 Local data overview  PPOR findings  Women’s Health Assessment  Preconception health

Source: Tarrant County Public Health, 2010

Is it education?

Source: National Center for Health Statistics, 2002

TC Infant Mortality Rate Hispanics Whites Blacks Infant Mortality Rates by Maternal Education Level, Tarrant County < High School DiplomaHigh School DiplomaSome College/Degree Education Level Infant Mortality Rate Source: Tarrant County Public Health, 2010

TC Infant Mortality Rate Hispanics Whites Blacks Infant Mortality Rates by Maternal Age, Tarrant County Infant Mortality Rate Source: Tarrant County Public Health, 2010

Developed by McCarthy & WHO Simple approach Strong conceptual basis Mobilizes communities Prioritizes prevention efforts CityMatCH PPOR:

 Examines the four “Periods of Risk”: 1. Maternal Health / Prematurity 2. Maternal Care 3. Newborn Care 4. Infant Health for various population groups  Identifies groups and periods of risk with the most deaths, highest rates  Uses comparison groups to estimate “excess deaths” for these groups and periods of risk

*Feto-infant mortality per 1,000 live births & fetal deaths Infant Health 1.7 Newborn Care 1.4 Maternal Care 1.7 Maternal Health/Prematurity 3.1 FETO-INFANT MORTALITY RATES, ALL RACIAL/ETHNIC GROUPS:

Maternal Health/ Prematurity Preconception Health Perinatal Care mortality rate among VLBW babies VLBW births Interventions

Maternal Health/ Prematurity Preconception Health VLBW births Interventions To Summarize… PPOR-Phase I PPOR-Phase II

Targeted women in specific zip codes Face-to-face survey assessed health status, health behaviors, knowledge, neighborhood and organizational factors affecting their health 405 respondents

18

Source: The Annie E. Casey Foundation, State Level Data Online, Tarrant County Infant Mortality Task Force, 2005 Healthy People 2010 Goal: 4.5

, Source: National Center for Health Statistics, BRFSS, Texas, , Females 18-44, National Center for Health Statistics, NHANES, United States , Females 20-44

 Lack of fruits and vegetables › 88% eat less than five fruits and vegetables a day  Lack of grocery stores in designated area

22 Source: CDC Health Date for All Ages (HDAA) Texas, BFRSS, US, NHIS,

25% reported feeling down, depressed or hopeless every day, or nearly everyday over the past 2 weeks 8% of women experienced intimate partner violence in the past year

 Women are unhealthy, compromising their opportunity for healthy pregnancy  Improving the health of women holds great promise in improving the health of babies  Many opportunities to address and improve women’s health through prevention and promotion  Everyone has an important role to play

CDC defines preconception health as “a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management”

 Prevention and management of health risks and conditions  Includes management of fertility, including contraception, in order to empower women to plan and prepare for pregnancies Source: Kent H, Johnson K, Curtis M, Richardson Hood J, Atrash H. Proceedings of the Preconception Health and Health Care Clinical, Public Health, and Consumer Workgroup Meetings. Atlanta, GA: CDC; 2006.

 Perinatal periods of risk analyses indicate that interventions should focus on African American women and on the maternal health/ prematurity period of risk  Consistent with preconception health, including family planning and addressing health behaviors such as smoking and drug abuse

From -- Anticipation and Management to Health Promotion and Prevention From -- Healthy Mothers, Healthy Babies to Healthy Women Healthy Mothers Healthy Babies Paradigm Shift

To promote the health of women of reproductive age before conception and thereby improve pregnancy-related outcomes … A LIFE COURSE APPROACH Preconception Care - Goal

 Dr. Anita Kurian, Tarrant County Public Health  Micky Moerbe, Tarrant County Public Health  Amy Raines, Fort Worth Women’s Health Initiative  Dr. Hani Atrash, CDC