Alabama Administrative Code
Title 410 - STATE HEALTH PLANNING AND DEVELOPMENT AGENCY
Chapter 410-2-2 - HEALTH PRIORITIES
Section 410-2-2-.02 - Maternal And Child Health
Universal Citation: AL Admin Code R 410-2-2-.02
Current through Register Vol. 43, No. 02, November 27, 2024
(1) The Problem
(a) Alabama's infant mortality
was 9.0 per 1,000 live births in 2005. In 2014 the provisional rate improved to
8.7 deaths per 1,000 live births, a drop from the 2005 rate. Reasons for the
improvements include a number of factors related primarily to improved Medicaid
coverage.
1. Medicaid has been expanded to
serve more children and pregnant women who do not receive cash assistance such
as Aid to Families with Dependent Children. This trend started in 1988 with
expansion of eligibility to pregnant women and children up to age one (1) with
incomes under 100 percent (100%) of the federal poverty level and now up to one
hundred thirty-three percent (133%) of the federal poverty level.
2. As of September 1, 1991, Medicaid had
workers out-stationed at hospitals, county health departments and other health
facilities throughout the state to determine Medicaid eligibility for children
and pregnant women who need help with payment for health care but who do not
qualify for cash assistance.
3. The
Alabama Medicaid Agency received a 1915(b) waiver to create the Alabama
Coordinated Care Network for maternity, family planning, children, foster
children, and eligible adults beginning October 1, 2019, for three (3) years.
The objective is to better coordinate the care, follow-up, and follow-through
for Medicaid recipients residing in any one of the seven (7) regions. Each
region will have a contracted entity responsible for the coordination of care
and services for Medicaid eligibles. Quality measures are key to the success of
the waiver.
4. ADPH, in
collaboration with the Alabama Department of Human Resources, implemented the
Alabama Unwed Pregnancy Prevention Program (AUPPP) in 2001 and the Family
Planning Teen Care Coordination Program in 2002. The AUPPP addresses adolescent
pregnancy and unwed pregnancy by providing funding support to community-based
projects, a statewide teen pregnancy prevention campaign, and media outreach.
The teen care coordination program provides medical social support to teens age
eighteen (18) and under receiving family planning services in local health
departments.
5. Other programs
implemented by ADPH that are affecting infant mortality include the Alabama
Child Death Review Program legislated in 1997, a campaign addressing
"back-to-sleep", a "safety for sleeping babies" brochure, and folic acid
outreach. According to the Alabama Child Death Review Program, approximately
eighty percent (80%) of infant deaths in Alabama are attributable to unsafe
sleeping conditions.
(b)
Progress has been made in Maternal and Child Health in the state. In 2005,
Alabama's infant mortality rate was 0.93%, and in 2014 declined to 0.87%. In
"real terms", 517 of Alabama's babies failed to reach their first birthday in
2014. Those at highest risk for infant mortality are infants born to blacks,
single mothers, teenagers, and the socio-economically disadvantaged. Over
thirty percent (30%) of Alabama's population is black and other. Close to
one-half (1/2) of the births in 2014 (43.2%) were to unmarried women, and 8.5%
of infants resulted from teenage pregnancies.
(c) Infant death is not the only problem
associated with high-risk birth. Research indicates that for every baby who
dies, three (3) more are born with handicapping conditions. In 2014, 10.1% of
babies were born with a low birth weight, putting them at greater risk for
handicapping conditions. Ensure the newborn screening component is followed as
it identifies problems in newborns early in their development so interventions
and therapies can be applied for long term outcomes.
(d) Alabama's women and children must receive
adequate health care -- health care that is primarily preventive, appropriate
for the need, and available. Barriers to care include the following:
1. Outreach Efforts. Outreach efforts at the
local community level are varied and sometimes nonexistent. Some children do
not receive the minimal recommended number of preventive health care visits as
outlined by the American Academy of Pediatrics, thus immunization rates for
these infants and young children are low, and conditions that could be
identified through routine screening exams go untreated.
2. Diminishing Rural Health Services and
Delivery Hospitals. Alabama continues to experience a decline in rural
population and health providers. Hospitals are financially challenged due to
declining population and reductions in federal reimbursement. Only twenty-nine
(29) counties have a birthing hospital. Innovative means of delivering care to
rural Alabama is needed for primary care, intermediate/interventional, and
emergency or hospitalization.
3.
Perinatal Services. Several components of the perinatal system are not
available in all areas of the state. These components are obstetrical and
neonatal outreach education, maternal-fetal and newborn transport systems, and
high-risk infant follow-up. Case management to include tracking and follow-up
for women and infants is not available in some areas. There is a need for
additional social workers at the local level to provide these
services.
4. Child Mental Health. A
significant deficit of child mental health professionals, social workers, and
residential resources continues for children under age eight (8). The lack of
residential resources in Alabama for those with pure mental and behavioral
health issues puts pressure on hospitals to retain them or send them several
states away for long term rehabilitation or care.
5. Adolescent Mental Health. The resource
deficit for adolescent trained professionals should be noted. As important is
the lack of adolescent designed residential or mental/behavioral health
rehabilitation, and in particular, for those with adolescents mental/behavioral
health diagnoses and physical health needs such as gastrointestinal
tubes.
(2) Recommendations
(a) Improve the accessibility
of services to maternity and pediatric patients through expansion and
improvement of services to women and children.
1. Outreach efforts should be strengthened
and targeted to maternity and pediatric patients.
2. Evaluation of case management services
should be designed and implemented and management data for the Alabama
Department of Public Health should be refined.
(b) Strengthen the Alabama Perinatal Program
to implement programs that address recommendations issued by the State
Perinatal Advisory Council (SPAC) in 2002. Provide statewide follow-up of all
infants identified as high-risk. Improve maternal-fetal and neonatal transport
systems.
(c) Maintain and
strengthen interagency and private sector efforts directed toward decreasing
the amount and effects of substance abuse in women of childbearing age and
their children. Efforts to increase intervention and treatments should be
encouraged. Child abuse and neglect has risen significantly with the opioid and
meth usage. DHR's foster care system is burdened with babies and children of
substance abuse mothers. The affected newborns will experience some health care
issues long term, though what those issues may be is unknown.
(d) Encourage access in schools for perinatal
testing, counseling, prenatal education, and care.
(e) The Statewide Health Coordinating Council
(SHCC) is committed to maintaining and strengthening efforts to expand and
improve quality pediatric health care throughout Alabama's health care delivery
system. This should be achieved through pediatric-trained personnel and systems
whose expertise is to care for children -- pediatric-trained physicians (family
physicians, pediatricians, pediatric sub-specialists, etc.), nurses (including
pediatric and family nurse practitioners), developmental specialists, mental
health specialists, and other team members located in health care delivery
sites and systems (physicians' offices, multi-specialty ambulatory clinics,
health maintenance organizations, children's hospitals, and other service
sites).
Author: Statewide Health Coordinating Council (SHCC)
Statutory Authority: Code of Ala. 1975, § 22-21-260(4).
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