Maternal & Child Health Among Detroit Michigan’s Lower Socio.docx

Maternal & Child Health Among Detroit Michigan’s Lower
Socioeconomic Group
Delroy Barnett
Christina Bergman
Maria Victoria Blanton
Veverly Brooks
Jennifer Castro
Ashford University
HCA415- Public and Community Health
Instructor: Tynan Mara
April 6, 2015
1
Target Population
Detroit Michigan Population:688,701
Percent of White American: 10.6%
Percent of Black American: 82.7%
Percentage of Women: 52.7%
Pregnancy Related Deaths 36.6 per 100,000 births.

Pregnancy Associates Deaths 75 pre 100,000 births.
Pregnancy Related deaths - 50.8 per 100,000 births in African
Americans.
-3rd highest in nation
As of 2010, Detroit Michigan has a total population of 688,701
people. Of the 688,701 people, 10.6 % are White American and
82.7% are Black American. The community of Detroit is
dealing with a rising concern with maternal health and
pregnancy related mortality rates. Of the total population,
52.7% (or 362,945) are women. The cause of mortality among
maternal mothers is obstetric causes, medical, accidents,
suicide, assaults, and other causes. Per year on average, 6
women die from pregnancy issues, this amount is three times
higher than that of the national average. These high mortality
rates are more common in African American women than other
races. Pregnancy related deaths among African Americans is
50.8 per 100,000 live births. This makes Detroit Michigan the
third highest city of pregnancy related mortality in the nation.
The high mortality rates in Detroit are due to health conditions,
poverty, and proper health care. These numbers show that it is
dangerous for a pregnant women to live and give birth in
Detroit.
2
Thesis Statement

Thesis
The health disparities among women and children in
Detroit are some of the worst in the nation. “The maternal
mortality rate for black mothers in 2002 was almost 25 deaths
per 100,000 live births, compared to nearly 6 deaths per
100,000 live births among white mothers and more than 7
deaths…among Hispanic mothers” (National Institute of Health,
2006, p.x). That is nearly four times the national average. More
focus needs to be placed on maternal and child health in low
socio-economic areas of Detroit.
Factors & Causes
Over 40% of population is living in poverty
Chronic Diseases
Limited access/ quality of health care
Obstetric, Medical, Accidents leading cause

While normally a major health concern in less developed
countries, maternal and child health in the United States has
become a major concern. “Child mortality is highly preventable
and can be reduced greatly through improvement of
environmental conditions and hygiene levels, as well as
increased parental compliance with immunizations for vaccine
preventable diseases…Many of these deaths were caused by
preventable or easily treatable condition or by malnutrition
(WHO, 2012c; WHO, 2012a)” (Friis, Bell, & Philibert,
2013). Poverty is a detrimental impact on the maternal health of
women in Detroit. With the median income at $26,325,
compared to $48,411 nationally, women do not have the
financial means to properly take care of themselves. Quality
food, vitamins (prenatal), access to hygiene, and access to
healthcare are all factors that are the result of the poverty issue
in Detroit. Chronic Diseases are also a major contributor to the
mortality rate. Obesity, Diabetes, and high blood pressure are
all common chronic diseases among maternal mothers in
Detroit. These diseases increase the health risk of both the
mother and fetus. The most common cause of death among
maternal women in Detroit are Obstetric causes, Medical, and
accidental deaths.
4
Most frequent Cause of Death 2005-2010All Obstetric Causes
Medical, Non Obstetric Accident Other Assualts
Suicides 0.30000000000000032 0.36000000000000032
0.23 0.2 7.0000000000000034E-2
4.0000000000000105E-2
Essential Services In Community
Harambee Care Program (MIHP)
In home visits

