Health Disparities
The Roles of Healthy Start Service Provision on Perinatal Outcomes among Healthy Start Participants, South Carolina, 2011-2019 Jihong Liu* Jihong Liu Xingpei Zhao Rokonuzzaman S.M. Ishan Suthar Curisa Tucker Kimberly Alston
Healthy Start (HS) Programs are federally funded, community-based initiatives designed to reduce disparities in perinatal outcomes in communities where infant mortality rates were 1.5 to 2 times higher than the national average. However, few studies have evaluated the effectiveness of direct HS service delivery in improving perinatal outcomes.
This cohort study included 2,142 mother-newborn dyads who were served by the Midlands HS Program from 2011 to 2019 in South Carolina. The birth certificates were linked with program data, restricted to singleton births with a birthweight of ≥500 grams. HS staff recorded all services provided via home visits, office visits, phone calls, or mailings, including access to perinatal care, health education, screening and referral for depression, parenting, and father involvement etc. Participants were grouped as receiving low (0-1), modest (2-4), and high (≥5) service groups based on the total number of services received during pregnancy.
HS participants were 25.3 years old (±5.6), 59.0% African Americans, 33.3% White, 7.7% other races, 55.2% with a high school education or less, and 74.5% on Medicaid. HS participants received a mean of 4.5 services (±6.0), with 43.4% of participants receiving modest services and 24.4% high levels of services. After adjusting for maternal age, race, education, Medicaid, prepregnancy BMI, parity, and adverse pregnancy histories, compared to low levels of services, both modest and high levels of HS services were associated with lower risks of prenatal smoking (ORHigh: 0.73, 95% CI 0.50-1.08; ORModest: 0.70, 0.50-0.97), gestational hypertension (ORHigh: 0.58, 0.37-0.89; ORModest: 0.67, 0.47-0.97), low birthweight (ORHigh: 0.61, 0.41-0.91; ORModest: 0.73, 0.52-1.02), and primary cesarean delivery (ORHigh: 0.95, 0.70-1.28; ORModest: 0.70, 0.53-0.92). Receiving ≥2 breastfeeding-related services was associated with higher odds of initiating breastfeeding (OR: 1.38, 1.07-1.80) compared to those not receiving breastfeeding services.
The results demonstrated that HS services provided by community health workers and social workers have potential to improve perinatal outcomes in underserved communities, suggesting that HS programs could play a significant role in reverse rising trends in maternal morbidity and infant mortality in the US.