Couple with newborn baby

RAND Solution

Improving Low Birth Weight Policy in Georgia

Challenge

Low birth weight (LBW) is a serious public health challenge. LBW infants are more likely to die before their first birthday and more likely to suffer from cognitive development issues and chronic health conditions, such as high blood pressure and asthma. The problems associated with LBW also continue into adulthood: Compared to their peers, LBW individuals attain less education and earn less income.

Context

Ultrasound during second trimester

Low birth weight (LBW) is defined as birth weight below five and a half pounds and is associated with worse outcomes throughout life. Accordingly, experts often cite the percentage of births with LBW as an indicator of population health. Similarly, alleviating LBW is a common public health policy goal.

Policymakers and health care providers have emphasized prenatal care and maternal smoking cessation as the primary strategies to reduce LBW. However, the percentage of LBW births in the United States grew steadily from 1990 to 2005. As of 2011, this figure was about eight percent.

Low birth weight is associated with worse outcomes throughout life.

Project Description

In 2008, Georgia policymakers confronted an unfortunate and perplexing trend: Despite decades of increasing prenatal care, low birth weight (LBW) had grown to its highest level in nearly 30 years.

One possibility was that this was due to the growing use of fertility treatments, which increase rates of multiple births, or to the rising average age of mothers. However, policymakers in Georgia did not want to attempt to develop solutions based on theories alone—they wanted evidence they could rely on.

Collaborating with Georgia Family Connection Partnership, which works to improve outcomes for children in the state, the RAND-operated Promising Practices Network (PPN) began to address this issue. PPN is an online clearinghouse of high-quality, evidence-based information on effective ways to improve the lives of children, families, and communities. Experts conducted a critical review of the latest scientific evidence on LBW and provided recommendations to help Georgia improve its outcomes in this area.

Research Questions

  1. What causes low birth weight (LBW)?
  2. Which prevention strategies are effective for reducing rates of LBW?
Pregnant woman with doctor

Key Findings & Recommendations

  • Evidence ruled out fertility treatment and the rising average age of mothers as the leading causes of Georgia's low birth weight (LBW) problems. Instead, a diverse mixture of risk factors are associated with LBW, including low family income and maternal hypertension, diabetes, or stress.
  • The wide range of contributing factors to LBW suggests the need for an equally broad range of interventions. RAND's Promising Practices Network identified the following evidence-based approaches:
    • Providing fertility planning to help women space births at least 18 months apart and reduce unwanted pregnancies
    • Improving pregnant women's health behaviors (e.g., ceasing tobacco and drug use, fostering appropriate weight gain)
    • Issuing health screenings to identify infections or physical abnormalities in pregnant women
    • Encouraging healthy preconception behaviors in women (e.g., taking folic acid supplements, timely identification of pregnancies)
    • Improving women's general health throughout life.

“[RAND] maintains an excellent database of proven and promising interventions dealing with problems affecting children and families, including programs meant to curb depression and other mental illnesses and those meant to combat violence.”

The Washington Post, WONKBLOG, following the Sandy Hook Elementary shooting

Impact

In 2008, RAND's Promising Practices Network (PPN) and Georgia Family Connection Partnership co-hosted a policy forum on preventing low birth weight (LBW) in Georgia, connecting key stakeholders in the state with leading researchers from across the country.

PPN also developed crucial resources to help inform the policy discussion. These included an informative issue brief on LBW, as well as a comprehensive list of resources, featuring programs that work, expert perspectives, databases and tools, fact sheets, and more.

Subsequently, Georgia's governor created a state task force to develop evidence-based recommendations for addressing LBW. Shortly thereafter, the Georgia Department of Public Health and other agencies implemented these across the state.

“RAND's Promising Practices Network (PPN) provides our local network of community partnerships with access to proven, up-to-date strategies to support their work with children and families across our state. PPN has become an invaluable, go-to resource to help these partnerships develop community plans and strategies.”

William T. Dent, Board Director, The Family and Community Trust, Missouri