Decreasing prematurity and improving birth outcomes from different perspectives

Background: Connecticut Department of Health (DPH) used policies, partnerships, and systems change to address the impact of racism on birth outcomes and infant health.

Methodology: Connecticut conducted a statewide maternal and child health needs assessment and the information is guiding their work on improving birth outcomes.

Findings: In 2009 in Connecticut, 9.8% of the population reported being non-Hispanic Black/African American, accounting for 12.4% of births and 65.4% of births paid by Medicaid. Whereas 74% of the population were non-Hispanic White/Caucasian, accounting for 57% of births and <24% of births paid for by Medicaid.

Interventions: Three strategies were implemented to enhance community action: 1) statewide focus groups convened in both rural/urban locations, areas of high and low socioeconomic status, and within communities of diverse race/ethnicity to discuss perceived discrimination/racism, cultural attitudes toward healthcare, intergenerational cycle of health behaviors, and use of assisted reproductive technology. 2) Convened a multi-sector community-based coalition to make local policy and systems change, build leadership within local communities, and create a communication/action pipeline between state and local entities. 3) A collaborative of Connecticut's Commissioner of DPH, Governor's office representative, MCH Director, Medicaid Medical Director, and March of Dimes to align and coordinate existing policies and systems in the state to improve birth outcomes.

Conclusions: Racial inequities have resulted from hundreds of years of oppression and discrimination; therefore, eliminating the resulting inequities and their impact on birth outcomes will not happen overnight. Eliminating racial inequities and their effects requires long term commitment from the community and state agencies.