MUSKOKA - Life’s twists and turns can be difficult for anyone to overcome, regardless of their financial or educational situations.
Money spent on prenatal care is one way to reduce future health-care costs, yet funding levels for programs like Great Beginnings have not changed for 15 years.
A system with its fair share of gaps and few guiding benchmarks along the way doesn’t make things any easier for teenage mothers and their newborns.
“For a lot of us that have been through it, there’s a lot of little gaps in the system that makes things difficult,” said Lindsay Proctor, a Nipissing University Muskoka campus student and former teenage mom who is well versed in the good and the bad of the prenatal and maternal health-care system. “There are a lot of wonderful programs that help. I often had great support, but there are a lot of gaps and a lack of connection between the services.”
A three-part Metroland investigation shows the provincial and federal government has virtually no hard targets that would allow it to gauge success or failure when it comes to monitoring maternal health, while an analysis of 535,000 provincial birth records has identified poor birth outcomes in Ontario neighbourhoods and communities where incomes and educational achievements are low and poverty is high.
While the bulk of the Muskoka region is in line with provincial averages in terms of health rates for infants and young teens giving birth, there are plenty of gaps young mothers and their children can fall through. Solutions will take time, money and a desire for change.
“It is really going to take a generation to see improved outcomes,” said Dr. Tina Kappos, chair of the region’s obstetrics committee, a doctor at South Muskoka Memorial Hospital in Bracebridge and adviser for a prenatal care program the hospital operates weekly.
She said funding and continuing hospital programming will be one way to address health outcomes, but the real solution lies in better education, particularly before a woman becomes pregnant.
“It’s really a reflection of what society needs to do; it really is in the educational areas,” she said. “I do think we are going to see a lot of changes in the next five years, but I don’t know they’ll all be good.”
Some issues that must be addressed have been highlighted through this series, which revealed that from 2006 to 2010:
• There were 19 communities in Ontario where more than 20 per cent of babies born were to teen mothers. At one remote northern native reserve, the rate of teen moms was a shocking 40 per cent, while the average rate of teen mothers in the province was 3.7 per cent.
• There was a northeast Ontario community where close to 23 per cent of babies weighed less than 2,500 grams or 5.5 pounds — the cut-off for low birth weight. There were also 10 communities where the rate of low-birth-weight babies was at least 10 per cent, while the Ontario average was 6.5 per cent.
• Poor birth outcomes were particularly pronounced in the province’s Far North and native reserves, where there are high levels of unemployment, household income is far below the Ontario average and many adults don’t have high school diplomas.
So what, exactly, does this laundry list of statistics tell us? Is maternal health improving in Ontario? Worsening? Are we doing better than expected?
It’s difficult to answer these questions, since few hard targets exist at the federal, provincial or municipal levels. Take low birth weight, for instance.
In 1997, Ontario’s health ministry set a concrete, unequivocal goal to reduce the province’s low birth weight rate — 5.7 per cent at the time — to 4 per cent by 2010.
But over that period, the rate actually became substantially worse despite the fact that Ontario’s annual health budget more than doubled to $44 billion from $17 billion. There were also apparently no consequences for failing to meet the mark.
“What I haven’t seen — and I expect doesn’t exist — is that any structure was put in place to achieve that objective,” said Neil Johnston, who assisted Metroland’s BORN project and is a faculty member in McMaster University’s department of medicine.
Ontario Health Minister Deb Matthews suggests the issue is more a question of semantics.
“Whether you set an aspirational target or look for movement in the right direction, I wouldn’t call that a profound difference of opinion,” she said. “I think it’s good to set targets. I also think it’s important to report on progress toward those targets, or lack of progress.”
But improving Ontario’s rate of low birth weight babies is more than just a quest for better statistics. There’s also a lot of money at stake.
Dr. Kappos explained in the years the annual health-care budget increased, gaps were created locally as processes changed.
