OUTCOME 1

Healthy Babies


BALTIMORE'S PROMISE HAS A GOAL THAT

Babies Are Born Healthy

Health conditions affect a child’s ability to learn and develop, starting in the earliest days and months of life. Children born pre-term or at low birthweight tend to have lower cognitive scores, increased incidence of ADHD, and more behavioral problems throughout childhood. Since 2005, Baltimore City has averaged over 9,200 births per year, with a recorded low of 8,656 in 2015. Baltimore’s Promise has identified infant mortality, low birthweight, and teen pregnancy as our key indicators for this outcome.

Babies are born healthy is an outcome that has been prioritized by the City of Baltimore, the State of Maryland, and the U.S. Department of Health and Human Services.

Key Metrics

Infant mortality rate

In 2015, 8.4 infants died per 1,000 live births.

Low birthweight

In 2015, 12.3% of births were infants weighing less than 5.5lbs.

Teen birth rate

In 2015, there were 41 live births per 1,000 females aged 15-19.

The Healthy Babies work group was formed in early 2015, and as part of its initial charge has worked to:

  • Identify and examine the impact of strategies to maintain and amplify the gains made to reduce rates of infant mortality, including efforts addressing racial disparities.
  • Identify and examine the impact of strategies and related policies to reduce the teen pregnancy rate, and further improve outcomes.

Baltimore's Promise has joined together with B'More for Healthy Babies, whose vision is that "all of Baltimore's babies are born at a healthy weight, full term, and ready to thrive in healthy families." We have worked together to reinvigorate the B'More for Healthy Babies Steering Committee and have created a new table to explore sustainable funding options for this effort.

Recommendations

In 2015, the Healthy Babies work group, in partnership with B’more for Healthy Babies (BHB), put forth the below set of initial, strategic recommendations to move the needle on our key indicators for this outcome. The group monitored the following progress to date:

RECOMMENDATION 1

Propose an automatic cross-check system for all pregnant women who are uninsured or on Medicaid and visit a hospital emergency department to determine if they have a prenatal risk assessment filed with the City. This could be done through Maryland's Health Information Exchange. The Baltimore City Health Department (BCHD) would then be able to reach out to women who are not in obstetrics care immediately, which in turn would set in motion the process of care and the risk assessment.

Progress to Date: A small group is piloting a PRA cross-check with women who visit hospital emergency rooms to test new protocols.

RECOMMENDATION 2

Work with Maryland's Department of Health and Mental Hygiene (DHMH) to create, as soon as possible, an easy online path to generate Prenatal Risk Assessments (PRAs) through the state's Health Information Exchange. The online path would include a feedback measure that would ensure that providers who fill out the PRA are aware of where women are in the process. The feedback measure would also provide data on the source of PRAs.

Progress to Date: The Baltimore City Health Department (BCHD) is leading efforts to develop an electronic PRA system. BCHD has assessed the current PRA processes in 10 clinics, and is considering cost, system compatibility, and impact as they proceed.

RECOMMENDATION 3

Propose a citywide policy that no granting agency, public or private, will make a grant for health to an organization that does not have a written policy on promoting smoking cessation. This policy should, at a minimum, prominently provide information on services available to Marylanders through the quitline. This should include all organizations that provide instructions in child safety seats.

Progress to Date: Efforts are underway to increase awareness and access to the Quitline, which provides cessation information on services available to Marylanders.

RECOMMENDATION 4

Request free airtime on local radio and TV stations for the B'More for Healthy Babies Safe Sleep Public Service Announcements. This request should be premised on the results of the campaign and the likelihood that further dissemination will save more lives.

Progress to Date: BHB launched a self-funded Safe Sleep campaign, including a new Sleep Safe video that was viewed 67,000 times in June 2016. Infant sleep-related deaths are at an all-time low thus far in 2016.

RECOMMENDATION 5

Propose that all substance use disorder treatment programs in the City screen patients for interest in family planning and have the capability to refer clients to receive family planning services.

Progress to Date: The Preventing Substance Exposed Pregnancies Coalition launched the Baltimore Reproductive Health Initiative Pilot Project to increase access to reproductive health services, including family planning for women receiving substance use disorder treatment in three sites. 

RECOMMENDATION 6

Write a letter of support, upon request, to BCHD and Baltimore City Public Schools (BCPS) in support of their proposed plan for improved reproductive health education.

Progress to Date: BCHD received a ve-year, $8.5 million award from the Of ce of Adolescent Health to support reproductive health education in all Baltimore City middle and high schools. All high schools are implementing Making Proud Choices: Out of Home Care and Title X clinics implementing Seventeen Days, a video-based intervention. Middle school implementation will begin in January 2017.

RECOMMENDATION 7

Endorse a proposal by B'More for Healthy Babies for expansion of Nurse-Family Partnership in the City within federally qualified health centers and embrace the concept of reaching all first-time teen parents with evidence-based home visiting.

