Should we transform folic acid programs into preconception health campaigns? The North Carolina experience Amy Mullenix, MSW, MSPH 3 rd National Preconception Health Summit June 14, 2011 Tampa, FL

Acknowledgements Preconception health leaders N.C. Attorney General’s Office N.C. Division of Public Health, Women’s Health Branch Sarah Verbiest at UNC Center for Maternal & Infant Health March of Dimes The “fairy dust” team

Continuous folic acid leadership and committee in NC since 1994 Infusion of funding in 2004 from Vitagrant; housed at March of Dimes; additional funding from other sources Large, comprehensive statewide campaign since 2005

And now what?

2006 CDC releases preconception health recommendations NC Folic Acid Campaign begins to plan for end of Vitagrant funding Board discusses potential role of Folic Acid Campaign in preconception health efforts Campaign commissions inventory of past & current preconception health activities

Looking Back Moving Forward North Carolina’s Path to Healthier Women and Babies

Folic AcidFull preconception health campaign MultivitaminsProviding leadership / applying our expertise statewide in preconception health Adding some preconception health messages Possibilities of expansion

Considerations + Compelling need for a preconception health campaign in NC Documented success in addressing one preconception health risk Infrastructure in place Impending loss of folic acid funding ? Narrow program focus had achieved results (39% drop in NTDs) All programs evaluated for promotion of folic acid vs other preconception health risks/issues Loss of brand identity

2007 State begins preconception health planning process Folic acid campaign pauses its transition Folic acid team provides leadership for state process 1 year process: 30+ organizations, needs assessment, multiple workgroups, identification of priorities Release of State Plan in 2008

North Carolina Preconception Health Strategic Plan

2008 Campaign develops strong relationships with potential collaborators in the NC preconception health “world” during state planning process As new preconception projects begin, Folic Acid Campaign is invited to contribute folic acid content, program expertise, etc. Campaign identifies portions of state plan relevant to its work & in light of its own strengths: health care provider education, lay health education, media & printed materials

2009 Campaign reaffirms desire to expand & examines potential messages Board approves the addition of healthy weight to folic acid campaign, with reproductive life planning as third message. Reaffirms emphasis on folic acid promotion for Hispanic women

Opportunities With additional funding, the Folic Acid Campaign can continue & grow Infrastructure & relationships already in place – can add new message without extensive “building” phase Grants provide opportunities to implement innovative programs without “starting over” (hiring new staff, developing new relationships, etc.) 13

Why healthy weight? Natural link between nutrition, folic acid & weight Health care providers consistently express desire for training on this topic; health care provider education is our specialty Potential for funding

2010 Active involvement by Campaign staff in the NC preconception health coalition Review of evidence-based healthy weight programs for women of childbearing age Development of new healthy weight curriculum & materials Development & testing of high school preconception health curriculum Development of new logo & brand identity

2011 Healthy weight trainings for health care providers, focusing first on public health providers (~500 trained YTD) Partnership with state (on federal grant) to develop provider trainings & resource guides for local communities on 5 topics: healthy weight, reproductive life planning, tobacco cessation, early entry into prenatal care, interconception medical home High school preconception health curriculum New website, tagline, materials, etc.

Lessons learned Current initiatives can be expanded within the broad framework of preconception health Collaborative, inclusive process can be time- consuming but reduces “ownership issues” and results in broad support and partnerships Strategic planning improves focus Traditional stop/start funding cycles maintain silos in both preconception health care delivery & public health programs Multi-year, multi-partner projects can actively leverage resources to sustain & transform public health programs

Who has capacity to expand? Folic acid councils Healthy Start programs State women’s health/interconception programs or agencies Adolescent health programs or agencies Infant mortality coalitions March of Dimes state chapters State Office of Women’s Health State Office of Minority Health

Questions to consider 1.How do our strengths and programs align with identified preconception health needs in our state? 2.Who are the partners that need to be at the table for effective transition to preconception health? 3.Which organization(s) in our state can provide: a high-functioning board, commitment, patience, leadership, & institutional support?

What’s next for you?

Thanks! Questions… Thoughts… Ideas… Amy Mullenix EveryWomanNC.com