The Development of a Regional Perinatal Forum Social Health Marketing Campaign for the Hudson Valley Region Janine Lewis, MPH, PhD(c) Northern Manhattan Perinatal Partnership: Practice Matters

Disclosure of Relevant Financial Relationships  No commercial interests to disclose

Objective  Discuss the development of a social marketing campaign targeting women of childbearing age and their families with messages promoting the reduction of primary elective Cesarean sections and inductions prior to 39 weeks’ gestation  Background/rationale for campaign  Steps completed to date  Future plans

Practice Matters  Practice Matters is the management consulting arm of the Northern Manhattan Perinatal Partnership (NMPP), a MCH agency well-prepared to equip professionals, agencies, and organizations with the strategic and operational know-how needed to ensure healthy birth outcomes.  Practice Matters was formed in 2007 under the leadership of Mario Drummonds, MS, LCSW, MBA, the Executive Director of NMPP.  NMPP’s Social Health Marketing Group, founded in 1997, is comprised of administrative, marketing, and case management staff skilled at developing marketing, outreach, and advertising campaigns for social service agencies, health facilities, and private businesses.

Trends in Cesarean Sections In 2007, there were 1.4 million Cesarean births, approximately 1/3 of all births in the US (CDC, 2010). 4-18% of Cesarean sections are conducted by maternal request (Fuchs and Wapner, 2006); 2.5% of all US births are Cesarean sections by maternal request ( Bettegowda et al, 2008)

Live Births by Method of Delivery, 2007 Source: NYS DOH Vital Statistics

Inductions  In 2006, approximately 22% of all pregnant women had their labor induced (ACOG, 2009)  Inductions may increase the likelihood that Cesarean sections may follow (Wilson et al, 2010; Yeast et al 1999)

Interventions related to Birth, 2008 (percentages) Source: NYS DOH Vital Statistics

ACOG Practice Bulletin, 2009  Recommendation: elective deliveries (inductions and Cesarean sections) not be performed before 39 weeks of gestation, to minimize prematurity-related neonatal complications.

Preterm Birth  Defined as infant born before 37 completed weeks of gestation  “Currently the most important problem in maternal-child health in the United States” (Wadhwa et al, 2001)  Has grown 27% since 1981 to a total of 12.4% of all live births  African-Americans have a PTB rate of times that of Whites  About 50% of PTB cases have no known etiology (but we do know that higher order births, uterine/cervical abnormalities, previous preterm birth are top risk factors)

Preterm Birth  Between , Cesarean section rates for infants born late preterm (34 to 36 completed weeks of gestation) and term and over (37 or more completed weeks of gestation) rose by almost 50%. (CDC, 2010)  Cause of 85% of perinatal mortality and morbidity in the US (Arias et al, 2003)  Most are considered late preterm (34-36 weeks)

Trends in Preterm Births

Relationship Between Cesarean section, Inductions and Preterm Births

WMC Social Marketing Campaign  Purpose: to reduce the number of primary elective Cesarean births and inductions  Secondary objective: reduction of total number of Cesareans, late preterm births  Mixed methods approach to data collection/market research  Deliverable: development of mock-ups/galleys

Development of Social Marketing Campaign  Secondary data analysis (May – June)  Hospital-based data  NYS DOH Vital Statistics  Peer-reviewed literature review  Development and submission of IRB protocol (June – July)  IRB approval (September)  Key Opinion Leader Interviews (October)  Focus Groups (October)  Topline Summary of Focus Groups/Interviews (November)  Development of campaign galleys/mockups (November – December)

Focus Groups  Four total:  Orange  Rockland  Westchester (2)  Women years of age (nulligravidas, pregnant, or have child under 1 year of age)  90 minutes in length  Hosted by Public Libraries/Community-Based Organizations  Recruitment by PM/HVRPF

Focus Groups - Demographics Rockland  African-American (AA), Latinas  Low SES  Pregnant/Postpartum Orange  White  middle SES  semi-rural Westchester #1  White  High SES  nulligravidas Westchester #2  African-American  mixed SES  Pregnant/postpartum

Focus Group – Preliminary Findings

Key Opinion Leader Interviews  N = 10  30 minutes in length  Representatives from non-profit organizations (community-based, voluntary health organizations, social service); fathers

Key Opinion Leader Interviews – Preliminary Findings

Next Steps  Complete development of mock-ups/galleys  Print/distribution

Acknowledgements  Mario Drummonds, Northern Manhattan Perinatal Partnership/Practice Matters  Tamara Wrenn, Practice Matters  WMC Awareness Campaign working group:  Dr. Heather Brumberg – PI  Cheryl Hunter-Grant  Caren Fairweather  Fran Menillo

For more information: Janine Lewis, MPH, PhD(c)