Nutritional help
Educational Classes
STARFISH Family Services
Financial Counseling
Books, Diapers, Family Activities
Baby Power Classes for new moms
There are several free programs that are offered in Detroit for
pregnant mothers and their children. One of the programs is
Harambee Care Program which is offered to women who are
Medicaid Eligible. This program offers several different
services which include but are not limited to: Parenting and
Childbirth Educational Classes, In Home visits with registered
nurses and social workers throughout a mothers pregnancy,
nutritional help and assessments, and even transportation to
educational classes if needed. This program is one of many
programs that reach out to maternal mothers in Detroit to help
them gain knowledge as well as have a safe pregnancy for both
the mother and the child.
Another essential service is Starfish Family Services which is a
nonprofit organization that works with families and children to
help set them up successfully for the future. This organization
works with new moms, infants and young children and provides

programs such as 1:1 financial counseling and family planning
strategies to help lower income families be able to provide the
essentials for the family. They also provide books, diapers, and
other family activities to help Detroit families and children
prosper. The organization implemented the Inkster Childhood
strategy which has made a tremendous impact in the community.
It has provided help to mothers through a program called Baby
Power, in which 60% of new moms had fewer symptoms of
depression because of the program. The goal of Starfish Family
Services is to “prevent problems before they escalate and help
strengthen relationships to build solid families that work.”
Starfish Family Services believes “in the potential of all
children and the power of healthy parent-child relationships to
break the cycles of poverty and create long-term positive
outcomes for children.”
5
Resources, Facilities, & Organizations
Millennium Development Goals 4 & 5
Head Start, Healthy Start, WIC, Medicaid
The National Survey of Children’s Health
Mortality Reduction Plan
In 2011, The Department of Maternal, Newborn, Child, and
Adolescent Health set out to fulfill Millennium Development
Goals (MDGs) number four, to reduce child mortality by two-
thirds between 1990 and 2015, and MDG number five, to reduce
maternal mortality by three quarters between 1990 and 2015.
According to WHO (2015), the department is to “take the lead

in WHO’s targeted efforts to improve the health of these
population groups and support countries to achieve these
MDGs”. The department is divided into three teams, all of
whom report to the Director, Dr. Elizabeth Mason. These
departments include Research and Development, Policy,
Planning, and Programmers, and Epidemiology, Monitoring, and
Evaluation.
“Government initiatives are important particularly for reducing
disparities that affect disadvantaged populations. Head Start,
Healthy Start, WIC and Medicaid are four federal programs that
target disparities in maternal and child health outcomes”
(Taylor & Nies, 2012). The National Survey of Children’s
Health (NSCH) collects information on physical, mental and
social health indicators among children and other factors to find
what influences their health and development. After the data is
collected it is used to define what is needed for “the
development, implementation, and monitoring of effective
health promotion and disease prevention” (Kogan, 2012). They
work in conjunction with the Data Resource Center for Child &
Adolescent Health and the data are disseminated for free for
policy makers, child advocates, and researchers in the hopes it
will promote improved health for children.
In 2012, the Department of Community Health for the State of
Michigan set forth their Infant Mortality Reduction Plan which
outlines eight initiatives. These include implementing a
statewide coordinated prenatal system, promote adoption of
policies to eliminate medically unnecessary deliveries before 39
weeks gestation, promote adoption of progesterone protocol for
high-risk women, promote safer infant sleeping practices to
prevent suffocation, expand home-visiting programs to support
vulnerable women and infants, support better health status of
women and girls, reduce unintended pregnancies, and weave the
social determinants of health in to all target strategies to
promote reduction of racial and ethnic disparities in infant
mortality.
6

Community Programs & Existing Policies
Programs
Wayne Children's Hospital
Access Program
Win Network of Detroit
Policies
Home Visiting Legislation
Medicaid Policy
There are multiple programs through the Detroit Michigan
Community, including WCHAP which is a private-public
community health system that works to improve the quality and
access of health care while also working together with
community partnerships and making health care more
affordable. Another program that is very beneficial to maternal
mothers is Win Network which has three main goals that they
work to reach. The first goal is to obtain 1500 at-risk maternal
women and help link them to community programs such as
United Way 2-1-1. Win Network reaches out to not only
pregnant women but also women going through postpartum and
new mothers who need help. Their second goal is to educate 500
healthcare workers such as physicians or nurses, and to also
create new technology and products that will help engage the
community to promote good health for pregnant women.
Michigan has many policies already in place to help reduce
infant mortality in its state. The Home Visiting Legislation

