Originally posted in the Every Woman Southeast blog, November 2017. 

Local community organizations across the Southeast are opening safe spaces for women of childbearing age to share their stories about preconception and perinatal health care. These are informal storytellers – everyday folks who share common threads, including motherhood and participation in a community infant mortality reduction program. However, these programs aren’t administered as a publicly funded program that simply meet project deliverables; these programs are often a place to call home. Enrolled participants are peers who support one another, form healthy relationships and even become family members. This Lessons Learned [weekly] series will focus on strategies to care for young families in the rural south from Defining Support to understanding Voluntary Kinship.

The Southeastern region of the US has historically reported high infant mortality rates. According to the 2005 data from the Centers for Disease Control and Prevention National Center for Health Statistics (CDC NCHS) the United States had a national infant mortality rate of 7.1 (per 1,000 live births) in 2005. In that year, states with the highest reported infant mortality rates (ranging from 8.2-11.5 deaths per 1,000 live births) higher than the national average were predominately in the Southeastern region of the country, i.e., North Carolina, South Carolina, Georgia, Alabama, Mississippi, Louisiana, Tennessee. Comparatively, the 2015 report showed a major decline in the infant mortality rates for the United States (5.9 per 1,000 live births) and the southeastern states mentioned (North Carolina, 7.3; South Carolina, 7.0; Georgia, 7.8; Alabama, 8.3; Mississippi, 9.3; Louisiana, 7.7; Tennessee, 7.0). These numbers are largely attributed to the success of federally-and state-funded maternal and child health programs that have provided a continuum of care to women and families across the United States, with specific attention to high risk populations in the country, i.e. the rural south.

These programs have adapted recommendations from the National Health Start Association’s Federal Healthy Start Initiative. In 2010, the National Healthy Start Association issued a white paper “National Network for Effective Home Visiting and Family Support Services,” a data driven, evidence-based recommendation for continuity of care for families of child bearing age. The white paper highlighted a “greater focus on prevention, social determinants of health, and racial/ethnic and socioeconomic inequalities in health and community-based health care models” (National Healthy Start Association, 2010) to reduce infant mortality rates across the country. Since 1991, federal Healthy Start has served “hundreds of thousands of families” with over 90% from marginalized groups i.e., African-American, Hispanic, Native American/Pacific Islander and families from Appalachia.

Interconception case management service provision includes screening for depression, domestic violence, health education, crime and child maltreatment (National Healthy Start, 2010). Services have been implemented by local health departments and community-based organizations with multidisciplinary home visiting staff (social workers, health educators, nurse care managers, etc.). North Carolina’s case management services have included adaptations from the Centering model which empower enrolled participants to make informed, healthier decisions for their families and their own lives. Participants not only receive case management services from the prenatal stage (when enrolled, theoretically) through postpartum (varies per program), but also provide peer support during monthly health education group sessions.  The topics covered by these sessions include but are not limited to nutrition (with support by EFNEP), contraceptive care, and building healthy relationships using evidenced-based curricula such as The Incredible Years program.

These services have proven helpful for participants. The Centering model not only empowers participants to make healthier decisions but also nurtures safe spaces for families with common issues to build supportive community structures. Young women of childbearing age (ages 15-35) have shared that these community based case management and new mom support programs have provided pathways to community resources and community support that their medical provider has not volunteered. This is important because these programs have a few limitations. They are grant funded programs with an intended audience, services are scheduled for a limited time and/or providing services during a specific period during the life span (i.e., prenatal through two or six months postpartum or possibly two years postpartum depending on program). Through a variety of interviews with young persons of childbearing age across the state of North Carolina, I have an expanded definition of support which includes fictive kinship. 

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