San Bernardino County Maternal Health Assets and Gaps

The Maternal Health Network uses relevant data to inform the experience of families accessing maternal health services before, during, and after pregnancy.

Motherhood

To support evidence-based decision making, the Maternal Health Network commissioned an asset and gaps analysis. The goal was to understand and document the broad landscape of existing maternal health components within the County. Network Members were asked to join one of five workgroups (Prenatal & Postpartum Primary Care and Oral Health, Birthing Supports, Behavioral Health & Substance Abuse Prevention/Intervention/Treatment, Prenatal & Post-partum Wellness, and Priority Populations) to review data indicators most relevant their workgroup.

Workgroup members reviewed the data gathered and identified areas of strength and potential areas for improvement around maternal and infant health outcomes. Additionally, workgroup members explored their unique role in addressing the identified areas of improvement, coming up with concrete next steps that may assist with improving indicators of health for women and infants. Those are described in more detail in the Asset and Gaps Summary report.

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Areas of Exploration

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Maternal Health Status

To understand the maternal health status of families in San Bernardino County, maternal health indicators and other data were gathered.

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Maternal Health Resources

To understand what supports are available throughout San Bernardino County related to maternal health, resources were mapped according to their type and location.

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Systems Issues

To understand systems issues associated with maternal health services, stakeholders were engaged through community gatherings as well as through provider discussions.

Maternal Health Sectors

The following sectors were identified as the most appropriate for providing a lens through which to evaluate the maternal health systems and supports in San Bernardino County. These sectors also provided the focus for the workgroups previously referenced in this report. The majority of workgroup participants were practitioners or advocates within the specified sector. 

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Birthing supports 

Birthing supports comprise individuals and organizations that provide prenatal services such as birthing education and other preparatory activities, as well as a location for and/or assisting in the actual birthing process. Ideal birthing supports help ensure that women have the birth experience of their choosing, by providing safe options grounded in both best practices and current research, as well as based around the mother-to-be’s preferences, medical history, and personal circumstances.

For the purposes of this project, birthing support providers encompass baby-friendly hospitals, hospitals with labor and delivery, birthing centers, midwives, and doulas.

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Behavioral Health & Substance Abuse Prevention, Intervention and Treatment

Maternal behavioral health and substance misuse are two factors that have the potential not only to negatively impact the mother and developing child during pregnancy, but to have long-term and long-lasting negative consequences for the emotional and physical health of both mother and child. With internal and external stigmas attached to the disclosure of either a behavioral health or substance misuse issue, finding ways to provide mothers with the help they need to overcome these barriers to a successful pregnancy can be challenging.

For the purposes of this project, behavioral health providers encompass counselors, psychiatrists, psychologists, and mental health support groups. Substance use intervention providers comprise “alcohol and other drug” (AOD) counselors, general counseling services, medication assisted treatment (MAT) programs, substance abuse intervention services, and substance abuse support groups.

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Prenatal & Postpartum Wellness

Perinatal and post-partum maternal wellness is focused on supporting a high overall quality of life for pregnant or planning to become pregnant women. Providing women with the most up-to-date research and best practices in exercise, nutrition, medicine, family planning, and birthing supports can help ensure a healthy lifestyle for women and their families before, during, and after pregnancy. This is best facilitated by a seamless continuum of care that delivers similar, reinforcing information to women via multiple resources at all stages of their pregnancy.

For the purposes of this project, wellness facilitators encompass birth preparation, education, and advocacy groups; breastfeeding supports and lactation consultants; counseling services; family resource centers/support services; federally qualified health centers; help-and hot-lines; home visiting programs; lactation consultants; support groups; and WIC services.

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Services for Priority Populations

While all women face a baseline set of challenges before, during, and after pregnancy, specific issues faced by marginalized groups may be exacerbated by pregnancy. Living in a high poverty area; experiencing food insecurity, homelessness, or intimate partner abuse; and/or being undocumented are extreme difficulties in and of themselves. Additionally, being a woman of color or a teen can carry its own set of challenges. Navigating one, or more, of these while pregnant requires access to special resources to support the delivery of a healthy baby and well-being of the mother.

For the purposes of this project, priority populations included women of color, teens, women who are undocumented immigrants, women who are victims of domestic violence, and women who are incarcerated.

Summary of Situation Facing Families in San Bernardino County

The following information represents cross-cutting assets and gaps identified by representatives from each sector of the Maternal Health Network. 

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Maternal Health Status

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Maternal Health Resources

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Systems Issues

Maternal Health Status

Data was collected to understand the maternal health status of families in San Bernardino County. It is important to note that where the County as a whole may be doing well, sub-populations can be suffering from negative health outcomes.

Areas of Strength


Health Insurance Coverage Most women in San Bernardino County who are pregnant or who are planning to become pregnant have insurance. Prenatal Care In San Bernardino County, women receive prenatal care within the first trimester at rates higher than the state average. Additionally, women receive adequate prenatal care at rates higher than the state average. That said, providers question whether women continue to receive consistent care beyond the first trimester. WIC Participation San Bernardino County has a significantly higher rate of women participating in WIC during pregnancy than the state average, with 60.9% of pregnant women accessing WIC services at some point during their pregnancy.




Areas for Improvement


Cesarean Births San Bernardino County has a higher rate of cesarean births (per live births) than the state average. Prenatal and Postpartum Supports Nearly one in ten (9%) of recently delivered women in California had no postpartum visits. Women on Medi-Cal were twice as likely to have no postpartum office visits, and more than twice as likely to have no postpartum, emotional or practical support compared to those with private insurance. In addition, very few women access the support of midwives or doulas for prenatal or postpartum support. Breastfeeding Women in San Bernardino are not breastfeeding exclusively for long durations. Whereas the national standard is that 46.2% of women breastfeed three months after delivery, in San Bernardino, the rate is only 22.6%. Focus on African American Families African American families fare worse than other race/ethnicity groups in many maternal health indicators, including early and adequate prenatal care, rates of cesarean births, and vaginal births after cesareans (VBACs).