which was passed in 2012 mandates that home visits are tracked
and outcomes are recorded to see if the home visits are having a
positive effect on maternal mothers. The funding is based off
evidence-based research and the state ensures that the results of
the programs are beneficial to both participant and community.
Another policy that is already in place is Michigan's Medicaid
policy. Michigan contributes $20 million to their medical
program and they also have a higher maximum income level for
Medicaid coverage based of the Federal Poverty Level
standards. There are only 8 other states with higher maximum
income levels.
Richard C. Boothman is the chief risk officer for the University
of Michigan’s health system and adjunct assistant professor at
the University of Michigan Medical School. He holds degrees
from the University of Michigan (AB) and the University of
Detroit Mercy School of Law (JD). In 2001, he implemented
what has become known as the Michigan Model for addressing
patient injuries and claims, which has since been the subject of
several journal articles, newspaper pieces, and media
presentations. He collaborated with then Senators Clinton and
Obama toward the introduction of the National MEDiC Act in
2005, testified before the U.S. Senate in 2006, and presently
serves as a consultant on two of several Agency for Healthcare
Research and Quality grants studying implementation of the
Michigan Model in other settings.
The city of Detroit and Wayne State University launched Make
Your Date campaign helping expectant mothers carry a healthy
baby to full term. Make Your Date is a not-for-profit
organization program working with other programs like the
Perinatology Research Branch of Eunice Kennedy Shriver,
National Institute od Child Health and Human Development, the
National Institutes of Health at Wayne State University (WSU),
and the Detroit Medical Center (DMC), the Women and Infants
Network (WIN) led by Henry Ford Health Systems, and the

Infant Mortality Project at St. John Hospital and Medical
Center. The program helps babies of Detroit since Detroit has
18 percent of babies born prematurely. This is six percent
higher then the state average. Studies show low birth weight
accounts for the city’s infant mortality rate of 14/1000, which is
twice the nations average. Expectant mothers who signs onto
Make Your Date will have access to support and evidence-based
medical services at no extra cost. They will receive prenatal
care information, education preterm birth prevention classes,
and regular ultrasounds. Ultrasounds help all pregnant women,
especially women with a short cervix who will need an
ultrasound to see a need for progesterone. Progesterone
treatment help reduce the risk of preterm births by 45 percent.
Meridian Health Plan offers progesterone on an immediate
basis. Expectant mother will also receive group prenatal care
already implemented by St. John Providence and the Detroit
Medical Center. It has been proven to reduce preterm birth
among African American women by more than 40 percent. The
Mayor of Detroit elected Sonia Hassan MD associate dean for
maternal, perinatal, and child health for Wayne State University
School of Medicine, director Vernice Anthony from Detroit
Public Health, and chief executive officer of Meridian Health
Plan, David Cotton, MD.
7
Policy Development & Facilitators
Education for Early Pregnancy Prevention
Enrollment in Medicaid &(re-enrollment)
Prenatal Care beginning 1st Trimester
Safe Delivery Act
Hutzel Women's Hospital
(Stakeholder)

There are many policies that are already in place for maternal
women in the state of Michigan. To help control mortality rates,
early pregnancy prevention, and increase safer deliveries, there
are several programs needs. Programs such as MOMS, Medicaid
Health Plan, Healthy Kids, and Medicaid Outreach, are just a
few of the programs offered to the women of Michigan to assist
them in getting medical coverage so they can get the proper care
they need while pregnant. These programs tie into policies that
help women receive the prenatal care they need during and after
pregnancy. There are also programs that focus on educating
women and their partners about adolescent intercourse, caring
for ones self, and healthy baby practices. These programs are
known are Plan First, Family Planning, Pregnant Women &
Infants, and Michigan Healthy Baby. The Safe Delivery Act is
through the department of Human Services in Michigan, and it
allows a mother who gave birth to safely give up her child
(abandonment) legally. The child must be given up within 72
hours of age, and must be given to a an employee that is on duty
at a hospital, fire department, or police station. This Act helps
protect an infant and will help find a loving home for the child.
Hutzel Women’s Hospital is in the metropolitan area of Detroit
and is a huge stakeholder for these policies and the development
of new polices. The reason this particular hospital is a good
stakeholder, is because they specialize in the care for women
and particularly, pregnancies. A medical facility such as Hutzel
Women’s Hospital can either help or hinder the effectiveness of
any developed policy or program. The hospital can either
support, promote and credit certain programs, or choose to not
promote or support programs. These types of stakeholders are
extremely important to both the community, and the committees
who develop these policies and programs.

