New program to address longstanding perinatal health disparities

Reviewed by Kate Anderton, B.Sc. (Editor)Apr 11 2019

Despite being home to a world-class medical center, renowned physicians and high-quality medical treatment, many communities in Houston experience significantly higher infant and maternal death rates. In some areas of Harris County, rates are nearly five times the national average, with black women and their babies at the greatest risk.

The University of Houston Graduate College of Social Work has received a $4,870,000 grant from the U.S. Health Resources and Services Administration to provide community-based and family-centered services and health education to residents in the 10 Houston-area ZIP codes with the highest rates of death and complications surrounding birth. That includes Houston's Third Ward.

Led by McClain Sampson, associate professor in the Graduate College of Social Work, the Healthy Start Initiative is the largest program in Houston designed to explicitly address these longstanding perinatal health disparities. While the services will be available to any woman who is pregnant or has just given birth, regardless of race or socio-economic status, the initiative will target black women, their partners, teenagers, infants and their families to promote preconception care, early prenatal care, longer intervals between pregnancies, fatherhood involvement and behaviors that can reduce risk.

"The major disparities in the number of mothers and infants who die or suffer major complications across racial and ethnic groups fueled my passion to lead this initiative. There's a major problem of inequity here," said Sampson. "By effectively implementing this program, the staff and I can work directly toward racial justice for expectant and pregnant mothers in Houston."

Houston's vast urban landscape and rapid growth present challenges for low- income residents, many of whom live in neighborhoods without convenient access to medical care. Demand for primary care has outpaced supply in many areas across Houston.

The targeted ZIP codes are: 77004, 77016, 77021, 77033, 77035, 77047, 77067, 77088,77091 and 77093. The rates of infant mortality, low birth weight and pre-term birth in these ZIP codes are at least 1.5 times the national average.

The program aims to reach 600 mothers and 100 fathers each year for the next five years. To help the parents navigate a fragmented healthcare system, case managers and community health workers will canvas neighborhoods to connect women with health insurance, transportation and timely, continuous and regular primary and preventive care at integrated health clinics, including the newly opened federally qualified health center on the UH campus.

"We have a history in this country of disconnected healthcare, and that can lead to very scary outcomes, especially for mothers and children," said Sampson. "Our case managers will connect them to integrated health centers where they can see the pediatrician, OB-GYN, primary care and behavioral health in the same location. It's a much more efficient way to take care of families."

Paula Myrick Short, UH senior vice president for academic affairs and provost, said Sampson's work is an example of the University's efforts to address health concerns in Houston and the state. "By addressing the issues surrounding infant and maternal mortality rates and planning a collaborative, intra-institutional approach to care, the Graduate College of Social Work is helping to direct the conversation on this issue."

Health education programs will provide families with information about managing stress and mental health, nutrition, sleep, sexual health and more. Sampson will also train doctors and nurses on implicit bias, or the idea that attitudes and stereotypes can unconsciously affect actions and decision-making.

"Research shows that implicit bias does occur in the health care setting," Sampson said. "Claims made to a provider by low-income minority patients, for example, can be dismissed more readily than those from a patient with more resources. The actions may be unconscious, but it needs to be addressed to achieve equity."

Started in 1991, the HRSA Healthy Start initiative currently funds 100 projects nationwide to improve the health of America's mothers and children before, during and beyond pregnancy. This is the first Healthy Start program in Houston since 2014.

Sampson will continue to work with the Houston Endowment Improving Maternal Health Steering Committee as well as building a larger network of stakeholders, including mothers at risk, to build capacity for change.