#UMNMCH student Carrie Baranowski (MPH 2022) wrote this reflection on how passion for serving underserved populations has steered her career thus far and culminated in enrollment of the UMN MCH Program.
Introduction
By applying for a Policy, Systems, and Environment grant from the Advancing a Healthier Wisconsin Endowment, Carrie proposed to change the health care delivery system at four health departments (Cities of Greenfield, Oak Creek, South Milwaukee/St. Francis, and West Allis) located in Milwaukee County by adopting new policies and procedures that will integrate specific services into existing public health nurses’ daily workflow. The services are 1) continuous enrollment in Family Planning Only Services (FPOS) Medicaid insurance program, 2) sexually transmitted infection (STI) testing & treatment, 3) pregnancy testing, 4) contraceptive provision, 5) basic primary care functions such as blood pressure, height, weight, and body mass index, and 6) managed referral to large health systems for comprehensive care. This will address health care access, planned pregnancy, and STI prevention in Milwaukee county.
Carrie’s Role
In her role as Family Planning & Reproductive Health Specialist at Health Care Education & Training (HCET), a not-for-profit training and technical assistance organization, Carrie completed the grant application and actively manages the implementation process of this project. Motivation for the project came from Milwaukee county public health data. Milwaukee county residents need access to insurance and reproductive health services outside of the city proper. Of the 30,651 cases of gonorrhea, chlamydia, and syphilis reported in WI in 2016, 15,301 (40.7%) were reported in Milwaukee County (1,2,3,4). The 2016 teen birth rate in Milwaukee County is 27.4 births per 1,000 teens, almost twice the rate of WI at 15.2 (5). Infant mortality per 1,000 births is 7.6 for Milwaukee County, 6.2 for WI, and 5.2 for the U.S (6). One-third of women in the U.S. at risk of unintended pregnancy do not use contraceptives or use them inconsistently; accounting for 95% of unintended pregnancies (7).
Inequities in Reproductive Health
In 2016, African Americans accounted for 47.5% of chlamydia cases, 56.5% of gonorrhea cases, and 61.9% of syphilis cases in Milwaukee County (1,2,3,4). The rate for Latinx versus Whites for all reportable STIs was 567 per 100,000 compared to 300 for Whites. In Milwaukee County, females have higher cases of chlamydia compared to men (67.2% compared to 32.6%) (1,2,3,4). Low income women often have trouble accessing and affording quality reproductive health services. The costs of unplanned pregnancy and STIs extend beyond the individual, and impact workforce, education completion, health care, and community.
Family Planning Only Services (FPOS) is a Medicaid program for WI residents who earn less than 300% of the federal poverty level. FPOS provides insurance for men and women’s health care that covers the integrated services. Within Milwaukee County there are few options for uninsured residents to enroll in FPOS or receive these reproductive health services. Federally qualified health centers and free clinics are primary care focused and do not routinely offer STI testing/treatment or contraception. The majority that offer these services are located within the City of Milwaukee leaving transportation a significant barrier.
Outcome
By integrating new policies and procedures at four health departments, existing staff will receive training to perform the services covered by FPOS, permanently changing their daily work flow, and enabling them to offer these much-needed services on a permanent basis within their community. The system change will lower the number of residents without insurance and lower the STI, unintended pregnancy, and teen birth rates in Milwaukee County.
Sources
- https://www.dhs.wisconsin.gov/publications/p00415-2016.pdf .
- https://www.dhs.wisconsin.gov/publications/p00415-2016-milw.pdf
- https://www.dhs.wisconsin.gov/publications/p00415-2016.ppt
- https://www.dhs.wisconsin.gov/publications/p00415-2016-milw.pdf
- https://www.dhs.wisconsin.gov/wish/teen-birth/form.htm
- https://www.dhs.wisconsin.gov/wish/infant-mortality/form.htm
- https://www.guttmacher.org/fact-sheet/state-facts-about-unintended-pregnancy-wisconsin
Carrie is a first year MCH MPH student. Her background is in family planning and reproductive health. Carrie received a BA in English Language and LIterature from Grand Valley State University in Grand Rapids, Michigan and that is where her passion for women’s rights and representation began. In her spare time, she enjoys cycling, hiking, kayaking, birding, gardening…pretty much any outdoor activity. After graduating, Carrie hopes to establish a career at a local or state-level health department to more directly impact underserved populations.
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