#UMNMCH student Delaine Anderson (she/her/hers), MPH 2022, wrote this reflection on how her deployment at the Minnesota Department of Health (MDH) has contributed to her career in MCH. In this piece, she describes her experience with MN PRAMS, an ongoing public health surveillance project.
I will complete my Master of Public Health (MPH) in Maternal and Child Health (MCH) in Spring 2022, with minors in Epidemiology and Health Services Research, Policy, and Administration. I pursued a degree in public health because I felt that the current needs of our underserved communities require the strengths of interdisciplinary teams. Public health uniquely prepares us to engage meaningfully with different sectors and professionals in working towards a common solution. My focus in maternal and child health came naturally – there is something powerful about engaging with the critical moment that everyone has experienced once: birth.
Strolling with PRAMS
Picture this: you’re working on a research report in high school about breastfeeding rates among low-income mothers in your state. A quick Google search leads you to a CDC data brief and you’re able to reference the data in your excellent report. You don’t worry about the quality because it comes from a trusted source – but have you ever wondered how the CDC got such granular data about parents in your state?
I never thought about it myself until I started working on the Minnesota Department of Health’s Pregnancy Risk Assessment Monitoring System (MN PRAMS) team. PRAMS is an ongoing, population-based surveillance system developed by CDC to reduce infant mortality, low birth weight, and preterm births. One of the goals of PRAMS is to determine why some babies are born healthy and others are not. CDC’s PRAMS program is currently implemented in forty-six states, the District of Columbia, New York City, Northern Mariana Islands, and Puerto Rico. These teams are responsible for randomly sampling individuals who recently gave birth to a liveborn infant during each surveillance year.
Greasing PRAMS’ wheels
Birthing parents are sampled from Minnesota’s birth certificate file between 2 and 6 months after giving birth and on a monthly basis, Minnesota PRAMS samples about 150 recent births. The sampled parent is then sent a survey to provide information about their prenatal, pregnancy, birth, and postpartum experiences. The survey is implemented in two phases: mail phase and phone phase. The survey is mailed three times to the birthing parent before we attempt to reach them by phone. In exchange for completing the survey—either by mail or phone interview—we provide a reward; the reward options for MN PRAMS participants are a $15 Visa gift card, a $9 voucher toward purchase of the birth certificate, or a Letters and Numbers Children’s music CD.
MN PRAMS contributes directly to MDH’s ability to “protect, maintain and improve the health of all Minnesotans”, as it monitors selected experiences and behaviors that occur before and during pregnancy and early infancy. By oversampling groups that experience health disparities and the highest levels of infant mortality in the state, MN PRAMS provides important, state-specific information needed to plan, develop, and modify programs and policies to eliminate health disparities and to measure progress toward goals in improving the health of all Minnesotans.
Paving my way with PRAMS
I participate in several portions of the PRAMS process; I help prepare the large batch mailings to go out to parents across the state and I perform data entry once we get these surveys mailed back to us. Correctly entering data for these parents is essential to creating reports that we provide back to the CDC for an annual national analysis of key indicators. These indicators range from prenatal vitamin usage and date of first prenatal visit to experiences during labor and experiences of discrimination by healthcare providers. We also ask questions about the baby’s health and experiences, which is especially important for parents to provide if their baby has passed away. We have a variety of protocols that team members follow to ensure confidentiality and correct data sharing, meaning that parents can trust that their information is properly de-identified and securely shared back to the CDC.
Being able to participate in a long-term surveillance project at our state public health agency has allowed me to learn about the different stages evidence goes through from data collection, data entry, analysis, dissemination, and policy formation. Understanding the procedures your state public health agency follows to ensure we provide good data for evidence is essential to the policy-making process. If we cannot provide evidence about something that is a problem in our birthing community, it is hard to allocate funding and efforts to an ‘invisible’ public health problem.
Looking at PRAMS from an interdisciplinary lens, there are many different professionals that are engaged with the surveillance project from start to finish and then all over again on a monthly basis. I myself will be entering medical school this fall to become a rural OB-GYN; being able to share with my future patients why we collect information about birthing parents and newborns is essential to building trust and providing adequate care in rural areas of the United States.
Delaine Anderson is a second-year MCH MPH student. Her background is in rural women’s health, health communications, and qualitative research. Delaine received her BS in Human Performance and Exercise Science with concentrations in Nutrition and Pre-Professional Development and a minor in Women Studies from the University of Alabama. Outside of her deployment, she is a graduate research assistant performing community based participatory research with the Center for Urban and Regional Affairs (CURA) and acts as a student primary investigator on an IRB approved study examining perceptions of diet and exercise based social media content on young women during the CoVID-19 pandemic. She recently won the American Public Health Association Council of Affiliate’s Outstanding Student of the Year award and previously won the Minnesota Public Health Association’s Student Achievement Award. In her spare time, Delaine enjoys graphic design, knitting, scrapbooking, and listening to podcasts about scary movies. After graduating, Delaine will start medical school to become a rural OB-GYN and fierce public health advocate.
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