Improving prenatal care access in South Georgia African-Americans does improve perinatal outcomes

Georgia's Southwest Public Health District serves a 14 county population of approximately 360,000 people, roughly 41.1% African-American and 57.8% Caucasian. The District's lead county, Dougherty, is 63.7% African-American and serves as the medical hub of a predominantly rural district. In 2006, the District's African-American infant mortality rate was 15.2 – more than triple the Caucasian rate (4.7). The 2008 Georgia Health Disparities Report noted the percentage of Dougherty's African-American low birth weight infants was 14.1, compared to the county rate of 8.4 and issued the county an F for inadequate prenatal care. With the loss of three high volume Medicaid obstetricians, the District initiated a public-private healthcare delivery model to expand low-income African-American women's access to early prenatal care in an effort to improve perinatal outcomes. After ascertaining collaborative agreements with four obstetric practices for after hour emergency care, prenatal care referral (routinely at 35 weeks) and delivery services, in October 2009 Dougherty County Health Department began CenteringPregnancy®, an evidenced-based model of group prenatal care. Since its inception, 177 new ob exams were completed and 62% of patients received ≥ four visits prior to transfer. The mean age is 22.6. 87% are African-American. The mean gestational age at the initial prenatal visit is 10 6/7 weeks. 6.9% had low birth weight infants compared to the above noted baseline rates. The centering patient's breastfeeding initiation rate of 68% compares favorably with the county WIC rate of 39%. These results demonstrate that early access to patient-centered prenatal care improves perinatal outcomes.