Progress to Date: BCHD is working in partnership with the Family League of Baltimore (FLB), NFP, and other stakeholders to review how to set up an integrated system of home visits, public health, hospitals, managed care organizations, and clinic stakeholders with the goal of ensuring NFP nurses are housed at city clinics, and FLB is researching best practices for implementation.

RECOMMENDATION 8

In support of the intimate partner violence (IPV) project led by DHMH, write all hospitals, clinics, and emergency rooms in Baltimore City to request that validated routine IPV screenings are offered to all patients at every possible visit. The current three-question screen supported by DHMH should be included. The letter should be co-signed with the local and state health departments, which can offer trainings that provide compelling healthcare data related to the importance of IPV screening and mechanisms for referral.

Progress to Date: The development of action steps regarding this recommendation is ongoing.

RECOMMENDATION 9

Leadership from B'More for Healthy Babies was actively involved in the work group and strongly endorsed the following recommendations:

  • Endorse a separate process to explore the identification of sustainable funding opportunities to support B'More for Healthy Babies. This should include both a short-term goal to maintain and stabilize existing infrastructure and a long-term goal to sustain initiatives in the years to come. This process should identify all untapped opportunities for reimbursable services, engage with entities that will benefit financially as progress is made, and consider unique and dedicated funding sources.
  • Revamp the B'More for Healthy Babies Steering Committee to include participants from the Healthy Babies work group who are not already members. It is also recommended that moving forward, the B'More for Healthy Babies Steering Committee and the Healthy Babies work group become one and the same.

Progress to Date: In January 2016, The Healthy Babies work group and BHB Steering Committee merged with a focus on examining BHB’s operations and supporting efforts to close funding gaps.

The BHB Financial Sustainability action team collaborated with DHMH to explore opportunities to leverage federal Medicaid matching funds for care coordination and home visiting services. A Medicaid waiver was submitted with input from BHB to include home visiting as part of the state’s Medicaid plan.

INFANT MORTALITY

Defined as deaths of infants less than one year old per 1,000 live births, the Maryland Department of Health and Mental Hygiene (DHMH) identified infant mortality as "one of the most critical indicators of the overall health of a population."

According to the Baltimore City Health Department, the 2015 infant mortality rate represents the lowest rate on record in Baltimore.

Infant Mortality (Per 1000 Births)

(Baltimore City & Maryland)

Infant Mortality (Per 1000 Births)

The 2015 infant mortality rate among black mothers in Baltimore City represents a decline of 48% from an eight-year peak of 18.5 in 2009.

Racial/ Ethnic Disparity in Baltimore City's Infant Mortality Rate (Per 1000 Births)

(Baltimore City)

Racial/ Ethnic Disparity in Baltimore City's Infant Mortality Rate (Per 1000 Births)

Low Birthweight Deliveries

Children born at low birthweight, defined as less than 5.5 lb, tend to have lower cognitive scores, increased incidence of ADHD, and more behavioral problems at school age. Additionally, being born at low birthweight increases the chances of mortality and morbidity, with one study showing survival rates under 20% for babies born under 500 g (1.1 lb). Research shows that mothers who receive early and consistent prenatal health care are more likely to give birth to babies born at a healthy weight. Baltimore City mothers continue to have a higher percentage of babies born with a low birthweight compared to the state's average.

In 2015, about 1 in 8 (12.3%) babies born in Baltimore City weighed about 5.5 lb (2,500 g) or less.

Low Birthweight Deliveries

(Baltimore City & Maryland)

Racial/ Ethnic Disparity in Baltimore City's Low Birthweight Deliveries

In 2015, 14.6% of black mothers in the city delivered underweight babies, while 8.4% of white mothers had underweight babies.

Racial/ Ethnic Disparity in Baltimore City's Low Birthweight Deliveries

(Baltimore City)

Racial/ Ethnic Disparity in Baltimore City's Low Birthweight Deliveries

BIRTHS TO TEENS

Pregnancy is inherently associated with risks; however, giving birth within certain age ranges is associated with higher risk levels. Research has identified age as a contributing factor to poor birth outcomes, with babies born to teen mothers being more likely to have poor birth outcomes, such as higher risk of preterm birth, low birthweight, and infant mortality. In Baltimore City, teen births have decreased dramatically since the late 1990s, but remain higher than the state's average. Reducing the number of teen births is a key component to increasing successful birth outcomes.

Between 2005 and 2014, the number of teenage females giving birth in Baltimore City declined significantly, from 66.2 per 1,000 to 41.0 — a 38% decrease.

Teen Birth Rate (Per 1,000 Females Ages 15-19)

(Baltimore City & Maryland)

Teen Birth Rate (Per 1,000 Females Ages 15-19)

Much of the decline in Baltimore City’s overall teen birth rate during the past 10 years can be attributed to decreases among black and Hispanic teenagers.

Racial/Ethnic Disparities in Baltimore City's Teen Birth Rate (Per 1,000 Females Ages 15-19)

(Baltimore City)

Racial/Ethnic Disparities in Baltimore City's Teen Birth Rate (Per 1,000 Females Ages 15-19)