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CHILDREN’S CABINET FINAL RECOMMENDED STRATEGIES FOR ALABAMA INTRODUCTION

In December 2017, Governor Kay Ivey convened the Children’s Cabinet to address the issue of infant mortality in Alabama. A subcommittee was created to develop an action plan. This subcommittee was comprised of leaders and staff from the following agencies: • Alabama Department of Early Childhood Education • Alabama Department of Human Resources • Alabama Department of Mental Health • Alabama Department of Public Health • Alabama Medicaid Agency • Alabama Office of Minority Affairs The Children’s Cabinet has adopted the recommendations of the working subcommittee to implement a pilot program to reduce infant mortality rates by at least 20% in three counties (Macon, Montgomery and Russell), within the next five years.

EXECUTIVE SUMMARY Infant mortality rates (IMR) are an important measure of a health within a state, and Alabama has long had very high IMR in comparison to the U.S. overall. There are many underlying factors that contribute to infant mortality including medical complications, behavioral, and environmental. The Children’s Cabinet subcommittee recommends a pilot program in three counties (Macon, Montgomery and Russell) that will focus on nurse visitation programs, safe sleep initiatives, utilization of a screening tool to identify substance use, depression and domestic violence, and the use of 17-alpha-hydroxyprogesterone (17-P) in women with previous preterm births. Additional ideas include making long-acting reversible contraceptives (LARC) available immediately after delivery, and further strengthening of Alabama’s perinatal regionalization guidelines. These programs have been demonstrated to reduce the IMR in other states, including South Carolina, whose own IMR reduction program offers Alabama a model for successful interventions. This pilot will measure numbers of preterm and low birth weight deliveries, pregnancies with adequate spacing, and neonatal intensive care unit (NICU) admissions. Successful outcomes in this pilot program could be used to justify additional funding requests to broaden the program to other Alabama counties or even statewide.

PRENATAL INTERVENTIONS 1. Preconception and Inter-conception Care. Provide pre- and inter-conception care at family planning clinics by expanding the ADPH Well-Woman Preventive Visit being