Dazzo, O. (2012). State of Michigan: Infant mortality reduction
plan. Retrieved from
http://mchb.hrsa.gov/pdfs/michiganinfantmortalityreductionplan
.pdf
http://www.cdc.gov/getsmart/program-planner/Step1.pdf
8
Essential Services
Mobilize Community Partnerships
Inform, Educate, Empower
Develop Policies
· Teach first-time parents how to care for their new baby.
· Provide car seat education to new parents.
· Develop a network of community service for elderly people
within the community
· Work with country board members to develop a policy for
playground safety in local communities.
The head of the state health department is usually a medical
doctor, appointed by the governor, who may carry the title of
director, commissioner, or secretary. However, because of the
political nature of the appointment, this individual may or may
not have extensive experience in community or public health.
Unfortunately, political influence sometimes reaches below the
level of commissioner to assistant commissioners and division

chiefs; it is the commissioner, assistant commissioners, and
division chiefs who set policy and provide direction for the
state health department. Middle and lower-level employees are
usually hired through a merit system and may or may not be
able to influence health department policy. These employees,
who carry out the routine work of the state health department,
are usually professionally trained health specialists such as
microbiologist, engineers, sanitarians, epidemiologists, nurses,
and health education specialist.
Most state health departments are organized into
divisions or bureaus that provide certain standard services.
Typical divisions include Administration, communicable
Disease Prevention and Control, Chronic Disease Prevention
and Control, vital and health statistics, Environmental health,
health Education or promotion, health services, maternal and
child health, mental health, occupation and industrial health,
dental health etc.
The resources and expertise of the state health
department are also at the disposal of local health departments.
Once particular area where the state health departments can be
helpful is laboratory services; many modern diagnostic tests are
simply too expensive for local health departments. Another area
is environmental health. Water and air pollution problems
usually extend beyond local jurisdictions, and their detection
and measurement often require equipment too expensive for
local governments to afford. This equipment and expertise are
often provided by the state health department.
9
Enforce Laws & Regulation

Link People & Assure Provision
The Women Infant Children (WIC) program is a Special
Supplement Nutrition Program (SSNP), which provides at risk
and low-income maternal mothers and their children nutrition,
education, and supplemental foods. WIC helps with prenatal
care and reduces the frequency of low-birth weight infants. WIC
program is also part of the Michigan Family Planning program
authorized under Title X federal funds of the Public Health
Service Act. Contraceptive services, reproductive healthcare are
provided funding and support for comprehensive and voluntary
family planning information and services to understand and
utilize by low-income men and women. WIC was created by
Congress in 1972 and administered by the United States
Department of Agriculture (USDA). It helps low-income
women, infants, and children up to the age of five who may be
at nutritional risk. The WIC program in Michigan is part of the
Bureau of Family, Maternal, and Child Health in the Michigan
Department of Community Health (MDCH). There are 49 WIC
agencies in Michigan who help maternal Michigan resident
mothers pregnant or post-partum with their infant and or child
up to the age of five. Family planning and WIC of Michigan
provides epidemiological support to the MDCH, the Bureau of
Disease Control, Prevention, and Epidemiology, and the Bureau

