1. Healthy Texas Babies: A Stakeholder-Driven Approach to Infant Mortality Reduction
Evelyn Delgado, Assistant Commissioner
Division for Family and Community Health Services
Texas Department of State Health Services

2. Infant Mortality Rate (IMR) Low Birth Weight (LBW) Preterm Birth (PTB)
Birth Outcomes Data
Infant Mortality Rate (IMR)
Texas: 6.1* African Americans: 9.9
Low Birth Weight (LBW)
Texas: 8.5 African Americans: 14.0
Preterm Birth (PTB)
Texas: 13.2 African Americans: 17.1
Maternal Age**
Less than 20: 13.5% of TX births; LBW 9.6; PTB 14.9
Greater than 40: 2% of TX births; LBW 12.3; PTB 18.6
US Context – IMR: 6.6; LBW: US 8.2; Preterm birth US 12.3 – UNDERLINED are rates that are higher in Texas than the US.
African Americans – We see major disparities between African Americans and other groups. Rates for IMR, LBW and PTB in whites and Latinas are similar.
Re: Maternal Age – Main points: While Teens make up a larger proportion of the births (in yellow: 13.5%), the outcomes for babies born to mothers over 40 are worse (in yellow), though preterm birth is worse than the state average for both groups.
*Data is rate per 1000 live births in 2008 ,Texas Natality and Mortality Files, Texas Department of State Health Services; National Vital Statistics Reports, National Center for Health Statistics, , available at
**Data from March of Dimes PeriStats averaged data.

3. What is Healthy Texas Babies?
Healthy Texas Babies (HTB) is an initiative to decrease infant mortality
Goals of Healthy Texas Babies Initiative:
Provide local partnerships and coalitions with major roles in shaping programs in their communities
Use evidence-based interventions
Decrease preterm birth rate by 8% over 2 years
Save ~ $7.2 million in Medicaid costs over 2 years

4. Simultaneous Policy Actions
Legislature passed three related perinatal health bills
HB 1983 – Eliminates Medicaid payment for elective inductions and c-sections before the 39th week
HB 824 – Creates an outreach campaign to promote fathers' involvement with their children before birth
HB 2636 – Creates a council to study neonatal intensive care unit regionalization
Legislature appropriated $4.1 million in General Revenue funds to DSHS funding the Healthy Texas Babies initiative

5. What We Have Accomplished So Far
NICU Regionalization
Dissemination of NICU & OB survey under direction of HHSC
HHSC convening NICU council using materials developed by workgroup
39-Weeks initiative
Medicaid rules change for reimbursement of non-indicated pre-39 week deliveries
March of Dimes and WIC collaboration
Development of web-based well-woman curriculum for WIC participants

6. What We Have Accomplished So Far
Increased public awareness of the issue
Healthy Texas Babies website & media campaign
Tools, best practices and community updates
Text4baby – DSHS is lead outreach partner for Texas
Fatherhood initiatives
WIC is distributing Office of the Attorney General “Maps for Dads” publication in all WIC sites
DSHS, OAG working on development of fatherhood survey

7. Distribution of HTB Information & Funds
Fund local initiatives led by coalitions of stakeholders and government organizations
Provider education
Community Health Worker/Promotor(a) trainings
DSHS Grand Rounds Series
Texas Health Steps module
In-person trainings statewide

8. Moving forward Expand Expert Panel membership
Multi-agency Work Group develops additional deliverables
Link to faith community, academic community, etc.
Implement programming based on NICU & OB Survey results, results of fatherhood survey and other data collection activities
Align HTB objectives with existing programs at the state and local levels

9. National Perspective ASTHO Presidential Challenge DHHS – HRSA
Best Practice Subcommittee for ASTHO Healthy Babies Project
DHHS – HRSA
Region 4 & 6 Infant Mortality Summit
Big 5 – March of Dimes
AMCHP Action Learning Collaborative
HHS Secretary’s Advisory Committee on Infant Mortality
Main points: Multiple opportunities for visibility for this issue at the local level (working with providers, community members) up to the national level.
ASTHO Presidential Challenge – Impetus for states to focus on this issue, with Texas serving as a model. Dr. Lakey and other DSHS & HHSC staff participating on Healthy Babies Best Practice Subcommittee.
DHHS-HRSA – Region 4 & 6 Infant Mortality Summit to receive technical assistance from HRSA. Collaborative effort among state partners, ASTHO, AMCHP & HRSA on the national stage.
Big 5 – March of Dimes invited Evelyn and Rebecca to participate with other Big 5 states to look at data collected and practice change results of the initiative.
AMCHP Action Learning Collaborative - looks at role of racism and social determinants of health in the context of infant mortality and data-driven responses (AMCHP, CityMatCH).
HHS Advisory Committee on Infant Mortality – feeds into other multistate and federal agency efforts to establish best practices in national programming.

10. For more information or to get involved in the Healthy Texas Babies Initiative:
Aisling McGuckin RN, MSN, MPH
Texas Department of State Health Services
Office of Title V & Family Health
(512)
Thank you