August 12, 2011 16th Annual Alabama Perinatal Conference Every Woman Southeast: Creating Strategic Partnerships to Improve Women’s Health August 12, 2011 16th Annual Alabama Perinatal Conference Sarah Verbiest, DrPH, MSW, MPH University of North Carolina at Chapel Hill Center for Maternal and Infant Health

Acknowledgements Lori Reeves, Florida Chapter March of Dimes Carol Brady, NE Florida Healthy Start Coalition, Inc. Drs Michael Lu, Cherie Pies, & Milt Kotelchuck The Leadership Team Funders: The National Office and Florida, Alabama and Georgia Chapters of the March of Dimes; and the Office of the Dean of the School of Medicine at UNC-CH. Total funding to date is about $30,000

Objectives Discuss preconception health issues that impact women’s health and birth outcomes Describe the Every Woman Southeast Coalition Identify preconception health resources

http://www.cbo.gov/doc.cfm?index=6219&type=0 A society's infant mortality rate is considered an important indicator of its health, because infant mortality is associated with socioeconomic status, access to health care, and the health status of women of childbearing age. (Congressional Budget Office, 1992)

Issues that impact women of childbearing age Preconception Health Issues that impact women of childbearing age

Stagnant Infant Mortality Rates

Racial and ethnic disparities persist Infant Mortality Rates by Race, U.S. 2004-06 Average

Challenges to Women’s Health - Alabama 22.8% of women did not have health coverage 6.5% were diagnosed with diabetes, including GDM 23.4% report inadequate social support 57% do not engage in adequate physical activity Source - RNDMU IPV: regionally and nationally, 1:4 women will experience some form of Interpersonal Violence in her lifetime. There are no major differences by race/ethnicity.

Challenges to Women’s Health - Alabama 15.5% report not having good mental health in the past 30 days 3.7% were abused by their spouse the year before they became pregnant 1:4 women will experience some form of interpersonal violence in her lifetime Source - RNDMU IPV: regionally and nationally, 1:4 women will experience some form of Interpersonal Violence in her lifetime. There are no major differences by race/ethnicity.

Challenges to Women’s Health- Alabama Our region has high rates of infant mortality, preterm birth, STIs, poverty, unplanned pregnancy, overweight/obesity and chronic disease. African American women and infants have more than a double risk for these conditions. Grassroots effort to lead from the middle for change. ** The RNDMU Project, 2009; BRFSS data

Challenges to Women’s Health- Alabama Our region has high rates of infant mortality, preterm birth, STIs, poverty, unplanned pregnancy, overweight/obesity and chronic disease. African American women and infants have more than a double risk for these conditions. Grassroots effort to lead from the middle for change. ** The RNDMU Project, 2009; BRFSS data

Challenges to Women’s Health Folic Acid Use in Alabama

Life Course Perspective Early Programming – Health and social conditions of one generation directly impact the health status and reproductive life capital of the next. Cumulative Pathways – chronic accumulations of stress results in wear and tear contribute to declining health over time. Rather than focusing on risks, behaviors & services during pregnancy, summative effects of health, life events are examined.

Life Course Perspective Socioeconomic status, race and racism, health care, health status, stress, nutrition and weight, and a range of other behaviors impact birth outcomes. Factors impact racial, ethnic groups differently and may explain disparities despite equal access to care during pregnancy. Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Mat Child Health J. 2003;7:13-30

Why this matters… Women & infants in the Southeast have poorer health outcomes than the rest of the country as well as significant health disparities for minority populations. There are many untapped opportunities for connecting silos and creating synergy. Research has shown the importance of a healthy lifestyle for women during their childbearing years and the positive impact this has on future generations. Limited resources require innovation & partnerships! Our region has high rates of infant mortality, preterm birth, STIs, poverty, unplanned pregnancy, overweight/obesity and chronic disease. African American women and infants have more than a double risk for these conditions. Grassroots effort to lead from the middle for change.

Our emerging Coalition Every Woman Southeast Our emerging Coalition

The CDC Framework for Every Woman Recommendations for Preconception Health & Health Care Use federal and state agency support to encourage more integrated preconception health practices in clinics and programs. Develop and support public health practice collaborative groups to promote shared learning and dissemination of approaches.

About “Every Woman” California created the Every Woman, Every Time preconception toolkit for professionals in the early 2000’s. Florida obtained permission in 2008 to update those materials under the EveryWoman Florida moniker; other states are using EveryWoman, too. EveryWoman gives a common reference for the campaign without the use of the term “preconception”.

