The Los Angeles County Preconception Health Collaborative Project Cynthia A. Harding, MPH Maternal, Child, and Adolescent Health Programs Los Angeles County

Los Angeles, California LAC a wonderfully diverse population of 10 million people Over half comprised of racial/ethnic minorities Over 200 languages spoken 69.8% of women age 18-44 live in households with income below 300% of FPL (2005 LA Health Survey) 10% of women age 18-44 in households with income below 300% of FPL have food insecurity with hunger (2005 LA Health Survey) 1 2

Selected Perinatal Health Statistics, 2004 Compared with HP 2010 Goals Medi-Cal funds prenatal care for over half of LAC births. Racial/ethnic and geographic disparities are continuing challenges. Women with poor birth outcomes at risk of poor birth outcomes in future pregnancies. LAC has one of higher teen birth rates compared to other California counties. 3

Selected Health Conditions and Behaviors Women 18 – 44 Years, 2005 Alcohol consumption, (past month) Depression/depressive disorder Diabetes High blood pressure Obesity Smoking LAC1 48.9% 13.8% 3.0% 8.8% 17.1% 12.2% CA2 53.6% - 2.3% 9.3% 17.9% 12.3% Many health conditions associated with poor birth outcomes are preventable. Among LAC women aged 18-44 years old, 38.3% have difficulty getting medical care & 24.9% have no regular source of health care (2005 LA Health Survey). Every dollar invested in preconception care for diabetes saves five dollars in medical costs (Carolina Reyes, no data source cited). Data source: 2005 LA Health Survey. 12005 LA Health Survey 22005 California Health Interview Survey 4

Efforts to Improve Birth Outcomes Los Angeles County 2005 Perinatal Summit Diverse stakeholders & leadership Unified call to action Recommendation to promote improved preconception health LAC has connected leadership, committed stakeholders, sufficient resources, and political will to address preconception health. 1998 approval of CA Prop 10, the California Children and Families First Act. 50-cent surtax on cigarettes and tobacco product to improve early childhood development from prenatal  age five. 2001 First5 LA Healthy Births Initiative. $15 million to improve birth outcomes in LAC. First5 LA selected LABBN to provide implement Healthy Births Initiative. 2004 First5 LA approved LABBN’s plan to implement Healthy Births Initiative. 5

Preconception Care Council of California Sponsored by CA Dept. of Public Health & March of Dimes CA Chapter Statewide forum for planning and decision-making for the integration, development and promotion of preconception care Clearinghouse for Preconception efforts across the State

Public Health Department Los Angeles County Preconception Health Community Profile Foundations Churches Schools LAC Dept LAC Dept Parks & Recreation First5 LA Mental Health California Family Black Infant Breastfeeding Health Councils Health Program Hospitals Task Force of Greater Los Asthma Angeles Coalition MCH Access Service PHFE-WIC Planning Areas LA Best Physicians LAC Health March of Healthy Babies Midwives Dept of Public Plans Dimes Births Network Nurse Practitioners Social Services Learning Community Clinics LA Care Collaboratives Association Los Angeles County Public Health Department 6

Los Angeles Collaborative Core Members California Family Health Council LA Best Babies Network LA County Public Health Department March of Dimes PHFE – WIC Program 7

Collaborative Activities Baseline preconception health (PCH) data Speakers’ Bureau presentation on PCH Curriculum to integrate pre- & interconception health into family planning clinics Interconception Care - Case Management of High Risk Women in PHFE – WIC Improve communication among stakeholders CDC Recommendation Collaborative Activity(ies) Individual responsibility across lifespan LABBN will develop reproductive lifeplan toolkit. CFHC project. Consumer awareness CFHC project, WIC project, communication among stakeholders. Preventive visits Speakers’ Bureau to educate providers & public Interventions for identified risks WIC project, CFHC project Interconception care WIC project Monitor HEDIS postpartum visits via briefs -7 NA 8. PH Programs and Strategies Speakers’ Bureau, briefs, communication Research briefs, monitoring data via LAMB, LA Hope, vital records, LA Health Survey Monitoring Improvements “ ” 8

Short-Range Project Goals Preconception brief Speakers’ Bureau presentation Toolkit to plan reproductive life plan Integrate pre- interconception care into Title X family planning programs PHFE-WIC case management to high-risk mothers PHFE-WIC CM to moms of preterm and low birthweight babies. 9

Long-Range Project Goals Policy/advocacy Increase postpartum visits Improve content of risk reduction/health promotion at postpartum visit Decrease: Unintended pregnancies Prepregnancy obesity Infant mortality Low birthweight births Policy/advocacy: interconception care financing, extend Medi-Cal financing 2 yrs postpartum, preconception care in CA health care reform debate. Monitor health data & indicators; use for programmatic & policy work. 10

Putting the Pieces Together State Partners L. A. Public Health CDC

Questions? Partners State L.A. Public Health C D

Maternal, Child, and Adolescent Health Programs Los Angeles County Cynthia A. Harding, MPH Director Maternal, Child, and Adolescent Health Programs Los Angeles County charding@ph.lacounty.gov 213-639-6400 12