of Family, Maternal, and Child Health through Title X which
than provides important epidemiologic study design, statistical
analysis, technical expertise, program evaluation, and policy
and program development evident through data analysis of their
WIC recipients according to Kendal, Peterson, Manning, Xu,
Neville, and Hogue (2002). Wic offers cross-referral with
Medicaid, but managed care organizations (MCO) and public
sector programs as separate sites can slow offered service to
some clients. Detroit has poor overall pregnancy outcomes and
infant immunization rates therefore the WIC program has been
evaluated in a quasi-experimental approach as a beneficial
impact to the maternal and child mortality problems of Detroit.
Data was collected from African American infants enrolled in
Medicaid and WIC which was about 90% of the 6548 WiC
infants receiving Medicaid. Like in my state of Illinois, WIC
recipient mothers must come in for an appointment to pick up
food vouchers as well as receive nutrition educational support.
The Detroit Health Department also require the infants at 6 to
12 months to come in for assessment and monitoring. WIC data
system tracked immunizations and vaccinations. In order for
WIC to be updated at certain collocated MCO,12 to 14 month
old babies needed vaccinations completed for diphtheria,
pertussis, tetanus, polio, hepatitis B, Haemophihis influenzae B,
measles, mumps, and rubella. Managed Care Organizations still
lack collocating with WIC and Medicaid programs which can
improve epidemiological data for future maternal and child care
of Detroit clients. Unfortunately not all MCO intervention
groups observed on the WIC and Medicaid program had a
benchmark approach, which was universal. This reminded of the
ACA and its differing state implementations with essential
health care services.
Kendal, A., Peterson, A., Manning, C., Xu, F., Neville, L., and
Hogue, C. (2002). Improving the health of infants on Medicaid
by collocating special supplemental nutrition clinics with
managed care provider sites. American Journal of Public Health.
Vol. 92. No. 3. PP. 399-403.

11
Assure Competent Workforce
Effectiveness, Accessibility, Quality
Five principles that characterize the population-based approach
are (a) a community perspective, (b) a clinical epidemiology
perspective (using population-based data), (c) evidence-based
practice, (d) an emphasis on effective outcomes, and (e) an
emphasis on primary prevention (Ibrahim, Savitz, Carey, &
Wagner, 2001)
The quality of personal health services is not the issue in
Detroit, rather it is the accessibility. People who have access
tend to receive decent healthcare but for the uninsured, just
getting proper pre and post natal care has been difficult.
Fortunately, Detroit has several initiatives to address maternal
and child health through community programs. Population-
based health services focus on wellness and preventative care

for the community. The Wayne Children’s Healthcare Access
Program places emphasis on health education that is essential in
early development. They offer an array of resources and
referrals and boast a high quality rating. The Women-Inspired
Network (WIN) is an easily accessible and successful
organization that has proven effective for pre-natal, new
mothers, and those afflicted with post-partum depression.
Although they are centered in Detroit they have outreach
programs throughout the state of Michigan. In June of 2014,
Wayne University started the Make Your Date campaign which
works to reduce the city’s infant mortality rate. Although too
soon to tell, the campaign has significantly raised awareness to
the issue and emphasizes pre natal care to promote live births.
13
Conclusion
Synopsis
Research is imperative in assessing a health concern,
developing programs/policies and researching new innovative
health solutions
The 10th Essential service (research for new insight and
innovations) plays a vital role in all three public health
organizational functions. In order to assess a health concern,
research is needed to determine if there is a need for a concern
to be addresses. Once it is determined that indeed a community

has a health concern that needs to be addressed, policies can be
put into place. Developing policies require some extensive
research as well. With the legal and ethical concerns of public
health, policies must be developed is an appropriate way.
Researching the community that will be influenced along with
their needs, values, and ideas must all be considered.
Implementing programs and policies will only work if they are
presented in a way that the community will positively receive
and understand. As for Maternal and child health, this health
concern is very serious but can also become very hard to
address due to the individuals involves. Lifestyles, financial
means, and ethnicity must all be researched and taken into
account when implementing any policies or programs. After
programs are in place, research and evaluation are imperative in
order to understand the effectiveness of the programs and
policies. Programs such and Medicaid, WIC, MIHP, are all
programs that have been implemented and are showing high
levels of effectiveness in the community. New innovative health
methods and research should continue to aid in overall
improvement of the maternal health situation. Setting goals to
reduce mortality rates such be taken into account when looking
into new innovative programs for improving the maternal and
child health of women of Michigan.
14
References
About | WCHAP. (n.d.). Retrieved from http://wchap.org/about/
Aday, L. A. (2005). Reinventing public health: policies and
practices for a healthy nation. San Francisco, CA: Jossey-Bass.
Bledsoe, C. (2014, July 10). Maternal Death Rates in Detroit
Triple the National Average | Wyandotte, MI Patch.
Retrieved from
http://patch.com/michigan/wyandotte/maternal-death-rates-
in- detroit-triple- the-national-average
Detroit (city) QuickFacts from the US Census Bureau.(2015,

