Measuring Health Outcomes

Amish Women’s Health and Pregnancy Depth Interviews, for the Central PA Center of Excellence for Research on Pregnancy Outcomes

This groundbreaking research into reproductive health and pregnancy outcomes among Amish women in Lancaster County, Pennsylvania was a major part of the Central Pennsylvania Women’s Health Study, a four-year, multidisciplinary effort to find the reasons for and reduce disparities in adverse pregnancy outcomes. No such study had ever been conducted among Amish women. By comparing the results of a study of such a culturally distinct group of women with the results of other studies, it was hoped that the reasons for low birth weight and premature births would become clearer.

The research was conducted under the auspices of the Central Pennsylvania Center of Excellence for Research on Pregnancy Outcomes at the Penn State Milton S. Hershey Medical Center, funded by a federal grant through the Pennsylvania Department of Health. Part of a collaborative project that started in 2004 and joined four partner organizations—Pennsylvania State University, the Family Health Council of Central Pennsylvania, Franklin & Marshall College, and Lock Haven University.

In order to best capture the data, the Center designed a questionnaire to facilitate in-person depth interviews, both because of the sensitive nature of the topic and because the Amish do not have telephones. Questions were drawn from surveys on health and pregnancy used for other populations, and changed to accommodate the Amish culture where necessary. Interview topics included mental, physical, and reproductive health, pregnancy and childbirth, health behaviors, stress, and health care. Specially trained interviewers visited 288 Amish women of childbearing age in 2004 and 2005, and follow-up interviews were done two years later with 202 of the women who had participated in the first survey.

Rates of adverse pregnancy outcomes tend to be higher among low-income, minority, less-educated, and medically underserved women, particularly in rural areas. The Amish are often exposed to pesticides, drink well water that may contain nitrates, and have little formal education. In addition, they experience a higher than usual incidence of some genetic disorders and birth defects, and Amish women often do not obtain sophisticated prenatal care and usually deliver their babies at home. Therefore, our initial premise was that Amish women would have higher rates of poor pregnancy outcomes than non-Amish women.

Yet our study found that Amish women have higher fertility rates and fewer low-birthweight babies, and are no more likely to have premature babies, than women in the general population. Analysis suggests the likely reasons for higher rates of successful pregnancy outcomes among these women are that the culture encourages, supports, and welcomes mothers-to-be, and Amish women as a group experience less stress and depression than the general population. Contrary to expectations, the study also found that Amish women do seek sophisticated medical care and hospitalization when they feel such care is necessary, and many do take multivitamins during pregnancy.

Results from the study are being used in many ways. Several significant papers based on the research have been published. Also, the Center of Excellence for Research on Pregnancy Outcomes project is now implementing programs to help women who are considering pregnancy improve their health status and habits, in order to decrease the prevalence of adverse pregnancy outcomes. Our data from the Amish study suggesting that stress reduction and community support is important for a successful pregnancy has been pivotal to designing these programs.

Faculty at Franklin & Marshall also developed a highly praised multidisciplinary course based on the research, called Public Health Research: Pregnancy Outcomes in American Women. The course has received recognition from the Science Education for New Civic Engagements and Responsibilities (SENCER) community of the National Science Foundation as a model course, and was presented at the SENCER Summer Institute 2008 in San Jose, California.