- My name is Janean Dilworth-Bart. I am the chair of the Prenatal to Five initiative and the chair of the Department of Human Development and Family Studies in the School of Human Ecology. It is my pleasure to welcome each of you to this summit, an unprecedented one-day gathering of scholars, practitioners, early childhood professionals and community members representing 50 counties. I want to be sure to show you the counties.  [audience laughs]  50 counties and seven tribal nations. Also represented are over 100 agencies and a dozen institutes of higher learning. Through our work, each of us is focused on one question. How can we ensure better outcomes for our children, for all children? To paraphrase Angela Davis, we are not accepting things we cannot change. We are changing things we cannot accept.  [audience applauds]  What each of you, through your work, is dedicated to changing, to improving, is the health and wellbeing of all children and families who live in Wisconsin and in our tribal nations. Together, we will create an agenda full of possibility for children, families and communities and the hope for a healthy tomorrow. Today, we will work through the barriers that stand in the way of healthy pregnancy and birth. Today, we will uncover the thorny issues that prevent children from being ready to thrive in school on that very first day of kindergarten. Today, we will talk honestly about what works or what doesn't work in our urban, rural and indigenous communities. I also want to express my personal gratitude and the gratitude of the Prenatal to Five planning committee to each of you for being here today. There's an enormous amount of expertise in this room. All of you here, and others not here, could provide amazing examples and insights. We hope as our network continues, there will be more sharing from individuals and groups who are passionate about the work they're doing. We are very, very grateful to those who worked hard to present the examples we'll hear today. Now I'd like to draw your attention to the child resilience systems model in your handout and on the screen. Center for Child and Family Wellbeing Director, Julie Poehlmann-Tynan developed this model based on the resilience literature and your responses to our fall survey. We have organized the talks according to this model and will refer to it throughout the day. In the center, each color represents an important domain of child development, like emotional wellbeing, language development and physical health. In the circle surrounding those domains, young children's key contexts are represented, including families and early childcare setting. In the outer ring, policies, programs and practices from the wider society are depicted. All of these contexts influence infants and young children as they develop. Our work almost always spans more than one of the domains depicted here. This model provides a useful heuristic as we start to drill down into the issues and provides us an opportunity to expand our thinking to include innovative ideas that cross domains. We'll begin with physical health and then travel around the circle counterclockwise.  - Good morning. I'm starting the physical health section, which are gonna talk about the critical role of women's health before, during and after pregnancy. My name is Debbie Ehrenthal. I'm an internist in the School of Medicine and Public Health and I've worked clinically and in research and women's health and maternal and child health through my career. So this is the famous Time cover that helps reinforce the critical importance of the prenatal period for so many different reasons. We know that birth weight and gestational age are tied to later health of kids as adults and their educational attainment. There's strong evidence that low birth weight is tied to future adult health and cardiovascular disease and diabetes and we also know, as was earlier mentioned, the importance of adverse childhood experiences and how they carry forward and impact health. But children begin their lives with tremendous disparities and here in Wisconsin, as in the U.S., African American families bear an undue burden of low birth weight and infant mortality and here we see babies are twice as likely to be born low birthweight if their mom was African American. So what drives these disparities? This population health framework, developed here at UW by Pat Remington and David Kindig, does a wonderful job depicting the various contributions to health. It's not just health behaviors and it's not only healthcare that contributes to health and it's critical that we remember the importance of the social determinants of health, here a portion to about 50% of health and that's certainly true in perinatal outcomes. So, what do we know about the health of women in Wisconsin? We have data from a CDC surveillance system, pregnancy risk assessment and monitoring system that's administered here to the population in Wisconsin and helps us understand these various contributors. Here, we see racial disparities in prenatal care here in Wisconsin. Even though we don't have disparities in insurance, we still have access issues here and we see that African American moms are much more likely to report inadequate prenatal care. We also have information for moms who had their babies about their household income and here we see extraordinary differences in resources available to moms with young children. This figure shows that more than 50% of African American moms report a household income of less than $10,000 a year. And then finally, we have information of women's lives and experiences. This figure shows the stresses that women report during pregnancy and again, we know the critical importance of stress in driving adverse outcomes during pregnancy, specifically prematurity. So we know, based on all of this information from national data, from local data, and from the voices of woman having babies here in Wisconsin that we have tremendous differences and experiences during pregnancy and even prior to that and they come together in a way that has an impact on a child's health from the start. These are some preliminary data that are as yet unpublished from a project we're doing to try to understand what the drivers of kindergarten reading readiness is, which is the "five" end of Prenatal to Five. These are results of kindergarten reading screeners administered to all children who entered kindergarten in the public school system in Wisconsin and here we see that simply birth weight is a huge predictor of kids' readiness for reading and here we see that babies born low birthweight are substantially more likely to be in the lowest decile at entering school. So they're starting, bearing the burden of the adverse health outcomes of the pregnancy and their health at birth. So what kind of strategies do we have that we know work to help support moms before pregnancy, during pregnancy and in early childhood? Healthcare has no silver bullet here. There is no intervention that we know that will always prevent prematurity, but healthcare strategies are important and we saw the issues that we have here in Wisconsin just accessing care, but healthcare begins before pregnancy