Preconception Health Planning in NC Sarah Verbiest, MSW, MPH

1. Preconception Health Planning in NC Sarah Verbiest, MSW, MPH

2. Presentation Purpose • Describe NC planning efforts • Share some data • Share lessons learned so far

3. The “we” in welcome • 70+ colleagues in public health, research, minority health, and medicine Creating and enacting a new focus on women’s wellness will take all of us!

4. Why do we care? In North Carolina… • 45th in the nation for high rates of infant death • One out of 7 babies is born preterm • 3,000+ babies are born w/anomalies each year • African American babies have a 2.5 fold greater risk of death than Caucasian babies • 45% of pregnancies are unplanned

5. Why do we care? For women of reproductive age (18-44): • 23.5% of women smoke • 23.6% of women are uninsured (69.9% of Hispanics) • 7.9% report binge drinking in the past month • 6.1% of women have asthma • 2.4% are diabetic, 3.4% have cardiac disease and 13.1% are hypertensive • High numbers of Chlamydia cases (617.9/100,000)

6. Why do we care? • 28% of women of all ages don’t engage in physical activity • 24.8% of women 18-44 are obese (40% for African American women) • 23.4% have poor mental health • 19% nonimmune to Rubella • African American women are disproportionately affected by poor health • Women’s wellness care is highly fragmented

7. Planning Steps • State Infant Mortality Collaborative (2004-06) • CDC’s Recommendations for Preconception Health and Health Care prompt a need to respond • June 2006 the Folic Acid Council commissioned an inventory of preconception services in NC.

8. The Booklet • A tool to initiate conversation & prompt collaborative action • Contents: • Details about preconception health • Lists of challenges • Specifics of 3 decades of NC projects • Next Step Ideas

9. Accomplishments • Family Planning Medicaid Waiver • Folic Acid Campaign since 1994 • School Curriculum • Worksite Health Promotion • Preconception Health Risk Appraisal • Eat Smart Move More / Healthy Women, Healthy Weight • Free NC Quitline • Syphilis Elimination Project

10. Planning Steps March 2007 Think Tank Meeting #1 • To initiate a focused, collaborative, comprehensive process to create a state Preconception Action Plan • Review of Participants, Group Notes and Ideas May 2007 Think Tank Meeting #2 • To collect diverse ideas and understand how preconception fits into existing work

11. Planning Steps • Looking under rocks – finding detailed data about women of childbearing age in North Carolina • Quantitative – what indicators do we have? What indicators do we need to gauge outcomes? • Qualitative – what have we learned about NC women – what do we still need to know?

12. Partnerships • There are many groups working on different elements of preconception health. There are a variety of products, perspectives and approaches. • NC’s efforts will integrate preconception messages as appropriate into the existing public health and medical infrastructure.

13. What women say… • Behavior Change: Awareness not enough to change behaviors. Knowledge of family history, family support and healthcare options can lead to change. • Stress: Emotional, physical and financial stress negatively influence health. Need more social support and networking.

14. What women say… • Mental health issues, especially depression, are significant. Lack of resources in communities. • Barriers to Health Care: Cost. Racism. Lack of - access, trust/ respect, childcare, and transportation.

15. What women say… • Approach to Healthcare: Prefer holistic approach. • Substance Use: Many women reported they knew someone struggling with drug addiction. • Most pregnancies are unplanned. Women are concerned about becoming pregnant but don’t use contraception. Inconvenient clinic hours and quality of care problems with family planning services.

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

17. Guiding Principles • Focus on the whole woman – not only her reproductive capacity • Consider the woman’s health needs and related wellness recommendations within the context of her family and community • Be careful that messages don’t imply that certain groups of women should not become mothers • Be cognizant of health disparities and prioritize programs with potential to close the gaps

18. Areas of Interest • Adolescents • Clinical practice – continuity of care • Interconception Health • Data & Research • Integrating new messages into current campaigns • Policy & Advocacy

19. Themes • Include men & families • Start early / young • Use existing programs to carry messages • Build on public health outreach into worksites, private practice, and communities

20. Messaging • Give consumers messages they want to hear – not what we think they want to hear. • Use social marketing principles • Consistent messages • Concise and Clear • Keep Literacy Levels Low • In Spanish

21. The Website www.mombaby.org • Resources • National News • Minutes • Feedback

23. Developing Core Plan for Review Think Tank #3 August 2007 We commit to seeing the ideas through to an action plan – and the action plan through to funding and implementation.

24. Questions?