Improving pregnancy outcomes for Latinas: Comenzando bien

Birth rates for Hispanics are the highest of any ethnic group in Tennessee and exceed average rates among Hispanic women in the United States. On average, only 56% of Hispanics receive adequate prenatal care in Tennessee, compared with 81% of whites. The high birth rate, coupled with the low number of women receiving adequate prenatal care, prompted an intervention using the "Comenzando bien" (good beginning) prenatal curriculum at a Public Health WIC Clinic in Memphis. Developed by the March of Dimes in partnership with the National Alliance for Hispanic Health, "Comenzando bien" integrates cultural traditions and beliefs with medically sound prenatal health practices. The program features a cognitive component (prenatal care information) and a behavior-oriented component, geared to producing positive health behavior change. A native Spanish-speaking “promotora” served as a lay health educator. She delivered the seven-session curriculum in group meetings and conducted vigorous follow-up and outreach in the Latino community. Session topics included: “Madre hay una sola” (The Importance of Having a Healthy Baby); “Cuidarme es cuidarte” (Taking Advantage of Prenatal Care); “La cita” (My Prenatal Care Visit); “Comiendo para dos” (Nutrition During Pregnancy); “Tomelo con calma” (Physical Stress During Pregnancy); “Cada cabeza es un mundo” (Nurturing Relationships During Pregnancy); “Habitos que danan” (Drug, Alcohol, and Tobacco Use). Measurable objectives were to 1) increase knowledge regarding the importance of early prenatal care, healthy nutrition practices, and avoiding alcohol, drugs, and tobacco; and 2) increase the percentage of Latino women who seek prenatal care early in their pregnancy. Data from two years of intervention indicated that participants (n=127) were primarily of Mexican origin (90%), and recent arrivals to the U.S. (< 5 years) and Memphis (< 3 years). With an average age of 26.5, nearly 75% had less than a 10th grade education. Forty-two percent (42%) had a family history of diabetes. Prior prenatal risks were high: 13% reported previous miscarriages, and 3% stillborn infants. Twenty-five percent (25%) asked for help with stress. Positive outcomes with the "Comenzando bien" intervention included significant matched pre-post knowledge changes (p<0.001). While seven participants experienced maternal complications or jaundiced infants, of the 75 deliveries, none were premature, and only one newborn weighed less than 5 pounds (4 lb, 10 oz). This compares favorably with an average 11% prematurity rate among Hispanics in Tennessee. During the first year, our average time of first prenatal visit was at 17.6 weeks' gestation. In Year 2 the average time was at 21.2 weeks (ranging from 3.6 - 35 weeks). Additionally, 84% of participants breastfed their infants. Through "Comenzando bien", the promotora created a supportive environment that reinforced participants' cultural traditions and encouraged prenatal care. Since Hispanic values embrace "la familia" (family), "confianza" (trust), and "respeto" (respect), a program that is culturally-based and behaviorally-oriented has great potential to improve pregnancy outcomes.