Maternal and Child Health

Background

West Virginia, along with the rest of the nation, recognizes the need to reduce the infant mortality rate and decrease the number of low and very low birthweight babies.

Access to early prenatal care contributes greatly to these efforts. There are several barriers that have made it difficult for indigent women to access early care, including: lack of transportation, lack of obstetrical providers in their community, lack of payment mechanisms, and a lack of understanding of the importance of early care. The children of West Virginia's indigent families experience similar difficulties in obtaining health care. Rural communities are isolated from larger towns with medical centers, leaving many families cut off from health care facilities.

Various programs within the Office of Maternal and Child Health (OMCH), West Virginia Bureau of Public Health, are working closely with the West Virginia Medicaid Program, the medical community, and various other public and private agencies to better address the needs of high-risk pregnant women and infants and provide for the health care needs of the state's children, issues that are the focus of Objectives 14.1 through 14.3.

The Objectives

OBJECTIVE 14.1 Reduce low birthweight to an incidence of no more than 5% of live births and very low birthweight to no more than 1% of live births.

UPDATE The percent of resident live births that were low birthweight (less than 2,500 grams or 5.5 pounds) has ranged from a low of 6.4% in 1988 to a high of 7.9% in 1995 (see Figure 1). There has been an increasing trend in low birthweight since 1992; at the present rate of increase, the year 2000 percentage is projected to be 8.1%. Very low birthweight (< 1,500 grams) has remained relatively stable over the last decade, ranging from a low of 1.0% in 1991 to a high of 1.4% in 1995. A rate of 1.3% is projected for the year 2000.

OBJECTIVE 14.2 Reduce the infant mortality rate to no more than 7 deaths per 1,000 live births.

UPDATE From 1986 through 1995, the overall infant mortality rate in West Virginia has ranged from a high of 10.2 deaths per 1,000 live births in 1986 to a low of 6.1 in 1994 (see Figure 3). The 1995 infant death rate rose to 7.6, but this did not change the overall downward trend of the past decade. At the present rate of decline, the year 2000 infant mortality rate is projected to be 6.0. The 1995 infant mortality rate among white infants in the state was 7.3, down from a high of 9.6 in 1986. The state infant mortality rate for African-American infants in 1995 was 14.9, down from a decade high of 28.9 in 1986. The national year 2000 target rate for mortality among African-American infants is 11.0 deaths per 1,000 live births.

OBJECTIVE 14.3 Increase to at least 90% the proportion of babies aged 18 months and younger who receive recommended primary care services at the appropriate intervals.

UPDATE No state data are currently available for this objective. Baseline data are also unavailable on the national level.

Meeting the Objectives

Several programs within OMCH address the problems identified in the objectives, using the health promotion channels to the communities listed in the box on the previous page to reach the target populations as possible. The Office is involved in many initiatives that address the problems of pregnant women and children in the state.

Patients may enter into the care system through a myriad of organized Maternal and Child Health efforts. Many community health centers provide outreach and tracking activities to ensure continuity of care for patients. Patients may obtain information about Maternal and Child Health programs by utilizing several toll-free telephone numbers.

A recent initiative, effective July 1, 1990, was an obstetrical fee increased for providers of service for Medicaid patients. Expanded Medicaid eligibility has increased the number of pregnant women and children eligible for Maternal and Child Health services.

The West Virginia Bureau for Public Health, with start-up funds made available by the Robert Wood Johnson Foundation, has implemented a perinatal program entitled the Right From the Start Project. This project is designed to identify enhanced services and provide care coordination through community-based agencies to high-risk pregnant women and infants. These services include a variety of educational opportunities (e.g., childbirth education, parenting classes), preventive health care, and support opportunities and services.

All pregnant women and high-risk infants receiving government-sponsored care (Title V/MCH and Medicaid) are eligible for Right From the Start services. Identification of eligible patients occurs through the statewide medical/social assessment called the Problem-Oriented Patient Risk Assessment System (POPRAS) and the Birth Score Project, which is a newborn screening at the time of birth to identify infants at risk of mortality and developmental disabilities.

Infants identified by the Birth Score Project are also referred to the Early Intervention Part H Program and the Children with Special Health Care Needs Program, both housed in the OMCH's Division of Children's Specialty Care. The earliest possible identification of children with special health care needs is an ongoing objective of this division.

The Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT/Medicaid) and the Pediatric Health Services Program (PHS/uninsured low-income children) are both designed to provide for the health care needs of children. These programs are constantly striving to increase the number of children served. EPSDT children are identified by a computer printout prepared by the Office of Family Support every month. PHS children are identified by the providers themselves. Children for both programs are also identified by Head Start, school health nurses, the West Virginia Statewide Birth Score Project, foster care, and from informational pamphlets that are distributed in health fairs held in schools, shopping malls, county fairs, and other selected sites.

Maternal and Child Health - Meeting the Objectives

Lead Entities:
Division of Women's Services, OMCH
Pediatric Program, OMCH

Plan Coordinators:
Diane Kopcial, Director, Women's Services
Joan Faris, Director, Pediatric Program
Office of Maternal and Child Health
WV Bureau for Public Health
(304) 558-5388
1-800-642-8522 or 1-800-642-9704

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