Black Infant Health Program – Public Health Department

In 1989, with the passage of Senate Bill (SB) 165, Budget Act of 1989 (Alquist, Chapter 93, Statutes of 1988), California began to more aggressively address the challenge of improving the health of African American women, infants, and children by promoting health and health care during the prenatal and postpartum periods and providing services in a supportive and culturally-competent manner. Originally a pilot project in four sites, the BIH Program has expanded its reach to 17 local health jurisdictions (LHJ) where over 90 percent of all African-American births occur in California (BSMF, 2008).The primary focus of the original BIH Program, established in 1989, was getting participants into prenatal care.

In 1993, CDPH/MCAH contracted with the University of Southern California (USC) to conduct an assessment of the BIH Program. The assessment revealed that the participants served had multiple, complex needs beyond the scope of the services being provided by the program. Implementation of a standardized statewide “best practice” model was recommended based on findings from the assessment. It was recommended that the standardized services should encourage advocacy and empowerment skills and include outreach, case management, social support and empowerment, prevention, health behavior modification and male parenting. Based on the findings in the USC assessment, six BIH models were developed to address the various needs of the participants and the fathers of the babies in 1995. These models were:

• Prenatal Care Outreach and Care Coordination
• Comprehensive Case Management
• Social Support and Empowerment
• The Role of Men
• Health Behavior Modification
• Prevention

In 2006, CDPH/MCAH commissioned UCSF/ Center on Social Disparities in Health (CSDH) to conduct an assessment of the BIH Program. The Black Infant Health Program: Comprehensive Assessment Report and Recommendations found that there is no definitive scientific evidence about how to decrease racial disparities in birth outcomes, but solely getting prenatal care will not close the gap. Interventions that have shown great promise are group-based prenatal care emphasizing social support and empowerment yielding promising results in one recent study. There is mixed evidence regarding the effect of social support on birth outcomes, but positive effects have been demonstrated on a variety of maternal health outcomes across the life course, and social support has been shown to buffer against stress. Effects of empowerment on birth outcomes have not been tested but empowerment has improved a wide array of health behaviors and health-related outcomes in the health promotion literature.

Based on these findings, the assessment recommended a single core model for the BIH program that addresses health promotion, social support, empowerment, and health education throughout a woman’s pregnancy and early parenting that builds upon promising models. The assessment concluded that standardizing interventions across sites would help the program’s long-term sustainability by generating information about program impact that is both scientifically sound and compelling to policy-makers, and that bringing program content in line with current scientific knowledge—e.g., regarding the importance of social support and empowerment in health behavior change and of social and economic factors in health outcomes—would make the BIH Program more effective in meeting its participants’ needs and achieving program objectives.

Building on successful components of existing BIH Program models and incorporating other promising practices, the resulting model supplements recommended medical care outside of BIH with participants-centered social services–integrating prenatal, postpartum, parenting and infant health education and promotion with social support and empowerment into one standardized model that will be implemented at all sites.

To better meet the health-related needs of pregnant and postpartum African American women who are the target population for BIH, CDPH/MCAH is implementing a standardized BIH Program that features both: (1) a group intervention designed to encourage empowerment and social support in the context of a life course perspective; and (2) enhanced social service case management to link participants with needed community and health-related services. The goal of the program is to provide services in a culturally-relevant manner that respects participants’ beliefs and cultural values while promoting overall health and wellness, and recognizing that women’s health and health related behaviors are shaped by non-medical factors (e.g., the effects of stress related to limited social and economic resources as well as racism and discrimination).

The BIH Program has been developed to address these social determinants of health in ways that are relevant, culturally affirming and empowering to participants.