Family Planning Effects On Childbearing Among Mississippi Women

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Family Planning Effects On Childbearing Among
Mississippi Women

• Siddeeqah Bilal-Thomas, MPH
• Marianne Zotti, DrPH, MS, RN

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Background
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Background

• Consider Family Planning Waiver
• Expand baseline data
• Repeat birth population
• Inter-pregnancy (IP) Intervals
• MSDH program populations

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What Are We Looking For?
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Objectives

• Are FP and MSDH program populations comparable?
• What are the state and program IP intervals?
• What is the effect of IP intervals on low birth
  weight?

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Sample

• Criteria for inclusion (N38,746)
• Mississippi resident
• Woman gives birth in 1996
• Criteria for MSDH inclusion
• Above criteria
• Programs with at least 80 of recipients at or
  below 150 of poverty level income
• Recipient of MSDH service within 240 days of 1996
  delivery

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Objective 1
EDUCATION

• Describe MSDH program participants
• N38,746

RACE
AGE
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Program Descriptions

• No MSDH service
• Family Planning
• MSDH service

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Non-MSDH Service Group

• White women
• 62 of sample
• 69 gt 25 years of age
• 64 education levels gt12 years
• Low LBW, preterm, and repeat birth rates
• 90 married
• 14 of IP intervals at 18-24 months

• Black women
• 38 of sample
• 44 gt 25 years of age
• 39 education levels gt12 years
• High LBW, preterm, and repeat birth rates
• 32 Married
• 10 IP intervals of 18-24 months

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MSDH vs. Family Planning
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Objective 2
What are the high risk IP intervals?

• Observe Inter-pregnancy Intervals
• N7,363

What are FP IP intervals?
What are the state IP intervals?
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Inter-Pregnancy Interval

• Sample (N7,363)
• Original cohort
• ?1 subsequent birth by December 31, 1998
• Singleton births and first births among plural
  births

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Inter-Pregnancy Interval Formula
-
?
Gestational Age
IP interval
?
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Inter-Pregnancy Intervals

• Adverse outcomes
• Low birth weight
• Preterm delivery
• Possibly small for gestational age (SGA)
• Optimum intervals 18-23 months
• Black women IP interval lt9 months
• White women IP interval lt3 months

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Inter-pregnancy Intervals
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High Risk Inter-pregnancy Intervals
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Repeat Birth Rate
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Service Inter-pregnancy Intervals
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Objective 2 Summary

• Majority of State IP intervals 6-12 months
• Higher of black women in risky IP intervals (lt9
  months)
• MSDH highest in low IP intervals
• FP highest optimum IP intervals

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Objective 3
age
race

• Determine relevant risk factors for
• Low birth weight
• N-7,312

service
IP interval
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IP Intervals of Women with LBW

• Significant IP intervals for White women were
  0-3 months
• OR2.5
• There were NO significant intervals for black
  women.

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Low Birth Weight Logistic Model

• Factor
• IP interval
• Race
• Smoker
• Education

• Odds Ratio
• 3.3
• 2.6
• 1.7
• 1.4

IP interval of ?3 months compared to gt3
months Education of ?9 years education compared
to gt9 years of education
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Objective 3 Summary

• LBW
• IP intervals ?3 months are at highest risk to
  deliver low birth weight babies
• Black women are at higher risk
• Women who smoked during pregnancy are at higher
  risk
• Lower education levels are at higher risk

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Public Health Implications

• Importance of IP interval taught to all
  populations
• Non-MSDH
• MSDH
• Cross training of staff
• Monitor IP intervals
• Importance to FP waiver

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