A new mobile health clinic is bringing gynecologic and obstetric care directly to patients in underserved suburbs across the Pittsburgh region. The initiative is designed to improve access to reproductive health care and bring down maternal and infant mortality rates.
“We're bringing essential obstetrics and gynecology services directly to under-resourced communities,” said Dr. Margaret Larkins-Pettigrew, Allegheny Health Network’s chief clinical diversity, equity and inclusion officer and member of the Allegheny County Board of Health. “We’re actively addressing the social determinants of health that create barriers to care.”
The clinic inside the green, 37-foot extended box truck will offer basic gynecologic care as well as prenatal services like ultrasound scans and heartbeat monitoring. It features a consultation area, an exam room with an ultrasound machine, a blood draw area and a restroom.
The truck was parked outside of the Carnegie Library of McKeesport Tuesday, which will be the first location where patients can receive care beginning in March. Officials said the mobile clinic will also make stops in Charleroi, Braddock and McKees Rocks throughout the year.
The locations were selected based on zip codes where a higher number of mothers and babies experience poor health outcomes. “These are the places we need to start,” Larkins-Pettigrew said, adding that plans for future locations are under consideration.
Dr. Grace Ferguson, the clinic’s lead physician, said the truck’s mobility can ease the burden of transportation for patients.
At the library in McKeesport, she estimated “from here, it's two buses and a 17-minute walk, which is really insurmountable if you have a baby in your belly or on your hip."
The initiative was conceived as a strategy to reduce the sobering maternal mortality rates experienced by Black and brown mothers. Black women die at rates two to three times higher than their white counterparts in Allegheny County, according to health department data released last year.
“These statistics … represent mothers, daughters, sisters, friends and all of those who are lost during this pregnancy journey,” Larkins-Pettigrew said.
The mobile clinic is part of a larger collaborative effort — called First Steps and Beyond — among health care systems, doulas, community organizations and local governments to ensure every baby born in Allegheny County will celebrate their first birthday. Coordinated by AHN and led by Larkins-Pettigrew, the $950,000 initiative was funded primarily by a federal grant from the U.S. Department of Health and Human Services.
Health system officials said Tuesday that the clinic is the latest piece of a longer-term commitment to health equity.
“By bringing a women’s mobile health clinic into diverse communities, we’re honoring our responsibility as a health care system to improve the lives of the mothers, daughters, aunts, wives, and other women who trust us to provide outstanding — and equitable — care,” said Dr. Marcia Klein-Patel, chair of the AHN Women's Institute.
Geographic location and lack of access to transportation are often cited as obstacles to accessing care in underserved communities. Mobile clinics for pregnant and postpartum women have proven successful elsewhere in the U.S. at getting care to vulnerable patients.
AHN’s OB-GYN mobile clinic will offer wellness visits, pap smears, breast exams, pelvic exams, routine vaccinations and birth control implantation or insertion. Pregnant women can also access a list of services including fetal ultrasounds to determine how far along a pregnancy is and how fetuses are developing as well as fetal heartbeat checks, growth scans and assessment about the viability of a pregnancy.
“Most of your pregnancy visits can happen on the van” Ferguson said. “[But] if something needs referral to our hospitals, our specialists here will coordinate that.”
Ferguson said staff will be able to connect patients to transportation services as well as financial aid programs to cover the cost of care. No patients will be turned away from the clinic.
Community mobile health services have been shown to improve early access to prenatal care, according to a study published by the National Library of Medicine. Researchers found that women using a mobile service typically initiated care three weeks sooner than their counterparts and were as likely to receive quality care as patients who visited a traditional OB office.
Prenatal care can be critical to ensuring a healthy pregnancy by closely monitoring the mother and child as well as advising patients about medications and what to avoid during pregnancy. Prenatal care has been found to reduce the risk of complications, premature birth and infant death.
The clinic will also make patient referrals to doulas, which have been cited as a key partner in healthy pregnancies and births. According to the National Institutes of Health, doula care may reduce the odds of preterm birth by 22%. Having a doula has been correlated with better delivery outcomes including reduced cesarean and premature deliveries.
“We know how valuable doulas are, especially in this space of trust in an education and [making] decisions about their care,” Larkins-Pettigrew said. “If [patients don’t] come in with a doula, we have doula services we’re going to refer them to.”
But beyond caring for women during pregnancy, providers like Ferguson hope the mobile clinic will drive up participation in postpartum care across the region, too. According to the American College of Obstetricians and Gynecologists, 40% of women do not attend a postpartum doctor appointment. Insufficient or zero postpartum care can lead to chronic health conditions and limit access to contraception.
Providers on the truck will be able to provide incision and wound care, future pregnancy planning and birth control as well as emotional support during the postpartum period.
Postpartum or not, patients will also be able to make appointments for an implantable contraceptive or IUD insertion on the truck. And they might find it easier to receive pain management during those procedures, according to Ferguson.
“One of the biggest challenges to pain management in the office is that we need you to have a ride home because if you receive something that makes you feel a little loopy, we can't have you driving home,” Ferguson said. But a ride from the appointment might be easier to get from a [truck] parked closer to home, she added.
At a press conference to launch the mobile clinic Tuesday, Allegheny County Executive Sara Innamorato said bettering health care access is a key priority of her administration’s plan “to create an Allegheny County for all.”
“We're taking a big step forward with the introduction of this mobile clinic to provide comprehensive OB-GYN care,” she said. “I know we're going to make great strides in addressing infant and maternal health care here in Allegheny County.”
