To reduce disparate birth outcomes and save the lives of both infants and their mothers, the Division of Public Health and the Delaware Healthy Mother and Infant Consortium awarded mini-grants to six community organizations.

The local grant recipients were announced Dec. 10 during the DHMIC’s quarterly meeting in Dover.

The state’s first mini-grants to reduce infant and maternal mortality aim to narrow the wide variance in birth outcomes between black women and white women by building state and local capacity and testing small-scale innovative strategies. The awards are evidence-based, as DPH’s Healthy Women Healthy Babies program identified communities, or “zones,” whose residents are at high risk for poor birth outcomes. Grant recipients will provide targeted services within the zones to women of childbearing age, 15-44 years, children, and their families. Awardees will support community-led place-based initiatives and shift the impact of social determinants of health that are tied to the root causes of infant mortality: poverty, racism, health access, food insecurity, housing and having a good job and a good education, all of which affect mothers and children.

“Members of the DHMIC are delighted to see resources being spent in the communities where women with disparate birth outcomes reside,” said Susan Noyes, DHMIC co-chair. “With our shift in priorities to address the social determinants of health, we believe we are on the right track in Delaware to improve birth outcomes.”

“Infant mortality is a leading health indicator to measure how healthy Delaware is,” said Lt. Gov. Bethany Hall-Long. “By investing resources in communities to ensure women receive necessary supports before, during and after their pregnancy, we not only promote and protect the health of mothers and babies, but also ensure a stronger, healthier Delaware.”

More than twice as many black infants in Delaware die before their first birthday than white infants, according to DPH Vital Statistics data. For the period 2014-2018, Delaware’s black infant mortality rate is 12.2 deaths per 1,000 live births and the white infant mortality rate is 4.5 deaths per 1,000 live births. In 2017, the U.S. black infant mortality rate was 10.97 per 1,000 live births and the white infant mortality rate was 4.67 per 1,000 live births.

“While we have seen a 22% reduction in our infant mortality rates from 2000-2018, babies born to black women are still 2.7 times more likely to die than babies born to white women,” said DPH Director Karyl Rattay. “Using data, we identified geographic areas in Delaware with high infant mortality rates and are focusing our attention to offering needed services in these defined ZIP codes to address this unconscionable disparity.”

Racial disparities in birth outcomes extend to mothers. In the U.S., black women die from pregnancy-related complications three to four times as often as white women, according to the U.S. Centers for Disease Control and Prevention’s Division of Reproductive Health. In Delaware, severe maternal morbidity rose by 37% between 2010 and 2014, according to the Delaware Child Death Review Commission’s Maternal Mortality Review Report, which reviewed cases from 2011 to 2017. Risk factors for pregnancy-related complications include obesity, pre-eclampsia, high blood pressure and substance use disorder, all of which are on the rise among Delaware women of reproductive age.

“I know firsthand of the challenges that women of color face during pregnancy, having endured complications during both my pregnancies,” said Rep. Melissa Minor-Brown, D-New Castle South, who distributed the award certificates to grantees at the meeting. “We must address the social determinants that affect maternal health outcomes, which is why it was critical that the community itself was part of the selection process for these grants. We have high expectations for this work to promote systems changes for Delawareans to achieve optimum health and well-being across the course of their lives.”

Grant funds totaling $327,925 were awarded to the community organizations for a one-year period. DPH and DHMIC will review the projects annually and have the option of renewing them for up to four additional years. Available funds were equitably distributed, based on the estimated number of women of reproductive age living in each Healthy Women Healthy Babies Zone, which were identified as “high-need” based on several data points/indicators, including: percent of teen births; mother’s high school education; percent of births to black mothers; percent using cigarettes during pregnancy; percent of families on Medicaid; percent of women with no prenatal care; percent of mothers with pre-pregnancy diabetes; percent of mothers with gestational diabetes; percent of mothers with pre-pregnancy hypertension; percent of mothers with gestational hypertension; percent of mothers with previous preterm birth; percent of mothers who were obese; percent of mothers with a preterm birth; percent of mothers with a low birth weight baby; and percent of mothers with neonatal deaths, less than 28 days.

The Delaware-based awardees are:

— Delaware Adolescent Program Inc. DAPI will serve teen mothers and their partners who live in high-risk zones throughout the state. DAPI will provide ongoing mentoring services and supports for social and emotional well-being and support in navigating the health and social services system, including maternal and child health care services, housing programs, financial management and economic empowerment. DAPI will also encourage college and career readiness based on each individual’s self-identified goals, identify and address adverse childhood experiences and offer stress reduction and maternal health courses and co-parenting workshops. DAPI will provide services at each of its service sites, located in each county, as well as directly in the community and in collaboration with a variety of community-based partners.

