The Birth Your Way group-based prevention program is a six-week, prenatal series that aims to prevent poor birth outcomes (low/high birth weight, premature birth, NICU stay, surgical birth) by utilizing evidence-based Psychoeducation, grounded in Acceptance and Commitment Therapy (ACT), to promote prenatal stress management and successful uptake of healthy prenatal behaviors learned via the Women Infant and Children (WIC) supplemental nutrition program, (e.g., diet, physical activity, and tobacco/alcohol cessation). An implementation science approach has been employed since 2012 to develop and implement Birth Your Way, in English only, within the WIC program.
WIC, a federal maternal child health program, is delivered nationally at the county/parish level to prevent poor health outcomes among low SES families by providing access to nutritional support and mandatory education in healthy prenatal behaviors. Birth Your Way uses evidence-based Psychoeducation to promote successful implementation of the healthy behaviors learned via WIC. Additionally, Birth Your Way promotes healthy fetal development through Psychoeducational trainings in prenatal stress management (see Figure 1), (A. Lightcap (ORI), 2012a). The Birth Your Way program is currently distributed (English language only) within WIC in the second most populous county in Oregon (Lane County), with campaigns underway to reach maximum impact, (e.g., maternal child health benefits/cost savings) on a national scale, (e.g., 80%+ WIC sites implementing Birth Your Way or appropriate adaptation by 2025). Over half of women receiving Lane County WIC prenatal services identify as primarily Spanish Speaking, making Lane County, Oregon an ideal development site for cultural adaptation of Birth Your Way (Lane County WIC Facts, 2017).
The Lane County Regional Area (LCRA) is an ideal development site for cultural adaptation of Birth Your Way as it contains a quickly growing Latinx immigrant population and the rural, socioeconomic and racial/ethnic discrimination barriers to health that recent Latinx immigrant families encounter in non-metro Oregon statewide. The LCRA is made up of all persons living within the county of Lane, Oregon (POP 350,000; 40% rural) and the city of Reedsport (POP 4090; 3% rural). Although nearly 60% of the regional area’s population lives within the metro area of Eugene/Springfield, the third largest metro area in Oregon, the regional area spans a largely rural and unincorporated geographic area extending from the Pacific Ocean to Oregon’s Cascade mountains (2016-2019 (CHIP), 2016). Rural Lane County families disproportionately lack access to perinatal health services, and this “rural disadvantage” is compounded by intersecting racial/ethnic and socioeconomic disparities ((CHNA), 2016; Adams & Ruffenach, 2016; Cooper, Hill, & Powe, 2002; Halim, Moy, & Yoshikawa, 2017; Johnelle Sparks, 2009; Kentoffio, Berkowitz, Atlas, Oo, & Percac-Lima, 2016)
Preliminary evidence from two randomized trials conducted between 2014 and 2018 suggests significant improvements in birth and infant health outcomes for English speaking women who receive the Birth Your Way prenatal intervention when compared to a usual care (WIC only) control condition (Lightcap, Lee, & Backen Jones, In Press). It is important to note that over 50% of expectant families receiving Lane County prenatal services are English language-learning immigrants from Mexico and Central America (Lane County WIC Facts, 2017). The Birth Your Way program is currently only available in English and has been developed within a white and Western cultural context. This is problematic, as the Latinx population is the fastest growing racial/ethnic group in Lane County, and “lack of language and cultural competency” within the local service infrastructure is identified as a threat to the health of Latinx immigrant, migrant, and/or undocumented families within the regional area (CHNA), 2016). For example, Latinx mothers in the regional area are more likely to receive inadequate or no prenatal care when compared to white mothers in Lane County, and recent Latinx immigrant families are at greatest risk (2016-2019 (CHIP), 2016; (CHNA), 2016; Adams & Ruffenach, 2016). Additionally, Latinx families residing within Oregon counties with large rural populations, such as Lane County, deliver low birth weight and pre-term infants at higher rates than the state and national averages (Cooper, Hill, & Powe, 2002; Oregon Vital Statistics, 2016; Urquia, O’Campo, & Heaman, 2012). A culturally responsive adaptation of the Birth Your Way prenatal prevention program for Oregon’s non-metro Latinx immigrant families may prove a vital factor in narrowing overall birth and infant health disparities in the state of Oregon.