Pregnancy Risk Assessment Monitoring System (PRAMS)

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Abstract: District of Columbia Department of Health PRAMS Application The District of Columbia is home to a diverse population, though health status is not equally distributed by race, ethnicity, or socioeconomic level, and sections of the city remain highly segregated (nearly 96% Black in the southeast quadrant of the city). This social and economic environment determines nearly half of our population health outcome and is reflected in maternal, infant and child health (MICH), where Black infants are almost twice as likely to be born prematurely and five times more likely to expire before their first birthday as compared to White infants. While key health outcomes such as infant mortality are captured through vital records, more comprehensive data surrounding maternal attitudes, knowledge, and behaviors are needed to understand root causes, appropriately target interventions, and institute policies to improve MICH outcomes. Current maternal behavior data are collected through specific programs (e.g. Healthy Start and Women, Infants and Children (WIC)), but only reflect small sample sizes and are not suitable for analyzing population health trends. Additional data needs identified in the DC Healthy People 2020 data development agenda and through the Title V Needs Assessment are breastfeeding persistence, unintended pregnancy, preconception health, maternal depression and intimate partner violence. PRAMS would be utilized to address these gaps in data, specifically for population-level health indicators where trend data drive policymaking and programmatic decision-making and evaluation. Surveillance systems, such as PRAMS, are the foundation of effective public health work. In order to achieve health equity, we need to understand population health status over time, convene key stakeholders to share findings, and shift the paradigm so that all sectors (e.g. transportation, environment, planning, public safety, etc.) and individuals recognize their role in and take action toward improving health for District mothers, infants and children. In achieving this, the District has implemented a Health in All Policies approach that will engage stakeholders in this way to help create collective accountability for the health of our population. Finally, PRAMS can serve as a health intervention in itself as it has the ability to connect those individuals who have experienced or are experiencing violence, depression, or other challenges to resources and support in our community.