Dickinson-Iron County Critical Health Indicators

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Adequacy of Prenatal Care                                                                                           

What Is It?

Adequate prenatal care, which includes initiating care in the first trimester and receiving regular care until delivery, may be an indicator of access to care and results in fewer birth complications and healthier babies. The effect of early prenatal care is strongest for high-risk groups such as teens and low income women. The Kessner Index is a standard measure of prenatal care based on information obtained from birth certificates. It combines information on the month prenatal care began, the gestational age at birth, and the number of prenatal visits.

How is the Dickinson-Iron District Health Department doing?

MDPH statistics indicate that in 1998, 76.6 and 84.1 percent of live births in Iron and Dickinson Counties, respectively, were to mothers with an adequate level of prenatal care. The Kids Count 2000 Data Book indicates Dickinson had an average adequate prenatal care rate of 96.8 percent from 1986-88, compared to a slight drop in the average rate to 96.6 percent during the period 1996-98, During these same periods, Iron County also dropped slightly from 95.5 percent to 94.3 percent. Again total volume numbers were relatively small.

Click on the map below to show the County specific rates.

How is the State of Michigan doing?

The percent of mothers in Michigan with adequate levels of prenatal care has been gradually increasing over the past 10 years from 70.9 percent in 1989 to 74.8 percent in 1998.

In 1997, 83.7 percent of live births were to mothers with an adequate level of care, 12.1 percent were considered intermediate and 3.8 percent were considered inadequate. In 1996, there were 83.5 percent of adequate, 13.2 percent intermediate level and 3.1 percent were considered inadequate levels of care.

Kids Count in Michigan 2000 Data Book indicates that 11,810 Michigan mothers in 1996-98 or 8.8 percent received inadequate prenatal care. This was a 68 percent negative change over the 1986-88 period.

How does the Dickinson-Iron District Health Department compare with Michigan and the U.S.?

The percent of live births to mothers with an adequate level of prenatal care in Dickinson County and Iron County is better than both Michigan and the U.S. (Michigan and the U.S. have similar data). In 1995, the most recent year for which figures are available, 74.3 percent of mothers received adequate levels of prenatal care in the U.S.

How are different populations affected?

Women 30-39 years of age are most likely to receive adequate levels of prenatal care while women under the age of 20 are least likely to receive adequate levels of prenatal care. State-wide, African-American women are least likely to receive adequate levels of prenatal care (57.2%) compared to whites and other races (79.0% and 73.3%, respectively). African-American women are two to three times more likely to experience inadequate levels of care when compared to women of other races.

What is the Dickinson-Iron District Health Department doing to affect this indicator?

The Dickinson-Iron County area is fortunate to have several medical providers delivering babies at the local Dickinson County hospital. These medical providers accept Medicaid, as does the hospital. Unfortunately, the Iron County hospital closed its Obstetrics department this year. This means a one hour drive to Dickinson or longer to Marquette or Wisconsin services. Efforts continue locally and on a state level to ensure that all pregnant women are informed about the availability of Medicaid coverage for pregnancy, at much higher income levels than most people realize. The Maternal Support and Infant Support Services Program, IMPETUS 0-3 program, PIE 0-5 program and other educational services continuously advertise and promote the need for prenatal services and impact greatly on repeat pregnancies.

The WIC Program attempts to outreach to all pregnant women and is often a first point of entry into care. A woman who thinks she may be pregnant can receive a pregnancy test and be enrolled at the health department. She can be directed to a medical provider at the same time, if necessary.

In spite of these efforts, some women fail to see a medical care provider for pregnancy until late in the pregnancy, if at all. Although these situations are few, these are very high risk families who need close follow-up. One of the main reasons a woman would not see a doctor for her pregnancy is denial of the pregnancy. This most often happens with young women with inadequate support. Fear of disclosure can lead to very late care. It can also cause the women to take risks by using substances or continuing to have risky sexual behavior.

Besides WIC, the MSS Programs and improved access to Medicaid, other local efforts to ensure good prenatal care include: 1.) An extensive peer education program that encourages pregnant teens to seek appropriate medical care. 2.) An active Suspected Child Abuse and Neglect team that assists at-risk pregnant customers to seek early medical care. 3.) Nursing outreach relationships with medical community service providers. Extensive surveys and needs assessments have been done with several collaborative grant proposals written based on the findings of the assessments. These assessments have served to provide needed documentation of needs within the community and aid in further program development for families with infants and young children. The department also provides prenatal and perinatal testing services that aid in the diagnosis of life threatening maternally-transmitted infectious diseases. Appropriate treatment can be rendered through testing and accurate diagnosis.

The Health Departments Family Planning program offers low-cost, confidential pregnancy testing. Referrals can be made for prenatal care services immediately.