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… 45 th 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?