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Addressing a worldwide challenge…

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Easy-reading maternal
health materials

‘Baby Basics’ — A Program
for Maternal Health Literacy

Louise Simon, RN, NC-BC
Lisa Bernstein, Executive Director
What To Expect Foundation

The World Health Organization states that “every day in 2010, about 800 women died due to the complications of pregnancy and childbirth. Out of these 800, 440 deaths occurred in sub-Saharan Africa and 230 in Southeast Asia. The risk of woman in a developing country dying — from a pregnancy-related cause — is about 25-times higher compared to a woman living in a developed country.”

Each year 650 American women still die in childbirth…

The Centers for Disease Control [CDC] statistics show a continuous rise in pregnancy related deaths in the United States from 7.2/100,000 in 1987 to a high of 17.8/100,000 in 2009. Each year, 650 American women still die in childbirth. The social determinants of perinatal health are sometimes subtle — stress from racism, poverty, or low literacy — cumulative — poor nutrition and obesity — and too often outside the scope or domain of the healthcare system, for example, from abuse by a domestic partner.

Education and literacy levels have been shown to positively impact prenatal health. Low-literacy correlates to increased mortality deaths, even as health literacy improves the decline of mortality rates. Although prenatal education programs have been available for over a hundred years, most are written at a high-school-educational level, requiring the ability to read and comprehend difficult, complex language, to have a basic understanding of health related topics and to navigate text to find answers.

Leading to healthier, happier pregnancies…

Ninety-million Americans still struggle with low-literacy. The Institute of Medicine defines health literacy as — “the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.” This life-course-perspective on health gives healthcare programs permission, if not a mandate, to put down the prescription pad and leave the exam room in search of better strategies for achieving the health of babies.

Pregnant women are especially receptive to tools, strategies, and support that will help them do the best for their baby. Yet, most low-income women do not receive comprehensive, coordinated care, or the health literacy education that would lead to healthier, happier pregnancies and would help moms to build skills to advocate for their own and their family’s health, education and well-being.

Women with low-literacy face added hurdles…

The ‘Baby Basics Program’ was informed by research that shows the effects of low-literacy on prenatal health and outcomes for low-income and at-risk women and their children. Dr. Ian Bennett, Assistant Professor of the Department of Family Medicine & Community Health at the University of Pennsylvania, studied why women did not access prenatal services and how this was linked to their literacy skills. He found that “women with low-literacy faced added hurdles to the navigation of the health care system for themselves and their children.” The stresses of poverty and a related increased risk of depression further complicated the challenges of getting the services they need.

‘Baby Basics’ is a prenatal health literacy program developed by the What to Expect Foundation [WTEF] to address health disparities and poor birth outcomes by helping health care providers and educators to fully engage and empower low-income pregnant women. Their mission is to provide “families in need with education and support so they, too can expect healthier pregnancies, safer deliveries and happier babies.”

Research into changing outcomes for at-risk families…

The ‘Baby Basics Program’ begins with a book — a comprehensive lower- literacy, evidence-based pregnancy guide — available in multiple languages, that addresses pregnancy information and concerns from a woman’s perspective. It does not create new systems. Instead the book, curriculum, additional tools and training all build staff capacity and skills — strengthening the efficacy and coordination of existing interventions, providing a framework for engaging pregnant women and fostering literacy and patient advocacy. From this book has grown a research-based program for changing the experience and outcomes of pregnancy for at-risk families.

As a comprehensive guide, ‘Baby Basics’ provides month-to-month prenatal information written at a 3rd to 5th grade-reading level. It addresses social, cultural, economic and language skills of families at or below the poverty level. Healthy prenatal outcomes depend on continuous prenatal care. An engaged and informed pregnant woman will adhere to prenatal visit schedules, recognize problems as they arise and receive timely intervention which results in healthy birth outcomes.