Maternal Health Resources

San Bernardino County is host to a variety of resources to support families within the maternal health system. Resources were identified and mapped according to their service sector and location. An interactive map of these resources can be accessed on the Resources tab of this website.

Areas of Strength


Stakeholders identified system strengths and areas where the service sector was adapting to meet the needs of families in San Bernardino County. Strengths identified included: County Coalitions
Stakeholders described a variety of coalitions that exist to support families throughout the maternal health system. Some of them include the Inland Empire Breastfeeding Coalition, the Inland Empire Maternal Mental Health Collaborative, the Oral Health Action Coalition – Inland Empire, the Inland Empire Birth Workers of Color, and the Perinatal Nurse Leadership Coalition. Information Sharing
Inland Empire Health Plan and Molina (the two primary health plans in San Bernardino County) were identified as doing well at providing information and training opportunities to their members. Innovative Practices
Stakeholders identified innovative practices within the maternal health system to include service integration models of care and a Doula Access Pilot Project being provided by IEHP Targeted Interventions
Targeted interventions such as the Black Infant Health Project and the Perinatal Equity Initiative (to address maternal health disparities) and transportation supports (to address barriers to access) are in place and working well.




Areas for Improvement


Areas where the system fails to meet the needs of families were also identified and include: Operational Variations
System stakeholders described operational variations amongst service providers, resulting in service provision disparities. The timeliness, quality and ease related to care can be impacted by the business model of the service organization, the approach to care utilized by a provider and/or the payment method of the consumer. Cultural Competency
Stakeholders describe a workforce that doesn’t provide services within a culturally competent framework. Furthermore, service providers do not always have the information, knowledge and/or resources to customize their service approach to targeted populations. Coordination of Care
Stakeholders identified a lack of coordination amongst service providers making continuity of care difficult and duplication of efforts likely. Data Deficiencies
System stakeholders identified significant data deficiencies that make it difficult to understand issues facing women in San Bernardino County, specifically within the priority populations. Additionally, the data currently available is outdated and may not reflect the current status of families within the maternal health system. Service Responsiveness
System stakeholders describe a system that doesn’t adequately support individuals as they enter the maternal health system, often leaving families to their own devices to understand what resources exist and how to access them. They described a system that doesn’t sufficiently listen to women regarding their concerns and desires or have a referral mechanism to connect families to the variety of resources that are available.





Maternal Health System

Areas of Strength


Stakeholders identified system strengths and areas where the service sector was adapting to meet the needs of families in San Bernardino County. Strengths identified included: County Coalitions
Stakeholders described a variety of coalitions that exist to support families throughout the maternal health system. Some of them include the Inland Empire Breastfeeding Coalition, the Inland Empire Maternal Mental Health Collaborative, the Oral Health Action Coalition – Inland Empire, the Inland Empire Birth Workers of Color, and the Perinatal Nurse Leadership Coalition. Information Sharing
Inland Empire Health Plan and Molina (the two primary health plans in San Bernardino County) were identified as doing well at providing information and training opportunities to their members. Innovative Practices
Stakeholders identified innovative practices within the maternal health system to include service integration models of care and a Doula Access Pilot Project being provided by IEHP Targeted Interventions
Targeted interventions such as the Black Infant Health Project and the Perinatal Equity Initiative (to address maternal health disparities) and transportation supports (to address barriers to access) are in place and working well.




Areas for Improvement


Areas where the system fails to meet the needs of families were also identified and include: Operational Variations
System stakeholders described operational variations amongst service providers, resulting in service provision disparities. The timeliness, quality and ease related to care can be impacted by the business model of the service organization, the approach to care utilized by a provider and/or the payment method of the consumer. Cultural Competency
Stakeholders describe a workforce that doesn’t provide services within a culturally competent framework. Furthermore, service providers do not always have the information, knowledge and/or resources to customize their service approach to targeted populations. Coordination of Care
Stakeholders identified a lack of coordination amongst service providers making continuity of care difficult and duplication of efforts likely. Data Deficiencies
System stakeholders identified significant data deficiencies that make it difficult to understand issues facing women in San Bernardino County, specifically within the priority populations. Additionally, the data currently available is outdated and may not reflect the current status of families within the maternal health system. Service Responsiveness
System stakeholders describe a system that doesn’t adequately support individuals as they enter the maternal health system, often leaving families to their own devices to understand what resources exist and how to access them. They described a system that doesn’t sufficiently listen to women regarding their concerns and desires or have a referral mechanism to connect families to the variety of resources that are available.





Conclusions

A number of consistently identified themes emerged from an analysis of all of the assets and gaps explored within the maternal health system serving San Bernardino County. These critical issues have been identified as the most pressing problems that should be addressed by the Network. 

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Equity

Ensure there will be equity in experiences and outcomes amongst African American/Black families engaged in the maternal health system as compared to other groups.

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Early Identification of Risk

Increase early screenings and connection to care for families with high risk pregnancies and ensure they know about and engage in healthy habits before, during and directly following pregnancy.

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Access to Community Resources

Improve coordination of care and cross collaboration between sector providers and county coalitions so that families will know about and will be able to access services that meet their full range of needs.

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Data Sufficiency

Increase reliable, timely and comprehensive data collection efforts across the maternal health network to drive quality improvement and decision making.

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Provider Capacity

Equip the Maternal Health Network with a sufficient workforce to meet community needs in a culturally competent fashion.