Putting Data to Use
Iowa PRAMS has identified 10 research priorities based on the maternal and child health priorities as determined through the Title V and Title X needs assessment processes for Iowa, as well as Healthy People 2020 objectives.
Priority Area #1: To enhance data collection and dissemination efforts to promote evidence-based decision making in planning, policy, evaluation, allocation and accountability.
IDPH will use data obtained through PRAMS to assess the effectiveness of our programmatic efforts. PRAMS data is likely to raise questions about the efficacy of current strategies and identify opportunities to benchmark successful programs as models for replication or those in need of technical assistance. PRAMS will allow IDPH to establish and maintain a statewide surveillance system of selected maternal behaviors and experiences that will enhance IDPH’s understanding of the relationship between maternal behaviors and pregnancy outcomes.
Priority Area #2: Reduce infant morbidity and mortality.
The Iowa infant mortality rate has declined steadily since 2000. However, significant racial and ethnic disparities exist. Reducing infant mortality is a key performance measure for Title V and Healthy People 2020 MCH Objectives. A more in-depth and detailed knowledge of the underlying causes of infant mortality and any racial disparities, will allow IDPH to investigate emerging issues in this area. Stakeholders will be encouraged to develop action plans to address the newly identified needs and to determine benchmarks and performance objectives to assess intervention effectiveness. PRAMS data will enable IDPH to monitor changes and trends in a manner that reliably supports use of ‘data to action.’
Priority Area #3: To improve pregnancy planning and spacing and prevent unintended pregnancy.
IDPH will use data obtained through PRAMS to learn more about barriers associated with the use of contraceptives and develop strategies to increase wanted, well-timed pregnancies. PRAMS offers the opportunity to increase our understanding of cultural norms and health behaviors of women across the state. PRAMS will also help IDPH develop culturally competent health promotion messages that promote the benefits of family planning, including pre-conception readiness, and improve outreach strategies for hard-to-reach populations.
Priority Area #4: Incorporate mental health into relevant preventive health efforts within MCH programs.
PRAMS will allow IDPH to monitor postpartum depression, set priorities, and advocate for policies and programs to improve maternal mental health. PRAMS data will provide a knowledge base from which IDPH can participate in efforts to promote expanded availability and improve the quality of mental health services and facilitate links between the mental health and health care communities.
Priority Area #5: To improve rates of breastfeeding.
The WIC program collects data on breastfeeding, however, it represents only those women receiving WIC services and is inadequate to provide the IDPH with a statewide assessment of how many mothers breastfeed and their duration of breastfeeding. Also, there is no way to measure the effectiveness of the state’s breastfeeding promotion programs. PRAMS data will be used to assess how many mothers are breastfeeding and what facilitators and barriers are associated with breastfeeding. Initially, this information will be used to develop standardized messages to be incorporated throughout the IDPH programs that serve pre-conception and pregnant women. PRAMS will allow the state to assess changes over time with special attention to changes in the breastfeeding behaviors of high-risk populations.
Priority Area #6: To decrease the use of tobacco in pregnant women and new mothers.
The only information regarding tobacco use during pregnancy is collected through birth certificates. PRAMS data will provide IDPH with a more accurate assessment of the characteristics of women who use tobacco products and the rates of relapse. PRAMS data will also reveal the type of health education provided to pregnant women about tobacco use and ways to quit. With PRAMS data linked to infant outcomes, IDPH will have a better understanding of the consequences of tobacco use by pregnant women and new mothers in Iowa. Using PRAMS data, IDPH would be able to improve screening for tobacco use, improve referral and follow-up for women seeking services at public health clinics and maternal and child health agencies, as well as monitor progress towards several performance measures.
Priority Area #7: To explore the prevalence of maternal alcohol use and binge drinking.
There are currently no data sources to estimate the prevalence of maternal alcohol use and binge drinking in the state of Iowa. PRAMS data will provide a knowledge base from which IDPH can address the issue, modify program designs, and implement advocacy efforts.
Priority Area #8: Improve access to preventive and restorative dental care for low-income pregnant women.
Active outreach to pregnant women about the need for preventive dental care has been implemented by oral health coordinators and maternal health care coordinators at local public health agencies. PRAMS data will allow the IDPH to assess the effectiveness of this outreach. As a Title V state performance measure, special attention will be paid to the percent of Medicaid-enrolled women receiving preventive dental health services during pregnancy. PRAMS data will also allow IDPH to assess the degree to which non-Medicaid recipients are able to access dental care.
Priority Area #9: Reduce racial disparities in maternal and child health outcomes.
Overall, available data at IDPH suggest that progress has been made towards reducing infant morbidity and mortality, but significant disparities have persisted among racial/ethnic groups. Disparities in birthweight, infant mortality, and sleep behaviors are of particular interest. With PRAMS data linked to infant outcomes, IDPH will have a better understanding of how perinatal services and maternal behaviors impact disparities in outcomes for mothers and infants in Iowa.
Priority Area #10: To apply the Life Course Model to help women obtain optimum health.
Using the Life Course Model (LCM), PRAMS will provide the state with much needed information to better understand and address disparities in health and disease patterns. The LCM will also be applied to understand factors that can help women attain optimal health and developmental trajectories over a lifetime and across generations. PRAMS data will support IDPH in its efforts to focus resources and strategies for a greater emphasis on early determinants of health; incorporate earlier detection of risks coupled with earlier intervention; and promote protective factors while reducing risk factors at the individual, family, and community levels. IDPH will also be able to develop more integrated, multi-sector service systems that become lifelong “pipelines” for healthy development.