March 24). Retrieved March 27, 2015, from
http://quickfacts.census.gov/qfd/states/26/2622000.html
Detroit Has Highest Maternal Mortality Rate - Birth Injury
Guide.(2014, August 22). Retrieved from
http://www.birthinjuryguide.org/2014/08/detroit-highest-
maternal- mortality-rate/
Friis, R. H., Bell, N. M., & Philibert, B.(2013).Community and
Public Health. San Diego, CA: Bridgepoint Education, Inc.
Harambee Care MIHP.(n.d.). Retrieved from
http://www.harambeecare.org/#!about/cjn9
Harrell, J. A., & Baker, E. L. (1994). The essential services of
public health. Leadership in Public Health, 3(3), 27-31.
15
References(Continued)
HealthyPeople.gov (2014). Maternal, Infant, and Child Health.
Retrieved on March 28, 2015 from
http://www.healthypeople.gov/2020/topicsobjectives/top
ic/maternal- infant-and-child-health/objectives
Ibrahim, M., Savitz, L., Carey, T., & Wagner, E. (2001).
Population-Based Health Principles in Medical and Public
Health Practice. Journal of Public Health Management, 7(3),
75-81.
Kogan, M., Ghandour, R., & Schempf, A. (2012, May 2).
Introduction to the Special Issue of Articles from the 2007
National Survey of Children's Health.

Learn about our work. (2015). Retrieved from
http://www.starfishonline.org/learn.html
Lipson, D., Birnbaum, M., Moon, M., Norton, S., &
Wallin, S. (1997, November 1). Health Policy for Low-
Income People in Michigan. Retrieved from
http://www.urban.org/publications/307321.html#sett
Maternal & Child Health Journal. pp. 1-5. doi:10.1007/s10995-
012-1007-x.
Maternal Infant Health Program - Policy. (2015). Retrieved
from http://www.michigan.gov/mihp/0,5421,7-311-
66379_66393---,00.html
16
Maternal, Newborn, Child, and Adolescent Health (2015).
Retrieved on April 2 from
http://www.who.int/maternal_child_adolescent/about /en/
Michigan Citizen. (2014). Program begins to help expectant
moms. Vol. 36. Issue 29. P.A3-A3.
Milbank Quarterly. (2012). Notes on contributors. Vol. 90.
Issue 4. P.791-796.

National Institute of Health (2006).Women of Color Health
Data Book 2006. National Institute of Health
Pregnant woman (2014). [image]. Retrieved from
http://www.medicaldaily.com/detroits- soaring-infant-
mortality-rate-make-your-date-campaign-aimed-decreasing-
baby- deaths-city
Shaefer, S., Herman, S., Frank, S., Adkins, M., and Terhaar, M.
(2010). Translating Infant Safe Sleep Evidence Into
Nursing Practice Shaefer, S. J. M., Herman, S. E., Frank S. J.,
Adkins, M. and Terhaar, M. Translating Infant Safe Sleep
Evidence Into Nursing Practice. Journal of Obstetric,
Gynecologic & Neonatal Nursing. Vol. 39. Issue 6. PP 618-
626.
State of Michigan 2012 Infant Mortality Reduction Plan
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http://mchb.hrsa.gov/pdfs/michiganinfantmortalityr
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Taylor, Y., & Nies, M. (2013). Measuring the Impact and
Outcomes of Maternal Child Health Federal Programs.
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