1. LAMB Why Do Women Decline Preconception Care Counseling? The L os A ngeles M ommy and B aby Project Shin Margaret Chao, Ph.D., M.P.H. Los Angeles County Department of Public Health Maternal Child, and Adolescent Health Programs

2. This project was supported by the Health Resources and Services Administrative (HRSA) # R40MC06635, Productivity and Investment Fund, and MCAH General grants.

3. Background Preconception care counseling (PCC) provides opportunities for women to gain awareness and understanding of how their health behaviors and family histories impact pregnancy Benefits of PCC well documented Little knowledge on who does/does not receive PCC in Los Angeles County and why

4. Study Questions What are the characteristics of women who do not have preconception care counseling? What are the reasons women do not have preconception care counseling?

5. Methods LAMB INSTRUMENTPROCEDURES Questions primarily drawn and adapted from validated survey instruments Focus groups; piloted Survey translated into Spanish, and Chinese. Telephone translation service for other languages. LA resident mothers 0-7 months after a live birth Stratified random sample Over sample LBW/PT births, African American, Asian/PI and Native American births Mail survey with telephone follow-up for non- respondents $20 gift certificate

6. During the six months before you got pregnant with your new baby, did you talk to a doctor, nurse, or other health care worker about how to prepare for a healthy pregnancy and baby? If yes, tell us why you did not see a doctor, nurse, or other health care worker to prepare for this baby. Knew how to prepare myself for pregnancy already Didnt expect to get pregnant Did not have enough money or insurance to pay for a check-up Did not have a regular doctor or nurse to talk to Had no way to get to the clinic or the doctors office Couldnt take time off from work Had no one to take care of my children Too many other things going on Couldnt find a doctor or nurse who spoke my language Other Preconception Counseling Questions

7. Statistical Analyses Prevalence rates of women who had no PCC Maternal characteristics associated with no PCC; perform multivariate analysis Major reasons why women had no PCC Sample weighting to adjust for sampling probabilities

8. Results

9. LAMB Demographics Race/EthnicityFamily Income N = 6,264

10. Women who had no Preconception Care Counseling, by Race/Ethnicity, 2007 LAMB Survey N = 4,264

11. White mothers is the reference group The multivariate model included: mothers education, age, marital status, and insurance status African American mothers more likely than white mothers to have no PCC visit Adjusted Odds Ratios and Confidence Limits for Race/Ethnicity Multivariate Model: Racial Disparities in no PCC aOR N = 4,264

12. <=12 yrs education Unmarried Uninsured before pregnancy Unintended pregnancy Young age Not a first time mother Selected Maternal Characteristics by PCC Status N = 6,264

13. Reasons for No PCC 2007 LAMB Survey N = 4,264

14. Reasons For No PCC by Race/Ethnicity 2007 LAMB Survey N = 4,264

15. Reasons For No PCC by Parity 2007 LAMB Survey N = 4,264

16. Over 70% of recently delivered mothers had no PCC Major reasons: Not expecting to get pregnant Knew how to prepare No regular doctor Not enough money or insurance for check-up Too much else going on Racial/ethnic disparities Younger age, lower education level, unmarried, unintended pregnancy, not a first time mother Conclusions

17. Public Health Implications

18. Identify subpopulations of women in need of outreach during the preconception period Integrate PCC as part of family planning services Need for awareness campaigns on importance of PCC Social policy changes to promote funding and access to PCC Maximize public health surveillance and related research mechanisms to evaluate the effectiveness of PCC Implications

19. Special Thanks to: Michael C. Lu, MD, MPH 2007 LAMB Principal Investigator Cynthia Harding, MPH Director, Los Angeles County MCAH Programs Diana Liu, MPH, Chandra Higgins, MPH, Marian Eldahaby, BA, Carmen Gutierrez, Alex Chen, MS Martha Martinez, Rozana Ceballos, BA Our Community Partners... and of course, mothers who completed the survey!

20. Contact Us Toll-free number: 1-866-706-LAMB For information about LAMB, visit: http://lapublichealth.org/mch/LAMB/LAMB.html http://lapublichealth.org/mch/LAMB/LAMB.html Margaret Chao schao@ph.lacounty.orgschao@ph.lacounty.org 213-639-6470