Adequate prenatal care is important to the health of both mothers and their babies. It has a positive effect on birthweight, full-term delivery, and the overall health of babies at birth and beyond. “Regular prenatal care helps you and your health provider monitor how your pregnancy is going. It also helps spot any potential health problems before they become serious. Some pregnant women may experience complications like gestational diabetes or preeclampsia. But with regular prenatal care, you'll be better able to manage any health issues that may come up." (March of Dimes).

Non-adequate prenatal care can result in low birthweight and premature births. For children, non-adequate prenatal care puts them at a higher risk for chronic illness and developmental delays. For families, caring for a child with long term health issues and developmental delays can be a source of increased stress as well as a financial strain. For the community, providing an appropriate education for children with health and developmental issues can require costly interventions and services. The cost of educating a typical child in Wethersfield is about $15,500 a year. Educating a child with special needs can cost many times that amount.

WECC believes researching and addressing the root causes behind mothers receiving non-adequate care will have a positive long term impact on the health and well being of our children and aid them in becoming developmentally successful learners. This in turn can have a positive impact on Wethersfield families and our community as a whole.

Historically, non-adequate prenatal care has not been an area of concern in Wethersfield. In the past, neither the Central Connecticut Health District nor the Town of Wethersfield Department of Youth and Social Services offered programs focused on prenatal care and healthy birth outcomes. WECC research has highlighted the need for further investigation and action and has begun the work of engaging partners to address this serious concern.

In order to have received Adequate Prenatal Care as defined by the Department of Public Health, one must start prenatal care in the first trimester and have nine prenatal care visits for a 36 week pregnancy (10 visits for a 37 week pregnancy, 11 visits for a 38 week pregnancy). This measure is not an indicator of the quality of the care received.

Wethersfield has higher rates of women receiving non-adequate prenatal care compared to the State and the Central Connecticut Health District (CCHD), the regional health district serving Wethersfield, Berlin, Newington, and Rocky Hill. The CCHD has identified the top five reasons women in our region do not receive adequate prenatal care:

1.Lack of Insurance

2.Lack of Knowledge

3.Lack of Support

4.Mental Health/Substance Abuse

5.Lack of Transportation

As the data shows, Wethersfield had seen a drop in the number of woman receiving non-adequate prenatal care in 2008 and 2009, reaching a low of 17.5% in 2009, which was more than 2% below the state average. Beginning in 2010, we once again saw an increase in the number of woman receiving non-adequate prenatal care. In 2011, that number peaked at 32.7%. In that year, of the 258 children born to Wethersfield families, the mothers of about 83 of the newborns had not received adequate prenatal care. This increase in the number of women receiving non-adequate prenatal care mirrored the statewide increase in 2010 and 2011. Research into the cause of the upswing is underway by WECC and the Central Connecticut Health District. WECC and the CCHD believe a correlation exists between the economic recession that began in 2007 and the notable decline in access to prenatal care, especially the care received by Wethersfield's economically disadvantaged mothers. As the World Health Organization anticipated in 2009,"The global financial crisis could have profound implications for the health spending plans of national governments. Unless countries have safety nets in place, the poor and vulnerable will be the first to suffer" (Bulletin of WHO, Vol. 81, #1, January 2009).

In 2012, Wethersfield saw a slight decline in the number of women receiving inadequate prenatal care. That year there were 265 births in Wethersfield with the mothers of 79 children receiving non-adequate care (29.9%). By 2013, that number once again increased to 31.2%.  2014 and 2015 have seen even higher numbers of women in Wethersfield receiving non-adequate prenatal care:  39.2% in 2014 and 38.6% in 2015.

Wethersfield Hispanic community saw a slight improvement in their curve. In 2011, 40% of Hispanic mothers received inadequate prenatal care. In 2012 and 2013, that percentage dropped to 28% but in 2014 and 2015 the percentage bumped up to 33% (please see Percentage of Wethersfield's Hispanic Mothers Receiving Non-Adequate Prenatal Care Scorecard for more details).

Conversely, the largest subgroup that is tracked by WECC, Non-Hispanic White Women, saw an increase in the number of mothers receiving non-adequate care in 2012 and 2013. In 2011, 29.7 % of Non-Hispanic White Women had received inadequate care. In 2012, there were 265 births in Wethersfield. 218 of those births were to non-Hispanic white mothers. The children of 66 of those mothers had non-adequate prenatal care which means we saw an increase to 30.4%. In 2013 there were 250 births in Wethersfield. 198 of those births were to non-Hispanic white mothers. The children of 62 of those mother received inadequate care which reflects and increase to 31.3% in that year. The numbers continue to rise each year with 39.9% in 2014 and 41.7% in 2015 of non-Hispanic white women in Wethersfield receiving inadequate prenatal care.  Please see the Percentage of Wethersfield's Non-Hispanic White Mothers Receiving Non-Adequate Prenatal Care scorecard for more detail.