Kappos used to help lead a drop-in sexual health clinic near the former Bracebridge and Muskoka Lakes Secondary School site. It was ideal for educating students in a non-judgmental setting, even providing free or less expensive forms of birth control.
After the health region amalgamated into the local health integration networks (LHINs) that clinic was closed and one tool to hamper early pregnancy was lost.
Dr. Kappos said public health nurses are now available in the high schools, but cannot replace the ease the drop-in clinic provided.
She also explained there is a lack of general practitioners entering the health fields, forcing mothers away from their home communities for prenatal and maternal care in the hospital. As general practitioners and obstetrics experts are lost, so is excellence of service and support. When there is a general decline in the number of people having babies, services become expendable.
“For example, there are about 29 hospitals in the local region, and 10 are having less than 50 births a year,” Dr. Kappos said. “So the discussion becomes, do we cancel the (obstetrics) services in those hospitals?”
“That’s a dangerous outcome, but that’s unfortunately what is likely to happen,” she added, saying the distance factor for maternal and prenatal care can then become an influence on the health of a baby.
And low birth weight babies are a considerable expense for the health-care system — sometimes for life, since they’re more prone to lifelong health problems than infants born at a healthy weight.
According to an Ontario Ministry of Health Promotion document published last year, the average hospital cost for a newborn of healthy birth weight in 2005-06 was about $1,000.
The same document estimated that in 2009, hospital costs would be about $88,000 for each low birth weight baby in the first year of life. Meanwhile, an Alberta study showed premature babies required five times more in direct health costs than full-term babies over the first seven years of life.
“They say for every dollar you spend on a prenatal program like Great Beginnings you’re saving more than $8 down the road,” said Debbie Fitzmaurice, manager of the Parry Sound-Muskoka Early Years system. “But for 15 years we’ve been operating Great Beginnings, we’ve had the same amount of funding, not even a cost of living increase.”
Based on those dated funding levels, Great Beginnings and HANDS have a cap of 10 participants for each of the nine area programs they operate. Providing crucial prenatal education and care, as well as access to food and peer support, the program, Fitzmaurice said, has been renewed for another two years, but at original funding levels.
Stephanie Myshrall, now in her early 30s but a former teenaged mom, said the Great Beginnings program was a fantastic support. Myshrall also is attending Nipissing University, juggling two children and a tough schedule. Like Proctor, she experienced huge gaps in the local health and social services systems. Finding local licensed child care, for example, is extremely difficult.
“It’s a huge issue here,” Proctor said. “And if you can’t find child care, that completely cuts your ability to access further education and continue to better yourself.”
“The lack of child care spaces here can affect what jobs you can take, what hours you can work,” Myshrall added. “It can be a nearly impossible juggling act.”
It’s unfair, however, to suggest nothing is being done to improve birth outcomes and maternal health.
At the federal level, Health Canada, which funds First Nations health care, provides at least $200 million each year to a variety of programs dedicated to improving the health of native mothers and children, including nutrition programs and programs aimed at preventing fetal alcohol syndrome.
In Ontario, the province established a poverty reduction strategy that aims to reduce the number of children living in poverty by 25 per cent by 2013. The province has also set a goal of reducing child obesity by 20 per cent by the same deadline.
“We’re all better off when all our children are better off,” said Matthews.
“Health is closely linked to their ability to eat nutritious food or to have stability in their housing,” she added. “Taking financial pressure off families is good for the health of kids and they’ll do better in school. Everything is connected and I think we have to look at it in an interconnected way.”
McMaster’s Johnston understands improving the health of Ontario’s mothers and babies will require the cooperation of various levels of government and local agencies on a variety of fronts.
But his assessment of the current situation is more pointed.
“I don’t think there’s a quick fix in this,” he said. “You have to harmonize all the bits and pieces. What we have right now is a wonderful jam session going on with all kinds of really deeply motivated, committed people, highly skilled in their professions.
“What we need is a symphony orchestra. We need everybody playing together and playing from the same score, and that requires structural changes.”