Jacqueline H. Grant, MD, MPH, MPA

Jacqueline H. Grant, MD, MPH, MPA

2004-2005

Maternal-Fetal Medicine Fellow,  Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC

Dr. Jacqueline Grant manages and provides direction to 14 county health departments and district programs, including environmental health, communicable diseases, emergency preparedness, oral health, and women's and child health. In addition to serving as the chief executive officer of the health district's county boards of health, she works cooperatively with the State Public Health Director, community partners, and local officials regarding public health issues. Dr. Grant was instrumental in acquiring a March of Dimes grant to launch the first Public Health-administered CenteringPregnancy® program in Georgia as well as the first such program in the southern half of the state. While the first site continued to address the needs of primarily African-American women, the program soon expanded into a second site primarily aimed at Hispanic women. She frequently speaks on Centering throughout Georgia and in 2012 received the Tee Rae Dismukes Award. Dr. Grant was selected to serve on the Patient-Centered Outcomes Research Institute's (PCORI) Inaugural Advisory Panel on Addressing Disparities in 2013.

Previously, Dr. Grant served as the medical director of the department of Obstetrics and Gynecology at the University of Missouri in Columbia. While there, she received national recognition in "Best Doctors of America, 2003-2004." In 1992, Dr. Grant completed a residency in Obstetrics and Gynecology at Emory University Affiliated Hospitals in Atlanta, GA, where she served as chief administrative resident. She later enjoyed a thriving private practice and faculty positions at Emory University, Morehouse School of Medicine, and the University of Missouri-Columbia.

Dr. Grant received a Bachelor's of Science in Chemistry from East Carolina University in Greenville, NC and an M.P.H. degree from the University of Alabama in Birmingham, before earning a doctor of medicine degree from the Morehouse School of Medicine in 1988. As a CFHU Fellow, she earned an M.P.A. degree from Harvard University's John F. Kennedy School of Government in 2005.

 

Community Empowerment Using 2003 Massachusetts Birth and Infant Mortality Data

Objective:

To analyze the 2003 Massachusetts birth and infant mortality data and provide reports to selected communities with the highest infant mortality and teen pregnancy rates in an effort to empower the communities to address the problem.

Background:

For more than ten years the Massachusetts Department of Health has reviewed and analyzed birth and infant mortality data which is then summarized and disseminated to the communities with the highest rates. The recipients of the community birth packets are expected to increase public awareness about the problem and mobilize the community to take action.

The infant mortality rate (IMR) is a standard health indicator which reflects a population’s maternal and child health as well its socioeconomic determinants. It has two components: neonatal and post-neonatal mortality rates. The neonatal mortality rate includes only those deaths occurring within the first 28 days of life. Post-neonatal mortality rate includes infant deaths which occur between 29 days and one year.  Since fetal deaths rates are also indicative of maternal health, this year for the first time, Massachusetts also analyzed the feto-infant mortality rates to provide a more complete assessment of the perinatal periods of risk.

The teenage pregnancy rate is also an indicator of population health and the socioeconomic determinants of health. Teenage pregnancy is associated with a higher prevalence of low birth weight and premature births, increased rates of infant morbidity and mortality, developmental delays, low educational attainment for both the parent and offspring, and increased rates of poverty.

Methods:

Data from the Massachusetts 2003 Birth Book, linked files, and Masschip were collected and analyzed for the communities with the highest teen pregnancy and infant mortality rates to determine trends and patterns.  Additionally, fetal and infant death certificates were reviewed for selected communities to determine cause of death and existing patterns.  Summary reports contained in the community packets were distributed to their respective communities as well as the local press.

Results:

The 2003 Massachusetts infant mortality rate of 4.8 deaths per 1,000 live births was the second lowest IMR in Massachusetts history and the lowest in the United States. However; there were disparities by community and race/ethnicity. The communities with the highest infant mortality were: Lowell, Arlington, Barnstable, New Bedford, and Lynn. All noted communities had decreased IMRs over the past ten years. Race/Ethnicity disparities have remained stable over the past ten years, with black infant mortality rate (12.7) nearly 3 times that of white non-Hispanic infants. Notably, the black-white disparity gap exceeds the community-Massachusetts disparity gap. There has been no community in Massachusetts in the last ten years with an infant mortality rate equal to or exceeding the infant mortality rate of blacks.  Worcester had 11 infant deaths of which 2 were attributed to positional asphyxia secondary to bed sharing.  The 2003 teen birth rate for Massachusetts was the lowest in state history and the second lowest in the United States. Decreasing teen pregnancy trends were seen in all racial ethnic groups and all communities except for Pittsfield. From 1990, the black non-Hispanic teenage pregnancy rate had the largest decrease (55%); however the current teen birth rate of 40.3 is 3 times the white non-Hispanic rate (13.7). The 2003 Hispanic teen birth rate of 78.3 is nearly twice the rate for blacks.

Recommendations:

  •     Instead of analyzing the IMR data to assess disparities within communities, some with relatively small numbers which may represent an isolated event, the emphasis should be placed on racial/ethnic disparities which have shown sustained wider gaps.
  •     Worcester should launch an educational campaign addressing the dangers of bed sharing emphasized in the Back to Sleep Program.
  •     The causes of death should be reviewed and linked to prenatal records and birth certificates to correlate feto-infant mortality with causes such as quality of care, maternal health conditions, and preventable deaths such as Sudden Infant Death Syndrome (SIDS), to better target prevention strategies as recommended by PPOR.
  •     Community programs targeting teen pregnancy prevention should be culturally and linguistically appropriate for Hispanic teens to eliminate disparities.
  •     Continue to provide teen birth data to communities and empower them to provide more comprehensive teen pregnancy prevention services.

Faculty Preceptors:

Hafsatou Diop, MD, MPH, Massachusetts Department of Public Health
Wanda Barefield, MD, MPH, Massachusetts Department of Public Health
Nancy Wilbur, PhD, Massachusetts Department of Public Health