This document analyzes low birth weight rates in Pickens County, South Carolina. It defines low birth weight as under 5.5 lbs and describes its main causes as preterm birth and restricted fetal growth. Pickens County's rate of 8.6% is lower than the state average but higher than the national top rate of 5.9%. The document then examines determinants like maternal health, behaviors, socioeconomic factors and race. It outlines past interventions targeting issues like teen pregnancy, nutrition and prenatal care. Finally, it proposes future multi-level interventions through education, community support and policy changes to improve population health and reduce healthcare costs from low birth weight complications.

1. Health Outcomes in
Pickens County
HEALTH OUTCOME: LOW BIRTH WEIGHT
DANIELLE MATTHEWS

2. Health Outcome of Concern:
Low Birth Weight (LBW)
 Definition: The percentage of live births with a low birth weight of
less than 2500 grams or about 5.5 lbs.
2 Main Reasons for Low Birth Weight Babies:
1) Premature birth- birth before 37 weeks of pregnancy
2) Fetal growth restriction (small for gestational age)- the baby does
not gain the weight he/she should prior to birth

3. Health Outcome of Concern:
Low Birth Weight (LBW)
Causes for Premature Birth and Fetal Growth Restriction:
1) Birth Defects- conditions from birth that affect/change the shape or
function of part of the baby’s body
Could affect the baby’s health and/or development
2) Infections- could slow the fetal growth in the womb
Some common infections:
Rubella (German measles)
Chickenpox
Toxoplasmosis

4. Low Birth Weight Complications
Respiratory-related complications
Brain bleeds
Heart problems and heart failure
Vision problems or vision loss
Intestinal damage

5. Cost of Low Birth Weight Births
These babies have increased hospital stays and complications which
increase healthcare cost.
Healthy, full-term baby hospital stay= about 2 days.
LBW baby hospital stay= about 13 days on average
Healthy, full-term babies cost about $600.
The average cost for LBW babies is about $15,100.
About 50% of families will use private or commercial insurance to cover
costs, and about 42% will use Medicaid to cover costs.
As of 2011, LBW babies cost the health care system about $26 billion
annually.

6. Low Birth Weight Rates
Top U.S. Performers: 5.9%
South Carolina range: 8.2-14.2%
South Carolina Average: 9.9%
Pickens County rate: 8.6%
Pickens County has a lower LBW
average than the SC average for LBW.
However, Pickens County has a higher
rate than the national rate.
Interventions should be implemented
in order to lower the current LBW
rates.

7. Pickens County (PI)
Pickens County is ranked 10th of the
46 counties in Quality of Life rankings.
Low birth weight is included in
Quality of Life ranking

8. Determinants of Low Birth Weight
MATERNAL EXPOSURES
Health behaviors
Tobacco use, alcohol use, and other substance use
and abuse
Access to health care
Prenatal checkups
Social and economic environment
Low socioeconomic status
Environmental risks
Environmental toxins related to poor neighborhoods
MATERNAL FACTORS
Health prior to pregnancy
Education status
Marital status
Nutritional status
Age
Less than 20 years old
Recent pregnancy
less than 6 months between pregnancies

9. Population Breakdown
Race 2009 2010 2011
Non-Hispanic
White
8.3% 6.7% 9.1%
Non-Hispanic
Black
13.2% 10.5% 21.9%
Non-Hispanic
Other
- 5.6% 17.4%
Hispanic 7.5% 9.7% 11.7%
All 8.4% 7.1% 10.4%
The population with the highest LBW rate
was Non-Hispanic black.
The non-Hispanic white population has a
considerably lower rate of LBW than all other
races.
Pickens County Low Birth Weight by Race Rates

10. Disparities in LBW could be
due to disparities in poverty
levels.
Related to income, education,
SES, etc. which are all
determinants of LBW
Poverty Rates by Ethnicity
Population Breakdown

11. Past Interventions and Policies
Reducing teen pregnancy has been a major determinant of interest in reducing the number
LBW babies born.
The most effective studies target young teens before they become sexually active, and they provide
access to contraceptives to the teens.
Ineffective campaigns do not target the teens early enough and/or do not target attitudes and
perceptions toward pregnancy, sex, and contraceptive use.

