Local data overview
 PPOR findings
 Women’s Health Assessment
 Preconception health

U.S.
Texas
Tarrant County
Infant Mortality Rate
9.0
8.5
8.0
7.5
7.0
6.5
6.0
5.5
5.0
1995
1996
1997
1998
Rate = number of infant deaths per 1,000 live births
1999
2000
2001
2002
2003
2004
2005
Year
Source: Tarrant County Public Health, 2010
Harris
Dallas
Tarrant
Bexar
Travis
Infant Mortality Rate
9.0
8.0
7.0
6.0
5.0
4.0
3.0
1997
1998
1999
Rate = number of infant deaths per 1,000 live births
2000
2001
2002
2003
2004
2005
Year
Source: Tarrant County Public Health, 2010
10.0
9.4
8.1
Infant Mortality Rate
8.0
7.4
6.9
6.7
6.0
5.7
5.2
5.1
Laredo
El Paso
4.0
2.0
0.0
Arlington
Fort
Worth
Dallas
Rate = number of infant deaths per 1,000 live births
Houston
San
Antonio
Austin
City
Source: Tarrant County Public Health, 2010
Whites
Blacks
Hispanics
All Races
Infant Mortality Rate
25.0
20.0
15.0
10.0
5.0
0.0
1995
1996
1997
1998
Rate = number of infant deaths per 1,000 live births
1999
2000
2001
2002
2003
2004
2005
Year
Source: Tarrant County Public Health, 2010
Is it education?
Source: National Center for Health Statistics, 2002
Infant Mortality Rates
by Maternal Education Level, Tarrant County 2002-2004
16
Whites
Blacks
Hispanics
14
Infant Mortality Rate
12
TC Infant
Mortality Rate
10
8
6
4
2
0
< High School Diploma
High School Diploma
Some College/Degree
Education Level
Source: Tarrant County Public Health, 2010
Infant Mortality Rates
by Maternal Age, Tarrant County 2002-2004
16
Whites
Blacks
Hispanics
14
Infant Mortality Rate
12
TC Infant
Mortality Rate
10
8
6
4
2
0
≤ 17
18-39
≥ 40
Maternal Age (in Years)
Source: Tarrant County Public Health, 2010
•Developed by McCarthy & WHO
• Simple approach
• Strong conceptual basis
• Mobilizes communities
• Prioritizes prevention efforts
CityMatCH PPOR: http://www.citymatch.org/ppor_index.php

Examines the four “Periods of Risk”:
1.
2.
3.
4.
Maternal Health / Prematurity
Maternal Care
Newborn Care
Infant Health
for various population groups

Identifies groups and periods of risk with the most
deaths, highest rates

Uses comparison groups to estimate “excess
deaths” for these groups and periods of risk
FETO-INFANT MORTALITY RATES, ALL
RACIAL/ETHNIC GROUPS: 2001-2003
Maternal Health/Prematurity
3.1
Maternal Care
1.7
Newborn Care
1.4
Infant Health
1.7
*Feto-infant mortality per 1,000 live births & fetal deaths
Maternal Health/
Prematurity
VLBW births
Preconception
Health
mortality rate
among VLBW babies
Interventions
Perinatal
Care
To Summarize…
Maternal Health/
Prematurity
PPOR-Phase I
VLBW births
PPOR-Phase II
Interventions
Preconception
Health
•Targeted
women 18-44 in specific zip
codes
•Face-to-face survey assessed health
status, health behaviors, knowledge,
neighborhood and organizational
factors affecting their health
•405 respondents
18
Healthy People 2010 Goal: 4.5
Source: The Annie E. Casey Foundation, State Level Data Online,
Tarrant County Infant Mortality Task Force, 2005
Source: National Center for Health Statistics, BRFSS, Texas, 2004-2006, Females 18-44, National
Center for Health Statistics, NHANES, United States 2003-2006, Females 20-44
,

Lack of fruits and vegetables
› 88% eat less than five fruits and vegetables a day

Lack of grocery stores in designated area
Source: CDC Health Date for All Ages (HDAA)http://209.217.72.34/HDAA/TableViewer/tableView.aspx?ReportId=161,
Texas, BFRSS , 2004-2006 US, NHIS, 2004-2006.
22
•
25% reported feeling down, depressed or
hopeless every day, or nearly everyday
over the past 2 weeks
•
8% of women experienced intimate
partner violence in the past year

Women are unhealthy, compromising their
opportunity for healthy pregnancy

Improving the health of women holds great
promise in improving the health of babies

Many opportunities to address and improve
women’s health through prevention and promotion

Everyone has an important role to play
•CDC
defines preconception health as “a
set of interventions that aim to identify and
modify biomedical, behavioral, and social
risks to a woman’s health or pregnancy
outcome through prevention and
management”
Prevention and management of health
risks and conditions
 Includes management of fertility,
including contraception, in order to
empower women to plan and prepare
for pregnancies

Source: Kent H, Johnson K, Curtis M, Richardson Hood J, Atrash H. Proceedings of the Preconception Health and Health Care
Clinical, Public Health, and Consumer Workgroup Meetings. Atlanta, GA: CDC; 2006.
Perinatal periods of risk analyses
indicate that interventions should focus
on African American women and on the
maternal health/ prematurity period of
risk
 Consistent with preconception health,
including family planning and
addressing health behaviors such as
smoking and drug abuse

Paradigm Shift
From -Anticipation and Management
to
Health Promotion and Prevention
From -Healthy Mothers, Healthy Babies
to
Healthy Women Healthy Mothers Healthy Babies
Preconception Care - Goal
To promote the health of women of
reproductive age before
conception and thereby improve
pregnancy-related
outcomes …
A LIFE COURSE APPROACH
Dr. Anita Kurian, Tarrant County Public
Health
 Micky Moerbe, Tarrant County Public
Health
 Amy Raines, Fort Worth Women’s Health
Initiative
 Dr. Hani Atrash, CDC