Expectant fathers report increased understanding…

‘Baby Basic” identifies teachable moments throughout the patient’s pregnancy. Every question asked by a pregnant woman provides an opportunity to encourage health literacy. Educating each woman on the use of the ‘Baby Basic’ book and planner — beginning with their first prenatal visit — engages her to be an active participant in her own prenatal care. Women using the ‘Baby Basic’ tools report increased satisfaction, have improved compliance with visit schedules and higher returns for post-partum visits. Moms have reported reading the ‘Baby Basic’ book with family members to prepare them for the impending delivery of a sibling. Expectant fathers report increased understanding of the month-to-month changes occurring in their spouse and feel better prepared for the birth of their baby.

Internationally, the connection between women’s health, education and economic success have been understood and extensively studied. A report on the ‘State of the World’s Mothers’ by Save the Children identified that the adult female literacy rate is one of the key indicators to assess ‘women’s well-being.’ This same report found that developing countries that have achieved a female literacy rate ranging from 70 to 83% have also achieved a low infant mortality rate of 50 per 100,000 or lower. A mother’s level of education also correlates closely with her child’s risk of dying before the age of two. Yet, still today, about two-third of the world’s 960 million illiterate adults are women.

“Investing in women’s literacy carries high returns…”

Irina Bokova, Director-General of UNESCO says it clearly — “when a woman is literate, she can make choices to dramatically change her life for the better…. investing in women’s literacy carries very high returns. It improves livelihoods, leads to better child and maternal health and favors girls’ access to education. In short, newly-literate women have a positive ripple effect on all development indicators.”

In 2013, then Secretary-of-State Hillary Clinton announced the Women’s Health Innovation Program — supported by the Bill & Melinda Gates Foundation — through a grant to the Secretary’s International Fund for Women and Girls. Through this grant, the Office of Global Women’s Issues partnered with the What to Expect Foundation to take ‘Baby Basics’ to developing nations. Called WTEF’s Women’s Health Innovation Program, it will be piloted in Bangladesh and Liberia in 2014.

“Listen closely to the story of pregnancy…”

To ensure the creation of an authentic book and program for each new country, WTEF will use and adapt a process best described as a willingness to “listen closely to the story of pregnancy” from a variety of perspectives, and will then create a book that engages & empowers expecting women — a book they want to learn from, no matter their literacy level. In addition to the creation of a book in each country’s respective language, the program will also include the creation of a group pregnancy ‘life-skills’ curriculum and group-facilitation ‘training for trainer’ programs designed to be specific to each country.

Just as ‘Baby Basics’ uses prenatal education — as a moment to help systems and programs improve quality and coordinate care — this is also a transformable time for expecting women by providing an opportunity for change. As we continue to move toward fulfilling the UN Millennium Goals (MDGs) — the ‘Baby Basics’ project provides a model framework for promoting health literacy and improved maternal outcomes.

“I would give ‘Baby Basics’ a 10!”

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Wikimedia image of graffiti in Lebanon depicting a pregnant woman. Photographer: Petteri Sulonen, used with the Creative Commons Attribution 2.0 Generic license.


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‘Baby Basics’ Poster available to everyone from the What to Expect Foundation.


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Infant & mother featured on the Mission webpage of the What to Expect Foundation.


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A pregnant learner is featured
on the Media Relations webpage of the What to Expect Foundation.


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Photo Source: UNESCO’s Irina Bokova featured in the Wikimedia Commons. Author: Rama. Used with terms of CeCILL and Creative Commons Attribution - Share Alike 2.0 France License.


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A mother and her family from Dhaka, Bangladesh, on their way home from a well-baby visit. From the International section of WTEF’s website — describing how WTEF is “currently working to identify potential partners….who can help to build hands-on, culturally appropriate ‘Baby Basics’ programs… and to make them accessible to women in need.

To watch inspired, informative videos about the benefits of ‘Baby Basics’ — click HERE >>

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Visitors at the Mapparium in the Mary Baker Eddy Library in Boston, Massachusetts. This was the site to launch Dr. Jean Watson's Million Nurse Project—during the 2010 International Year of the Nurse—to radiate heart-centered Love, Caring and Compassion through individual and collective global meditations. Photo Courtesy of the Mary Baker Eddy Library.