The Resource Mothers Program: How community health workers can reduce low birth weight among African-American clients in WIC programs

With a two-fold excess prevalence among African-American infants, low birth weight is arguably the most important contributor to the United States' persistently large difference in infant mortality between African Americans and whites. The purpose of this research was to understand whether and how the Resource Mothers Program, a component of the Women, Infants, and Children (WIC) clinic at Southside Medical Center, influenced birth outcomes among low-income African-American women. The Resource Mothers Program implemented the following strategies to reduce low birth weight among its' WIC clients: (1) improved access to and quality of prenatal care; (2) reduced prenatal smoking, drinking, and substance abuse; (3) prevented pregnancies among adolescent mothers and reduced pregnancies among women age 35 years and over; and (4) improved nutritional status. This research was conducted by investigating the differences between infants born to African-American women at two similar WIC clinics in Atlanta, Georgia, one with the Resource Mothers Program and the other without such a program. Both quantitative and qualitative research methods were utilized in this study.; Quantitative data for this study were obtained from the state of Georgia's WIC Program, for fiscal years 1999 and 2000. Included in the data were 361 clients from Southside Medical Center's WIC Program, and 152 clients from Grady Memorial Hospital's WIC Program. Results were also compared to data for all 49,558 WIC clients in the state of Georgia. Two types of data were used for the qualitative portion of the dissertation: (1) interviews with four resource mothers; and (2) interviews with 40 clients.; The qualitative data enhanced the study by providing information pertaining to the resource mothers, and their responsibilities in the clinic as well as their relationship with the clients, and by clarifying quantitative findings regarding the patients in both clinics. Overall, the analyses showed that in most categories the women at Southside (exposed to resource mothers) had lower rates of infants born with low (or very low) birth weight, than those at Grady (unexposed to resource mothers). After adjusting for age, marital status, family income, nutritional risk, alcohol use, cigarette use, and street drug use, the logistic regression analysis, found that mothers at Southside were one-third as likely as those at Grady to have a low birth weight baby (OR = .34; 95% CI = 0.16, 0.73). When excluding the education and alcohol variables from the model (because of substantial missing data for education, and because there were no alcohol users reported at Grady), clients of the Resource Mothers Program were still only half as likely to have a low birth weight baby (OR = 0.53, 95% CI = 0.30, 0.94). Of the potential mediating mechanisms, nutritional education and social support (informational, instrumental, emotional, and appraisal) were most important to the success of the Resource Mothers Program. According to the clients and resource mothers, the Resource Mothers Program was an asset to the WIC program. Both the clients and resource mothers benefited from the program.