health planning efforts in Orange County have identified three areas for which to focus on in the next few years – the need to reduce/eliminate health disparities, the need to encourage healthy lifestyle and the need to improve our current system of care to increase access to services. The need for high quality,culturally appropriate,easily accessible prenatal care for pregnant Black women crosses all three of these focus areas. Commonsense Childbirth, Inc./The Birth Place, Inc., located in Orange County, has developed a model of prenatal care that is showing encouraging birth outcomes for this high risk population. The Birth Place accepts all pregnant mothers regardless of ability to pay. Approximately 90% of the program’s patients are uninsured or under-insured (i.e. Medicaid).

In the past year, of 100 births to mothers who were patients of The Birth Place, only one baby was a LBW baby. This rate of 1% compares very favorably to the 13.3% LBW rate for Black babies in the county these past three years. The model of care is holistic and comprehensive and encourages and supports the women and their families and friends to come together as a team focused on one thing – a healthy baby brought to term.

Current wait times at the health department and community health centers for obstetrics care can be three to four months. Prenatal care should start in the first trimester for best outcomes and these important community providers do not currently have the capacity to expand. The Commonsense Childbirth/Birth Place program needs to continue to receive grants to maintain its ability to provide uncompensated care and in order to expand capacity and increase access to care for these high risk women and their babies. Long term sustainability of the project is being pursued with the Orange County Healthy Start Coalition, and other agencies. Early discussions with the Coalition have been encouraging. The Coalition’s staff and board are interested in the results of a formal evaluation as well as the ability to replicate the model in other settings.

Uncompensated care costs to the Birth Place 2006 is shown below: