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In This Issue:
Throughout the past decade, BWH’s vision to improve the health of pregnant women has been wrapped tightly around the issue of infant mortality. During the 1990’s, when infant mortality rates were on the rise, several key problems were identified. Contributing factors to infant mortality included long waits for prenatal appointments at hospital-based clinics; few community-based obstetricians; financial barriers to prenatal care; adequate housing; and possibly drug abuse. BWH responded. The hospital supported the placement of nurse midwives, obstetricians and pediatricians in community health centers. A perinatal case manager program was launched in five community health centers. And finally, a Center was developed to focus specifically on the health issues for families and pregnant women.
Now, ten years later, proper mechanisms have addressed and managed the problems that percolated in the 1990’s. However, new data shows that the disparity in infant mortality among black and white babies has widened. Additionally, the infant mortality rate has increased. So, where does this lead BWH? How will the hospital respond to the challenge to enhance obstetrical care and reverse infant mortality trends? JudyAnn Bibgy, MD, director, Office for Women, Family and Community Programs, and her colleagues are at the forefront of the investigation.
“The issues of the 1990’s are not issues anymore,” said Bigby. “We are focusing on what type of care women are receiving over their lifetime, not just during their reproductive years,” she added. “It is our goal to emphasize that continual medical care is vital not just when women are pregnant, because in some cases that is too late.”
Ensuring women have access to adequate medical care from adolescence to adulthood is the new challenge for the next decade, according to Bigby. BWH has already responded to this call by working with the Boston Public Health Commission on the Women’s Health Demonstration Project. The program includes comprehensive medical and social risk assessment and matches case managers with patients and with primary care physicians. The case manager’s role is to link women to health services and follow them through the patient’s continuum of care. The goal is to address issues such as unplanned pregnancies and chronic diseases like high blood pressure as well as issues such as domestic violence.
“In the next ten years, I would like to see a system of care that provides women the opportunity to stay in the system for a lifetime,” said Bigby. “We want women to be able to develop a trusting relationship with health care providers—one that starts during childhood and evolves into adulthood. We want them to know that they have a place to go to get help, where their issues and needs will be addressed, and where they will always be welcome.”