What is Every Woman Southeast? A coalition of leaders in Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee to build multi-state, multi-layered partnerships to improve the health of women and infants in the Southeast. We hope to foster capacity building and resource sharing, stimulate new ideas, develop new partnerships and strengthen old ones, and promote effective programs and mechanisms for moving the women’s health agenda forward in our region.

Coalition Building Blocks Southern Regional Task Force on Infant Mortality (1984-1997) Region IV Network for Data Management and Utilization Partnership History: Hold out the Lifeline, Folic Acid Southern strengths: resilient women, strong family structures, connection to the land, strong faith communities, and openness to discussions on race, equity and health Convened by the Southern Governor’s Association under the umbrella organization of the Council of State Governments

Objectives Create a successful, enduring coalition with measurable results. Operationalize the life course framework – put theory into practice. Promote health equity Train leaders to facilitate connectivity between sectors, to think about populations, and to address social determinants of health.

Objectives, Cont. Leverage policy and advocacy opportunities to support a strategic approach to improving the health of women and babies. Capitalize on social media and social capital. Highlight and build from a strengths-based perspective. Re-engage business and faith communities. Focus on the “grass tips” approach – share experiences from leaders in the field.

Accomplishments Conducted an online survey Recruited Regional and State Teams Held planning meeting on March 2, 2010. Produced a compendium of activities Launched blog, website and Facebook page Launched webinar series National Preconception Summit Partner Team conversations, idea generating, study Logic model and grant submissions – In Progress A copy of the compendium and survey results is on our website under About Us and Activities

Application of the Life Course Framework Has PROGRAMMATIC and POLICY implications. BROADENS the focus of MCH to include both health and social equity.

Changing Practice with a Life Course Focus Content of care and services include: Economic security Education Services are organized and delivered in ways that build resiliency and social capital and reduce dependency Group care Self care

Building Leadership Requires interdisciplinary, interagency collaboration to address complex needs

Please JOIN US and Get Involved! Next Steps Strengthen the Every Woman SE Partnership at the regional and state level this summer. Update website and increase # of people using social media. Finalize logic model and review with partners. Secure funding for several projects. Please JOIN US and Get Involved! Current focus for first project is on reproductive life planning for new mothers, to include decreasing short birth intervals and increasing postpartum visit utilization. We are also interested in doing work on a policy / advocacy level.

Resources

www.EveryWomanSoutheast.org 75% of survey respondents requested a regional website Main focus is to stay current on what other states are doing and have a contact there. It is also important to have a way to share information about what is happening at a national level.

Sample Page: Kentucky

Regional Webinars Purpose: To share different program models, ideas and best practice among the EWSE states. Topics to date: a) Building Statewide Partnerships around Preconception Health and b) Improving Interconception Health for High-Risk New Mothers. Speakers: Experienced leaders from the 8 states. Information about each speaker along with their slides is on our website. Upcoming topics: a) the postpartum visit; b) life course perspective; and c) integrating systems of health for women. 72% of survey respondents requested ongoing webinars

http://www.shepscenter.unc.edu/data/RNDMU/index.html

www.beforeandbeyond.org

Women’s Integrated Systems for Health (WISH) Training Women’s Integrated Systems for Health (WISH) Training public health and mental health professionals to apply a public health integrated approach to the design of women’s health policies and programs to address substance abuse, mental health, chronic disease and violence in women of reproductive age. Webinar Series, Orientation (online, self-paced study), Academy (intensive online learning opportunity) and a new MCH Library Knowledge Pathway Training grant funded by U.S. Health Resources and Services Administration’s Maternal and Child Health Bureau

Play the Game! Life Course Toolbox www.citymatch.org Life Course Game developed by CityMatCH and Contra Costa Health Services Interactive way to understand key concepts of Life Course framework. Life Course Toolbox www.citymatch.org

Shands Jax Nutrition Project Partnered with Second Harvest food bank Initiated WIC services on-site (new food package) Added Nutritionist to onsite Healthy Start team Nutrition education in waiting room Cooking demos Recipes using food items in bag

Centering Pregnancy Group prenatal care model Key elements: Self care Facilitated discussion, participant-led Group interaction and inter-dependence

Link to our blog via our website and friend us on Facebook Contact Information Contact for each state is listed on our website at www.EveryWomanSoutheast.org Link to our blog via our website and friend us on Facebook Sarah Verbiest sarahv@med.unc.edu (919) 843-7865