HSPH and Neighborhood Clinics Team Up to Improve Maternal Health
Earlier this decade, Boston had some of the worst infant mortality rates in the nation. To stop the needless death of children, Boston's health care providers and service agencies joined forces to make prenatal and infant health care available throughout the city.
Boston's infant mortality rates have improved, in part due to the work of this consortium. There is still more work to be done, however, and this time it is mothers whose health is targeted for improvement.
Karen Peterson (left), associate professor in the Departments of Nutrition
and Maternal and Child Health, and Barbara Gottlieb, assistant professor
in the Department of Maternal and Child Health, at the Brookside Community
Health Center in Jamaica Plain.
"The community health centers were successful in helping women take care of their babies," said Barbara Gottlieb, assistant professor in the Department of Maternal and Child Health. "But the mothers were a different problem. One of the questions we've been trying to answer recently is why will a woman bring her baby in for its six-week check-up but won't come in for her own six-week check up?"
Karen Peterson, associate professor in the Departments of Nutrition and Maternal and Child Health explained the importance of reaching this group of women: "Post-partum mothers are in a time period where they affect the health of three human beings. They care for their recently birthed babies. They're responsible for their own health, and they're at a time when prenatal care for their 'next-babies' is important."
The 1999 edition of the collaborative group is the Maternal and Child Health Community Health Science Consortium based at HSPH. The consortium is a collaboration of community health centers, a service agency, a hospital, and HSPH. Participants include the Brookside, Martha Eliot, Whittier Street Neighborhood, Southern Jamaica Plain, and South End Community Health Centers; Project Life, and Brigham and Women's Hospital.
The questions of 'What care do post-partum mothers need?' and 'How is that care best provided?' are what the consortium is trying to answer. The group hopes to advance the academic research behind the answers to these questions while simultaneously reaching and caring for postpartum mothers.
While research is important, it takes a backseat to providing immediate health care to the community. Gottlieb, who spends half her work-life treating patients at Brookside Health Clinic in Jamaica Plain, said "The primary goal of the health centers is treating the health needs of our patients.
"We're using our research to improve the health care, and using the health care to advance our research. For instance, we use health status questionnaires to identify a patient's health care needs. And then, after providing that care, we use the experience to assess the effectiveness of the questionnaire."
The researchers have also produced a postpartum written questionnaire that included measures of physical and mental health, fatigue, social support, and domestic violence. They then enlisted a subject group by randomly picking women from a list of all mothers who had received prenatal care at one of the consortium clinics or whose young children were pediatric patients. Post-partum was defined as between six weeks and 24 months post birth. Enlisting these women was an experience that exemplifies the challenges of providing care for this population.
"Some of our recruitment was straight-forward," said Peterson. "We'd mail them an invitation to participate and take it from there. But others were much more difficult to reach--we were trying to find people who move frequently, who don't have telephones, who don't speak English, and who may be suspicious of strangers who are trying to find them."
Gottlieb continued "The difficulty of reaching people to invite them to participate in our study is the same difficulty we have of reaching these people to invite them in for health care. When we're successful in either endeavor, it's through collaboration with the community and through persistence. It's by making phone call after phone call, by knocking on apartment doors, and by visiting neighborhood churches.
"In the end," said Gottlieb, "we had 420 women--truly representative of the postpartum women in these communitiesagree to answer our questionnaire."
The resulting data are currently being analyzed and will be used to help guide the provision of health care in the communities. Preliminary results suggest a surprising rate of post-partum depression affecting women up to 24 months after the birth of their babies. Another important finding is the number of black and Latina mothers who report having little or no social support in their lives.
According to Gottlieb, the consortium and its community/academic collaboration
represent "a process that integrates the experience and expertise
of community-based providers with the technical expertise and scientific
capacity of the research and academic community. It is this process that
holds the best hope of meeting the threats to the health and well-being
of women and children in our communities."
