Some healthy-pregnancy advocates are calling for a re-examination of Hawaii’s outreach to expectant mothers after a state Health Department report shows that nearly half of all Hawaii births are unintended, 19 percent of women binge-drink leading up to their pregnancies and 16 percent of island women are obese before they become pregnant.

"This is a call to action to rethink what we can do differently to reach those populations that we’re obviously not reaching," said Jackie Berry, executive director of the Healthy Mothers Healthy Babies Coalition of Hawaii.

Much of the data reported yesterday in the Health Department’s first Pregnancy Risk Assessment Monitoring System Trend Report did not surprise the people who work with high-risk, pregnant women.

But the lack of significant improvement in areas such as unintended pregnancies and smoking and drug use prompted advocates such as Dr. Tricia Wright, medical director of Kaimuki’s Path Clinic, to seek new ideas to improve Hawaii’s pregnancies.

"A lot of women have lost their work-based health insurance and still don’t realize there is help for them," Wright said. "This definitely calls for innovative approaches to meeting people where they’re at, as opposed to waiting for them to come in for care."

The report looked at 16 indicators for the years 2000 to 2004 and represents one piece of a federal Centers for Disease Control and Prevention project involving 37 states, New York City and the Yankton Sioux Tribe in South Dakota.

Out of 18,350 babies who are born across the islands in an average year, the Hawaii study found that:

» About 8,300 pregnancies, or 45 percent, are unintended. The rate of unintended pregnancies shot up to 73 percent among women under 20.

» One in six mothers are obese before they become pregnant. Obesity prior to pregnancy is particularly acute for Samoan women, who have a 50 percent rate.

» About 3,400 mothers, or 19 percent, binge-drink prior to pregnancy. Binge drinking in the three months before pregnancy is far worse among women 20 to 24 years old, who have a 26 percent rate.

» One in 10 moms smoke during pregnancy. Big Island women have the islands’ worst smoking rate while pregnant, at 12 percent.

» About 1,200 moms, or 6.5 percent, report violence from their intimate partners. Women under the age of 20 suffer the worst rate of violence from intimate partners, at 14 percent.

» About 500 moms use drugs while pregnant.

The Waianae Coast Comprehensive Health Center continues to see pregnant women who smoke and are overweight but has made progress in getting early, prenatal care for uninsured mothers, said Teresa Gonsalves, the center’s director of case management and utilization.

The center also has made it easier to receive nutritional counseling in conjunction with their doctors’ visits, Gonsalves said.

"Our target population is helping those that are uninsured or underinsured," Gonsalves said. "We do a screen for alcohol and substances, but smoking cigarettes is something we continuously work on. You would hope with the cost of cigarettes that this would decrease."

Dr. Chiyome Fukino, Hawaii’s health director, wrote in the Pregnancy Risk Assessment Monitoring System Trend Report that she hoped the data will "help generate ideas and develop solutions for some highly preventable issues facing our families."

At the Healthy Mothers Healthy Babies Coalition of Hawaii, Berry began thinking yesterday about how to make a positive dent in the data.

"The statistics have remained relatively the same, which isn’t really good," Berry said. "It shows that we’ve reached all the low-hanging fruit. Now we need to figure out how to reach those populations that just aren’t responding."