1. Moving towards measurable outcomes in maternal and child health
Yhenneko J. Taylor, MStat
State of the Science
Congress on Nursing Research
September 14, 2012

2. Acknowledgments Co-author Paper Mary A. Nies, PhD, RN
Maternal and Child Health Journal (Epub June 2012)

3. Overview MCH Issues Study Objectives Research Methods
Results of Evaluation Studies
Conclusions & Implications

4. Issues in maternal and child health
Healthy People 2020 Goal
Infant mortality
6.0 deaths per 1,000 live births
Early and adequate prenatal care
77.6% percent of pregnant women
Maternal mortality
11.4 deaths per 100,000 live births
Low birth weight
7.8% of live births
Preterm births
11.4% of live births
Preconception health
26.2% women taking folic acid

5. Strategies to address MCH issues
Holistic approaches
Social determinants
Preconception care
Community building
Father involvement

6. Federal efforts around MCH
Program
Target
Benefit
Head Start
Children ≤5yo
Education, medical, and dental
Healthy Start
Pregnant women and infants <2yo
Funds community projects to reduce infant mortality disparities
WIC
Pregnant women and children <5yo
Supplemental food packages
Medicaid
Pregnant women
Prenatal, delivery, and postnatal care

7. Objectives
Examine impact of programs that aim to improve the health of mothers and children under age five
Focus on health status and healthcare outcomes
Identify gaps in knowledge

8. Methods for literature review
Searched Medline, Academic Search Premier, CINAHL and PsycInfo
Inclusion criteria:
Published during 2006 to 2011
Assessed program impact on a health status or health care outcome

9. Four categories of studies
Twenty peer-reviewed studies met inclusion criteria

10. Evaluations of birth outcomes
Measures
Infant mortality
Birth weight
Preterm birth
Small for gestational age
Length of stay
Healthy Start
5 studies
Mixed results
Medicaid
4 studies
Lower LBW and PTB
WIC
2 studies

11. Breastfeeding and nutrition
WIC (4 studies)
Increased breastfeeding initiation
Decreased food insecurity
No change in exclusive breastfeeding
Measures
Breastfeeding initiation
Food insecurity
Exclusive breastfeeding

12. Maternal health outcomes
Measures
Depression
Family well-being
Length of hospital stay
Head Start
1 study
Reduced maternal depression
Medicaid
Decreased LOS for disadvantaged women
Healthy Start
No change in depression

13. Unintended pregnancy Medicaid Demonstrations Measures
Unintended pregnancy rates
Cost savings
Medicaid Demonstrations
2 studies
$2.76 to $4.02 saved per Medicaid dollar
24% fewer unintended pregnancies

14. Limitations Findings from peer-reviewed studies only
Variations in study quality
Included only recent studies

15. Conclusions
Large focus on infant and child health in comparison to maternal health
Studies are local and utilize large computerized databases
Variation in methodological rigor
Program benefits may vary by location and setting

16. Implications for Practice
Further research to increase our understanding of what works and help target resources
More well-planned evaluation studies are needed
Program data can help identify benefits for maternal health

17. Thank You
Yhenneko Taylor