Donna Strobino, PhD, Department of Population, Family & Reproductive Health

Lifecourse Perspectives on Health Clinical Aspects of Maternal & Newborn Health Womens Health Womens Health Policy Preventing Infant Mortality & Promoting the Health of Women, Infants & Children

Why Public Health Importance of Lifecourse Perspective Unique contribution of Lifecourse Application of Lifecourse to Preconception Health Policy and Practice Concerns using a Lifecourse Perspective Missed Opportunities

Wholistic view of health, including social determinants of health & context Lifecourse framework Lifecourse of the fetus? Girls health? Policy Implications Prevention Orientation

A lifecourse approach recognizes the role of time in shaping health & incorporates time into models which explain health outcomes. Time & timing are particularly relevant with regard to pregnancy & its consequences.

I n dividual time: chronological age, physical maturation, developmental & social maturation, social norms Historical time: calendar year, year of birth, technological development, economic change, social change

Life Span: length of time species is capable of living or length of life Life Cycle: regular, predictable series of life stages or reproductive cycle Life Course: age graded developmental trajectories shaped by context

Individuals health changes over time Determinants of health vary over time Relation between determinants and health can change over time Relation between determinants and health may depend on time

Recognizes complexity but provides an integrating model Big picture, highlights connections – important to public health mission and discussion of preconception health Thinking about pathways helps possible breaks in chains of risk, alter probabilities Allows focus on positive human development

To produce a healthy child with minimum compromise to the health of the mother To provide an acceptable birth process and postpartum experience

Pregnancy MenarcheMenopause Lifecourse Model of Childbearing Period Pregnancy

Providers recognize the possibility of reproduction at all health care visits with women of childbearing age About 50% of pregnancies are unplanned About 70% of women aged have had at least one preventive health visit in the past year

Traditional view of preconception period and policy: when is care provided and when are women eligible for insurance benefits? For what length of time prior to pregnancy should women be eligible for a preconception visit?

Only half of women with diabetes recall being counseled about good glycemic control before pregnancy Less than half of women with diabetes report seeking prepregnancy counseling in their last pregnancy

Wise argues that we need to recast preconception, prenatal & interconception care as part of a larger commitment to womens health focusing on the health of the newborn has not resulted in improvements in …. contraception, chronic disease management, abortion, or behavior and mental health services

Reminds us that women are important, womens health before and during pregnancy have an impact on her health postpartum and as she ages Focus on the fetus and newborn also ignores opportunities to promote womens health in the immediate preconception and interconception period

Reproductive & Perinatal Epidemiology Fetal & Infant Growth & Development Fetal origins of disease Intergenerational health No attention to earlier health of mother