Presentation on theme: "JHU WCHPC 2004 Opportunities for Integrating Perinatal and Women’s Health A Multiple Determinants and Lifespan Approach Based on the Work of D Misra, B."— Presentation transcript:
JHU WCHPC 2004 Opportunities for Integrating Perinatal and Women’s Health A Multiple Determinants and Lifespan Approach Based on the Work of D Misra, B Guyer and A Allston, with A Koontz and H Grason Am J Prev Med 2003:25(1)
JHU WCHPC 2004 Why a “new” framework? Perinatal health has failed to improve –Key indicators stagnant or worsened in past decade –U.S. ranks near bottom internationally Prenatal care has not yielded desired benefits. –Access and utilization have improved but improvements in perinatal health elude us. Fragmentation of women’s and perinatal health
JHU WCHPC 2004 Rationale LIFESPAN Powerful influences on pregnancy outcome occur long before pregnancy begins. Many U.S. pregnancies are unintended.
JHU WCHPC 2004 Rationale MULTIPLE DETERMINANTS Social, behavioral, environmental and biological forces all shape pregnancy. –Multiple determinants models can: Integrate multiple individual factors together. Show interrelationships between factors. Illustrate pathways by which factors might influence.
JHU WCHPC 2004 Rationale LIFESPAN/MULTIPLE DETERMINANTS Demography of pregnancy has changed dramatically in last few decades. –Older age at first pregnancy –Increase in multiple births
Women’s Reproductive Periods Preconceptional period –Period prior to (first) pregnancy –Often refers exclusively to brief period before pregnancy, a planning period Interconceptional period –Period between pregnancies –Encompasses entire time between pregnancies, including preconceptional period Women’s health?
JHU WCHPC 2004 Women’s Reproductive Periods Focuses attention toward the preconceptional and interconceptional periods as target points for intervention in addressing perinatal health. –Regardless of path taken, a woman will spend the bulk of her reproductive years in either preconceptional or interconceptional periods. Underpinning on which to build a perinatal health framework that considers all aspects of a woman’s life course in addressing perinatal health.
Conclusions Improvements in perinatal outcomes have plateaued because: –Interventions are focused on only the most proximal determinants (concurrent risk factors) –Fragmented health care system segments care during the pregnancy period from preconceptional and interconceptional periods.
JHU WCHPC 2004 Conclusions Model focuses on risk factors that influence perinatal outcomes but occur prior to and between pregnancies. Argue for creating system of health care that integrates multiple determinants of perinatal outcome across lifespan
JHU WCHPC 2004 Needed Changes in Public Health and Medical Arenas Model efforts after those undertaken to intervene in children to alter adult CVD risk. –Spending money for perinatal health on programs that focus on childhood behaviors related to nutrition, sexual activity, and smoking. –Consider changing existing funding structures for future gains. –Lobby for public financing of gaps, specifically for coverage of comprehensive care for nonpregnant women.
JHU WCHPC 2004 Needed Changes in Public Health and Medical Arenas In delivery and financing of medical care –Pediatricians and adolescent medical specialists need to have a role in preparing girls for later pregnancies Beginning to understand link between children’s health and adult chronic disease Need to understand link between children’s health and later perinatal outcomes.
JHU WCHPC 2004 Needed Changes in Public Health and Medical Arenas In delivery and financing of medical care –Changes in schedule of anticipatory guidance and prevention guidelines –Recognition of these services as reimbursable by health insurance and publicly funded programs.
JHU WCHPC 2004 Needed Changes in Public Health and Medical Arenas In delivery and financing of medical care –Internists considering needs of older women who might become mothers. –Linkages between broader array of providers.
JHU WCHPC 2004 Needed Changes in Public Health and Medical Arenas Address fragmentation of care –Family planning and prenatal care separate domains for practitioners, delivery sites, funding mechanisms. Public financing has made such care available to many. Yet … Gap in care as women transition Prenatal care limited to pregnancy Family planning provides care to non-pregnant but scope limited. Need care that does not recognize these boundaries.