BY KATHLEEN NELSON
May 1, 2020
The OB Care Center at SSM Health DePaul Hospital in St. Louis and a local food bank are "prescribing" food as medicine to provide a healthier start for moms-to-be and their families.
Since September 2018, the OB Care Center has partnered with Operation Food Search in a program called Fresh Rx Nourishing Healthy Starts. It provides an extra helping of locally produced, fresh, nutritious food and education on healthy eating habits to at-risk pregnant women. Operation Food Search is a nonprofit hunger relief organization that provides food to food pantries and school backpack feeding programs that together benefit more than 200,000 people each month in the St. Louis area.
Fresh Rx Nourishing Healthy Starts takes aim at food insecurity, a situation in which consistent access to adequate, nutritional food is limited by a lack of money and other resources. The National Institutes of Health reports that food insecurity can lead to gestational diabetes, vitamin deficiencies and elevated levels of stress and depression in mother-to-be and to preterm births, low birth weight, birth defects, developmental delays and infant mortality.
Building blocks
The federal government provides a first layer of support through its Supplemental Nutritional Assistance Program and a second through the Women Infants and Children benefit, available to pregnant women and mothers with children up to age five.
Estimates of food insecurity in the U.S. vary significantly, but indications are that food insecurity is spiking along with the extraordinary job losses in the economic shutdown necessitated by the COVID-19 pandemic.
An analysis published by Iowa State University reported that more than 42 million Americans lived in food insecure households in 2016 and that the majority of households receiving SNAP benefits were food insecure. "Household Food Insecurity in the U.S. in 2018," a U.S. Department of Agriculture Economic Research study, put the number of food insecure at 37 million. Feeding America, a nonprofit that provides food through a national network of food pantries, projects that the number of people who are food insecure could increase by from 10 million to 17 million, in the near term depending on the depth of the economic disruption this year.
Food as medicine
Food insecurity can be exacerbated for OB Care Center patients who are eligible for SNAP and WIC, but have not enrolled or do not access benefits. Jennie Oberkrom, manager of clinical integration for Operation Food Search, added that because of state budget cuts, some of the benefits have been reduced for those who are taking advantage of the supplemental food programs.
Oberkrom
The byproducts of food insecurity are pronounced among the population that the OB Care Center serves. In 2017, St. Louis City had a preterm birth rate of 12.6% overall and 18.9 % among black women. Neighboring St. Louis County, where DePaul Hospital is located, had an overall rate of 11.4 %, 16.8 % among black women. The national average was 9.9 %.
Fresh Rx Nourishing Healthy Starts aims to fill the food insecurity gap, reducing health care costs in the process. In its first year, it's shown promise. The average gestational age of the babies that are born to mothers who completed the program is 38.5 weeks, and the preterm birth rate is just 7%, far better than regional and national averages.
Pryor
OB Care Center
The OB Care Center at SSM Heath DePaul Hospital serves as the point of access to Fresh Rx Nourishing Healthy Starts. Situated in an area of north St. Louis with a high concentration of at-risk and medically underserved residents, the center is unique in Missouri in that it provides complete prenatal care to women, regardless of immigration or insurance status, or stage of pregnancy. Dr. Carolyn Pryor, medical director of maternal services for SSM Health-St. Louis as well as the OB Care Center, works with a nurse practitioner in exams and screening for other social services at the center.
"We serve as a safety net," Pryor said, noting that 96 percent of the patients either are enrolled in Medicaid or get enrolled before leaving their first visit so there is no delay in delivering care.
As part of their intake interview, the center's staff also asks moms-to-be whether they have worried about running out of food or whether they actually did. If the answer is yes, "we direct them to Jennie, and she takes it from there," Pryor said. Oberkrom added that since the outbreak of COVID-19, patients have been enrolled in Fresh Rx Nourishing Healthy Starts by telephone or through a virtual clinic visit.
In this February 2020 photo, Manausha Russ, left, admires daughter Aliza, and Jessica Lester, shows her plaid-clad son Liam. Both women took part in the Fresh Rx Nourishing Healthy Starts program.
Each week Fresh Rx Nourishing Healthy Starts provides a variety of protein, dairy, grains, fruits and vegetables that the participant and her family use to prepare three dinners a week. The kit includes local meat and produce that complements offerings from WIC and SNAP, especially with fresh choices. Because of the shelter at home rules related to the pandemic, all participants have their food delivered to them. (Oberkrom has found that about 70 percent of participants have obstacles to reliable transportation.)
The staff who prepare the kits and the delivery driver practice social distancing and follow all CDC guidelines for cleaning and sanitizing surfaces.
One of the delivery drivers is Manausha Russ, who graduated from the Fresh Rx Nourishing Health Starts program following the birth of her daughter, Aliza, and shares her experience with program participants.
"There's a lot of ladies that don't know about food programs," said Russ, who has three other young daughters. "I think a lot of people should know about it. It's really helpful for a lot of women."
The kitchen table and beyond
Fresh Rx Nourishing Healthy Starts also provides:
- Nutrition consulting from a registered dietitian.
- Access to nutrition and culinary resources.
- Supportive services.
"We know that food insecurity does not happen in a vacuum," said Oberkrom, who functions as a care coordinator for the participants in offering diapers, bus passes and resources for domestic violence issues, financial counseling, employment and education.
"It's not just about the food, it's the support," Oberkrom said. "It's all about the working together to let our patients know we've got their backs."
Russ has used the program both as a source for food and advice. "It's been helpful having someone there to talk to," she said. "If I have any questions, I can contact them and they can help me out. I'm cooking more, we're at a table together, talking. It's brought my family closer."
Women and their families are eligible for the program from the initial visit at the OB Care Center to the post-partum exam 60 days after birth. "That's a sad day," Pryor said. "It's hard to say goodbye."
Bringing the idea to scale
Since the program's inception, about 80 women have enrolled in Fresh Rx Nourishing Healthy Starts. In the short term, Pryor and Oberkrom hope to grow the program to include a pilot with a Missouri Medicaid managed care plan. Fresh Rx Nourishing Healthy Starts could accept enrollments directly from the plan — in addition to enrollments at the OB Care Center. Oberkrom said that given the food insecurity issues rising as a result of COVID-19, they expect increased participation. In the long term, they envision becoming a partnership model for health centers and food outreach programs across the state and country to address food insecurity during pregnancy.
"To have nutritious food is essential to improving the health of mothers-to-be and their families," Pryor said. "Relieving food insecurity alleviates other stress factors, allowing moms to focus on their babies. We hope to see a policy change so that insurance pays for this in the future."
In addition to DePaul, Fresh Rx Nourishing Healthy Starts also receives support from the Bayer Fund, a philanthropic arm of Bayer.