Georgia has among the poorest and most disparate maternal health with a large preventable fraction. Georgia has one of the highest Black maternal mortality rates in the nation, and there are disparities in the numbers of Black women entering pregnancy who are obese. Based on these disparities in Georgia, Morehouse School of Medicine (MSM) with the support of the Georgia Department of Public Health-Maternal and Child Health (GDPH-MCH) are expanding their existing partnership to address these health topics: maternal mortality and morbidity and nutrition and implement and evaluate Project D.I.N.E. Support, and evidence are needed to assist Georgia in expanding and strengthening statewide partnerships to decrease maternal mortality and morbidity by improving maternal nutritional outcomes, increasing rates of breastfeeding initiation, and increasing father involvement in these efforts.
The existing intervention that will be modified is the Health Resources & Service Administration (HRSA) -funded Healthy Start (HS) program. The population of focus for Project D.I.N.E. is Black Healthy Start pregnant mothers specifically in Brooks, Echols, Bleckley, Dodge, Johnson, Laurens, Montgomery, Pulaski, Telfair, Treutlen, Wilcox, and Wheeler, Lowndes, Clayton, Fulton, Muscogee, Cobb, and Douglas counties. These urban and rural counties received HS funding because they have infant mortality rates that are at least 1.5 times higher than the nation and significant disparities in maternal health. The proposed modification includes partnering with statewide academic and health partners to provide evidence-informed nutrition and breastfeeding education to reduce maternal risks for mortality and morbidity. Additionally, the modification includes engaging HS fathers in nutrition and breastfeeding education to influence and support healthy behaviors. Specifically, the two primary Project D.I.N.E. goals are to prevent maternal mortality and morbidity and to promote nutrition and breastfeeding education. The SMART quantified objectives are to: 1) increase HS capacity to involve fathers during and after pregnancy by September 2021, 2) implement EFNEP in three HS sites to reach 240 participants by September 2021, 3) implement breastfeeding education in three HS sites to reach 240 participants by September 2021, and 4) increase HS capacity to provide nutrition and breastfeeding education to HS participants by September 2021.
This project will help 1) build capacity, 2) demonstrate if modifications to existing evidence-informed interventions (Healthy Start) for maternal mortality and morbidity and nutrition will significantly improve health outcomes for pregnant Black Healthy Start participants, and 3) develop a plan to sustain the modified, successful program after the award period. The evaluation plan includes a process evaluation and outcome evaluation with an experimental design in which control and intervention HS sites will be employed to detect a statistically significant difference. Three of the six designated HS program sites (Cobb/Douglas, South Central Health District, West Central Health District) will implement the intensive nutritional and breastfeeding education intervention and the remaining three program sites (Center for Black Women’s Wellness, Clayton Health District, South Health District) will implement the standard HS program. At each site, 60 mothers at maternal stage, 20 mothers who indicated father involvement (and the respective 20 fathers) and another 40 mothers who indicated no father involvement, will be randomly selected for an overall total of 480 participants.