As part of our effort to "Turn the Curve" on prenatal care in Wethersfield, WECC has engaged partners on the state, regional and local level including our state legislative team, The Office of Early Childhood, the Central Connecticut Health District and Wethersfield's Department of Social and Youth Services. Since the fall of 2015, Wethersfield Families are eligible to participate in "Nurturing Families Network". NFN is a program created to meet the needs of first-time parents facing the challenges of parenthood by enhancing their strengths, providing education and creating community connections.

NFN is a home visiting program that works with mothers prenatally and up until the child reaches the age of 5. Providing voluntary services is just one of the many features of NFN, hence a participant may simply leave the program if she/he chooses to and can come back again prior to the child's 5th birthday and if there's a vacancy available.

Utilizing Home Visitors, NFN assists women by:

• conducting weekly home visits and providing pregnant women with health/nutrition educational support using approved curricula.
• ensuring that all pregnant women are registered and undergoing regular prenatal care.
• providing emotional support when needed and providing linkages to health/community resources.
• utilizing the 'Age and Stages Screening Tool' to ensure age-appropriate developmental milestones.
• having quarterly Focus Groups with clients and discussing issues about health, environmental safety, and nutrition.
• conducting a 9-week Prenatal Group with graduation upon completion.
• conducting a 23-week Parenting Group with graduation upon completion.
• establishing annual events for families( Christmas party, Mother's Day, etc.)

For more information about making a referral or signing up for Nurturing Families Network, contact Wethersfield's Department of Social and Youth Services: (860) 721-2977. WECC continues to seek partners to work on this serious issue.

Suggested interventions incorporated into strategies have been developed in accordance with research by WECC's Health Committee and best practices in the field. They include:

• Interviews with healthcare providers to collect data on why woman may not be getting adequate prenatal care
• Focus Groups with expectant mothers
• Prenatal Care Surveys conducted by the CCHD
• Resource Guide/Website that includes healthcare information for woman and children in Wethersfield
• Increased enrollment in insurance plans
• Study of role of transportation in increasing access to prenatal care

Strategy 1:Develop a better understanding of why some of Wethersfield's White non-Hispanic women are not receiving adequate prenatal care

Actions:

• Conduct interviews with additional healthcare providers serving Wethersfield women. Based on these results, investigate available data to further refine which factors contribute to non-adequate prenatal care.
• Conduct focus groups with expectant and/or new mothers to understand behaviors and barriers that may affect prenatal care.
• Incorporate prenatal care questions into the next BRFSS (Behavioral Risk Factor Surveillance System) community assessment conducted by the CCHD.

Strategy 2: Promote awareness and use of existing OB/GYN services in Wethersfield.

Actions:

• Partner with Wethersfield's OB/GYN providers on a facilitated referral program.
• Create one centrally located place for families to obtain information about Wethersfield services, including healthcare for expectant women and their children.
• Increase awareness and use of healthcare coverage options for pregnant women in Wethersfield by collaborating with the CT Department of Social Services (DSS) to promote and increase enrollment in the HUSKY insurance program.
• Determine whether the lack of transportation is a barrier to women receiving adequate prenatal care.

WECC's Health Initiative

Families have access to maternal, infant, and early childhood health resources:

• Identify health resources
• Connect children and families with appropriate services
• Support efforts to remove barriers and increase access

For more information, contact kbobin@wethersfield.me

• Office of Early Childhood (OEC)
• Central Connecticut Health District (CCHD)
• Town of Wethersfield Department of Youth and Social Services
• Hartford Foundation for Public Giving
• Wethersfield's Medical Community
• Parents

Beyond the Plan: WECC continues to track actions and partners that could potentially become part of our strategic focus and strategies:

Brainstorming ideas include:

• Investigate MIECHV (Maternal Infant Child Home Visiting) Programs
• Engage support of State Legislative Team, Social and Youth Services, and Central Connecticut Health District on issue of why MIECHV is not offered in this area
• Education programs for women though partnering with Planned Parenthood, WIC, Connecticut Department of Public Health and March of Dimes
• Creating public service announcements (PSA)
• Roadshow to PTOs and other Community Organizations
• Using social media to create awareness

Data related to Non-adequate Prenatal Care is updated annually by the Connecticut Department of Public Health and can be found in their Vital Statistic Report, Table 4. Based on experience, new data should be available each spring.

The Vital Statistic Report can be found at:

http://www.ct.gov/dph/cwp/view.asp?a=3132&q=394598&dphNav_GID=1601

and at www.CTData.org in the "Data Catalog" under "Health and Vital Statistics".