12. Past Interventions and Policies
The CDC has taken a preventative approach toward preventing birth defects, which can lead to
low birth weight, by intervening at prenatal care for women.
PACT
Planning ahead to get the recommended nutrition (folic acid) and regular prenatal visits
Avoid harmful substances
Alcohol, smoking, drugs, prevent infections that could all lead to LBW
Choose a healthy lifestyle
Healthy weight and manage chronic conditions
Talk to your healthcare provider
Safe medications and vaccines
This initiative is a great guideline for women who have access to care, are educated enough, and have
an income to support their nutrition and care, but this message is not going to be effective to the most
at risk women for LBW births.

13. Past Interventions and Policies
Some interventions have targeted maternal nutrition to reduce the number of LBW babies
Increasing participation and enrollment in the Special Supplemental Nutrition Program for Women,
Infants, and Children (WIC)
Results showed that the risk for a LBW pregnancy decreased as enrollment time in WIC increased.
Improving maternal nutrition has been effective in reducing LBW births, however programs
have had difficulty because these types of programs are very expensive and hard to manage.
Multivitamin supplementation has been used as an alternative to increase maternal nutrition
in a simpler way, but these studies have not shown significant reductions in LBW births.
Iron and folate supplementation are already being used to decrease LBW, so increasing multivitamin
supplementation does not provide any additionally significant results.

14. Social Ecological Model
 Almost every major, modifiable
determinant for LBW has been
intervened upon with variable
success.
 The model can be used to
implement interventions at various
levels.
 To be more successful, multiple
levels of determinants should be
targeted and intervention methods
should begin earlier- prior to
pregnancy.

15. Intervention Model
 Inputs: educational materials, money, intervention staff
 Activities: teen pregnancy prevention in middle schools, church-based nutrition education, community nutrition education
and demonstrations, increased education on healthy behaviors during pregnancy, increased access to healthy foods and
prenatal care
 Outputs: the number of teens reached, the number of prospective mothers reached, the number of women educated on
nutrition prior to pregnancy
 Outcomes: increased knowledge to prevent LBW, increased skills in how to prevent pregnancy (condom and other
contraceptive uses), increased healthy behaviors
 Impact: reduction in LBW rates, decreased rates of premature death, decreased morbidity later in life, reduced healthcare
costs, improved population health

16. Future Interventions and Policies
In order to reduce low birth weights in Pickens County, community wide interventions should be considered at
every level of the Social Ecological Model.
Intrapersonal level: Interventions should target young girls, women, and mothers to increase knowledge about
healthy behaviors and nutrition prior to and during pregnancy. Young girls should be targeted early for pregnancy
prevention and substance use prevention(tobacco and alcohol).
Interpersonal level: Increasing support for women during pregnancy for good nutrition through the support of
family and friends through classes held at community centers and churches. Increasing support and decreasing
negative stigma surrounding contraceptive use among teens through education.
Organizational level: Mobilizing schools to increase promotion of teen pregnancy prevention in middle schools.
Community level: Promoting recreational centers hosting monthly nutrition talks and demonstrations of healthy
eating practices. Increasing the advertisement and accessibility of farmer’s markets for fresh foods.
Public Policy level: Changing sexual education and/or health education in schools to include key factors in
reducing LBW, such as healthy behaviors (avoiding alcohol and tobacco), nutrition, and importance of prenatal
doctor visits. Increased access and affordability to prenatal care for women.

17. Importance of Low Birth Weight to
Population Health
Babies born at a low birth weight are more likely to have certain
health conditions later in life than healthy, normal weight babies.
Diabetes
Heart disease
High blood pressure
Metabolic syndrome
Obesity
LBW leads to conditions that are leading causes for premature
death and expensive chronic conditions (increased morbidity).

18. Premature Death

19. Triple Aim
Reducing the number of LBW births will…
 increase the health of the population in the future by reducing
premature death and risk factors for leading morbidities
Reduce health cost per capita by decreasing the healthcare costs for
caring for low birth weight babies
Increase positive experiences in care by reducing the disparities in care
between women of different races/ethnicities, socioeconomic status,
education level, etc.

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