— Reach Riverside Development Corporation, multi-generational maternal and child health program. At its Kingswood Community Center located in the Riverside community in Northeast Wilmington, REACH will serve women of childbearing age and their families, targeting women who live in ZIP codes 19801 and 19802. To reduce toxic stress to women of childbearing age, REACH will create a multi-generational maternal and child health program with three components. First, a peer-to-peer program will provide mindful and empathetic services pre-, during and post-pregnancy. The program will focus on stress and adverse childhood experiences training; examine the role of adverse experiences from a multigenerational lens; and address strategies to prevent transference of these experiences through the generation to children in particular. REACH plans to train at least 40 women during the period of the grant. Second, the organization will provide care management with referral and resource services, as well as case management via a community family and support service liaison. The liaison’s focus will be financial empowerment, self-sufficiency and housing. Third, REACH will provide workshops to increase fatherhood/partner engagement, using strategies for inclusion and parenting dynamics that support mothers and their children.

— Rose Hill Community Center, Women’s Wellness Program. The Rose Hill Community Center’s Women’s Wellness Program will offer women of childbearing age in the 19720 and 19801 ZIP codes the opportunity to take fitness, nutrition and self-improvement classes at no cost. Fitness classes will include yoga, Zumba and cardio kickboxing. One-on-one appointments with an on-site nurse will be available. Self-improvement classes will discuss ways to handle stress, positive self-image, combating negative attitudes, conflict management, effective communication, parenting 101, couponing, social media, professionalism, discipline versus punishment, financial literacy, community resources, stress management and goal setting. Free childcare will be available during classes. Participants will have access to an onsite mental health consultant who is a National Certified Counselor and Licensed Professional Counselor of Mental Health. Fitness activities and other services will be tailored to pregnant women and other participants with specific needs through meetings with a nurse and Women’s Wellness Program staff.

Delaware Coalition Against Domestic Violence, Community Health Worker Collaborative Project. DCADV will continue providing support and expand integration of its services with health services in New Castle County through its Community Health Worker Collaborative Project, which seeks to integrate domestic violence and health services to improve the health and safety of victims and survivors. The program will serve black and Hispanic/Latina women who are pregnant, parenting a child younger than 5, and/or of reproductive age, who are living in Wilmington, Claymont, Newark and New Castle, ZIP Codes 19703, 19809, 19802, 19801, 19805, 19804, 19702 and 19720. The program will manage and expand service delivery to the HWHB target population; administer flexible Health Access Funds to support the safety and health of the participants; and train health care providers on best practices for domestic violence assessment and response, interviews, focus groups and/or surveys for individuals at the two New Castle County domestic violence shelters. It will work with direct service providers in the maternal and child health care and victim services fields to learn challenges and explore possible solutions.

— The Delaware Multicultural and Civic Organization Inc. DEMCO will provide academic and life skills supports and job training education to young women of childbearing age, including those who are pregnant and parenting, who are living in Dover ZIP codes 19901 and 19904. Each woman served will be matched with a mentor to provide social and emotional support. The program will progress through a series of educational workshops to develop hard and soft skills to better prepare them for gainful employment and a career in the IT field. The program also includes support for fathers/partners, including effective fathers/partner parenting lessons and an opportunity to engage in job shadowing and internship placement.

— Hispanic American Association of Delaware, Mamas felices hijos felices/Happy Mothers, Happy Children. The Hispanic American Association of Delaware will provide pregnancy and postpartum support in Spanish to women ages 15-44 who live in ZIP code 19720 in New Castle County. A support group called Mamas felices, hijos felices — “Happy Mothers, Happy Children” — will be located at Garfield Park, which is within walking distance for a high number of Latino families. Mamas felices, hijos felices will create wellness, resilience, hope and connection for women adjusting to parenthood and experiencing pregnancy and postpartum emotional ups and downs. The support group will also address racism and language barriers by providing bilingual services. It will hire a dedicated community liaison to offer referrals to insurance and other needed services; reduce cultural mental health stigma in the Latino population; and provide support to families with recent migration and acculturative stress. The organization will also create a family network event to involve the whole family, especially fathers, and to connect the community to pregnancy and postpartum mental health resources.

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