March 14, 2007Preconception HealthThink Tank Meeting

The “we” in welcome

• Planning committee & booklet team

• You, your colleagues and your networks

Creating and enacting a new focus on women’s wellness will take all of us!

Why are we here?

• To respond to the CDC’s Recommendations for Preconception Health and Health Care

• To initiate a focused, collaborative and comprehensive process to create a state Preconception Action Plan

• To introduce Looking Back Moving Forward: North Carolina’s Path to Healthier Mothers and Babies

What is preconception care?• Interventions that identify and modify

biomedical, behavioral and social risks to a woman’s health through prevention and management before pregnancy.

What is preconception care?

• It includes:• A full scope of preventive and

primary care services for women before a first pregnancy or between pregnancies.

• More than a single visit but less than all well-woman care

• Interventions for men, couples, families and society at large.

Preconception risks

• Alcohol misuse• Poorly controlled

diabetes• Folic acid deficiency• Use of teraterogenic

prescription drugs• Lack of immunizations• HIV/AIDS• Poorly controlled

maternal PKU• Obesity• Exposure to STIs

• Tobacco use• Short intervals

between pregnancies• Starting a family <18

or > 35 years of age• Previous poor birth

outcome• Poor oral hygiene• High levels of stress• Illicit drug use• Poor mental health

The Preconception Care InitiativeA Collaborative Effort of over 35 National Organizations

Goals for improving preconception health

• Goal 1 - To improve the knowledge, attitudes, and behaviors of men and women related to preconception health.

• Goal 2 - To assure that all U.S. women of childbearing age receive preconception care services - screening, health promotion, and interventions - that will enable them to enter pregnancy in optimal health.

• Goal 3 - To reduce risks indicated by a prior adverse pregnancy outcome through interventions in the interconception (inter-pregnancy) period that can prevent or minimize health problems for a mother and her future children.

• Goal 4 - To reduce the disparities in adverse pregnancies outcomes.

Themes - areas for action

• Social marketing and health promotion for consumers

• Clinical practice• Public health and

community• Public policy and

finance• Data and research

Unique issues to preconception care

• Preconception – descriptive yes but doesn’t play well with many women

• Reproductive Life Planning – has some resonance but what does it mean in practice?

• Lots of research on pregnancy / prenatal care issues. Some information on folic acid. A dearth of information on this topic

Preconception Health in North Carolina

• There have been many efforts to address preconception health for women. Current health leaders may not be aware of the sum of these efforts, their impact and lessons learned. We need to build on history.

• Currently, there are many groups working on different elements of preconception health. There are a variety of products, perspectives and approaches.

• Challenge: Preconception health is multi-faceted and complex. There are many elements and a broad target population.

Why does it matter in North Carolina?

• We rank 45th in the nation for high rates of infant death

• One out of 8 babies is born preterm• 3,000+ babies are born with anomalies each

year• African American babies have a 2.5 fold

greater risk of death than Caucasian babies• Over $310 million a year spent for the cost

of NICU care in our state• 45% of pregnancies are unplanned

Why does it matter in North Carolina?

For women of reproductive age:• 24.4% of women smoke • 21.8% of women are uninsured• 6.8% report binge drinking in the past

month• 6.1% of women have asthma• 9.3% are diabetic, 3.4% have cardiac

disease and 3% are hypertensive• High numbers of Chlamydia cases

(617.9/100,000)

Why does it matter in North Carolina?

• 28% of women of all ages don’t engage in physical activity

• 52% of all NC adults are overweight or obese

• African American women are disproportionately affected by poor health and are at greater risk for all the conditions mentioned

• Women’s wellness care is highly fragmented

Focusing on the women in the middle

Women ages 18-44• Many programs in our

state address the needs of children and adolescents.

• Others address the needs of women as they age and face the impact of chronic disease.

• Many others care for pregnant women and new mothers

• What’s missing are the women in between!

The story of the booklet

• In June 2006 the Folic Acid Council were among the first responders to the CDC Recommendations and “commissioned” an inventory.

• Master Document was written (150+ pages)• Detailed info about the evidence, current best practice

models, impact• Listed the challenges around messaging and audience

segmentation• Specifics of 3 decades of NC preconception health projects• Comprehensive recommendations and ideas for North

Carolina

Downsized

• Comprehensive – yes Readable by anyone but preconception junkies? – no

• Culled back to 50 pages and sent to meet with Crittenden Advertising team• What is the purpose?• What images are required to portray this

concept?• Who is the audience?

Polished and published

• The purpose of this booklet is to provide an overview of the issue, begin discussion, and provide resources

• We hope it will be used as a tool to initiate conversation and prompt collaborative action

• www.mombaby.org is set up to collect feedback and ideas and offer them back to our larger community

Recognition

Merry-K MoosOur national pioneer

for preconception health

Leaders of successful programs who have set

the bar high

Voices who have kept the paradigm shift concept

alive and engaged

Expertise that exists among us on this topic

Thank you

• NC Prevention Partners for the meeting space• March of Dimes for lunch & printing the booklet• NC Folic Acid Council for the facilitator & the

booklet’s design• Crittenden for their beautiful work and patience• CMIH and review team for the booklet’s content• Planning team for their time and energy• You for assisting with next steps and distribution

For the rest of the day we will be working through a process to begin to create a preconception action plan for North Carolina.

We commit to seeing the ideas today through to an action plan –

and the action plan through to funding and implementation.