By Michelle Crouch
Suzanna Fox has seen firsthand why prenatal care is so important. An Atrium Health obstetrician-gynecologist who has delivered many babies over her 30-year career, she said some of her hardest cases were patients who hadn’t seen a doctor during their pregnancies.
“When we don’t get in front of patients early enough, that’s when a baby may be born with a problem,” said Fox, deputy chief physician executive and women’s health care service line leader for Atrium Health. “If we identify there is a risk, there are interventions we can do early in pregnancy. Many patients, when they get to us, it’s too late.”
Atrium is hoping to reach those patients earlier with a new mobile medical unit that will roll into some of Charlotte’s most diverse neighborhoods beginning this week. The giant turquoise “Drive to Thrive” bus will offer pregnancy tests, early prenatal care, access to same-day contraception and other reproductive health services.
Believed to be the first mobile clinic of its kind in North Carolina, it’s one of a growing number of initiatives across the state targeting a heart-wrenching problem: Too many babies are dying, especially African American babies.
A dismal infant mortality rate
Nearly seven out of every 1,000 infants born in North Carolina died in 2020, the most recent year for which data is available. That puts the state in the bottom tier in the U.S., No. 43 out of 50, when it comes to infant mortality – in a country that already has the worst infant mortality in the developed world.
Perhaps even more alarming is the Black/white disparity. African American babies in North Carolina are two and a half times more likely to die in their first year of life than white babies.
Even in Mecklenburg County, which has two robust hospital systems, 415 infants have died over the past five years in their first year of life, and the racial disparities are stark, according to Mecklenburg County Health Department data.
About 10 African American babies die in Mecklenburg per every 1,000 births, compared with 3.2 white babies, the data shows.
Why are more Black babies dying?
Infant mortality is a complex problem closely tied to economic and social inequities, said Belinda Pettiford, head of the Women, Infant and Community Wellness Section of the state’s Department of Health and Human Services.
She pointed to the state’s 2022–2026 Perinatal Health Strategic Plan, which takes a comprehensive look at some of the challenges and lays out strategies to eliminate disparities.
Patients can call 704-468-0137 to make an appointment to see a provider on the bus, but appointments aren’t required. You can see the unit’s initial schedule of locations here.
Health insurance coverage, access to transportation, lack of paid time off from work and other factors can all affect a woman’s ability to access care, Pettiford said. Structural racism and discrimination in the health care system also play a role.
Pettiford and Sarah Verbiest, executive director of the Collaborative for Maternal and Infant Health at the UNC School of Medicine, said they didn’t know of other mobile units in the state focused on reproductive health.
“I love the idea of getting resources and supports directly to people in the community,” Verbiest said.
In Charlotte, Mecklenburg County Health Director Raynard Washington said his staff is already working on a strategic plan to address infant mortality at the local level.
He wasn’t familiar with the details of Atrium’s mobile unit, but he said, “If it’s making access to prenatal care or even family planning services more widely available, then those impacts are significant … it’s the kind of effort we need to make available broadly.”
Seven years without an ‘oops’
OB/GYN Todd Kopczynski, who retired last year from Novant Health, and his wife, Barbara, provided the startup funding for the Drive to Thrive initiative with a $500,000 gift to the Atrium Health Foundation.
Kopcynski is also volunteering his time to see patients in the bus three days a week.
Kopczynski said their original idea was a mobile unit focused exclusively on contraception. In his practice, he said, he saw too many women devastated by unplanned pregnancies and too few who knew about long-acting reversible contraception methods like IUDs, or intrauterine devices.
“When we put in an IUD, they get up to seven years without having an ‘oops,’ and they can take it out anytime they want,” he said. “We want people to have babies when they want to have them.”
A serendipitous reunion
A family member arranged a meeting for the Kopczynskis with Atrium’s women’s care practice leaders in late 2021.
When he walked into that meeting, Kopczynski was surprised to see Suzanna Fox, whom he had worked with at Atrium three decades earlier when they were both resident physicians.
“I learned that she had a similar vision and had been for years trying to raise money to get a mobile medical unit,” he said. “It seemed like it was meant to be.”
Kopczynski said it was easy to combine his vision with Fox’s passion for early prenatal care, since both initiatives focus on boosting the health of moms and babies. Women with unintended pregnancies are more likely to delay prenatal care, increasing health risks for them and their babies.
Ultrasounds and IUDs
The 38-foot Drive to Thrive vehicle includes a reception area, a restroom, two exam rooms with gynecological beds and a mobile ultrasound unit. A tent will provide privacy and shelter from the weather for patients waiting outside, and a TV on the side of the bus will loop a video about contraceptive options, Kopczynski said.
Atrium worked with local religious and community partners to choose about six regular locations where the bus will be stationed, Fox said.
Each patient will be allotted about 30 minutes, Kopczynski said. That gives a provider enough time to answer a patient’s questions about pregnancy and/or contraception and to insert an IUD at the same appointment if that’s an option a patient chooses.
A bilingual social worker will sign eligible patients up for Medicaid on the spot, but those who aren’t eligible won’t be turned away, Fox said. The worker will also refer patients to local social services agencies.
Patients will have follow-up appointments made for them to be seen at a brick-and-mortar clinic near their home.
The idea is not to see the same patients over and over again in the mobile unit, Fox said, but “to ensure that all patients get connected to care. The thing that is closest to my heart right now is getting to patients who can’t get to us.”
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