1. March 14, 2007 Preconception Health Think Tank Meeting

2. The “we” in welcome Planning committee & booklet team You, your colleagues and your networks Creating and enacting a new focus on women’s wellness will take all of us!

3. Why are we here? To respond to the CDC’s Recommendations for Preconception Health and Health Care To initiate a focused, collaborative and comprehensive process to create a state Preconception Action Plan To introduce Looking Back Moving Forward: North Carolina’s Path to Healthier Mothers and Babies

4. What is preconception care? Interventions that identify and modify biomedical, behavioral and social risks to a woman’s health through prevention and management before pregnancy.

5. What is preconception care? It includes: A full scope of preventive and primary care services for women before a first pregnancy or between pregnancies. More than a single visit but less than all well-woman care Interventions for men, couples, families and society at large.

6. Preconception risks Alcohol misuse Poorly controlled diabetes Folic acid deficiency Use of teraterogenic prescription drugs Lack of immunizations HIV/AIDS Poorly controlled maternal PKU Obesity Exposure to STIs Tobacco use Short intervals between pregnancies Starting a family 35 years of age Previous poor birth outcome Poor oral hygiene High levels of stress Illicit drug use Poor mental health

7. The Preconception Care Initiative A Collaborative Effort of over 35 National Organizations

8. Goals for improving preconception health Goal 1 - To improve the knowledge, attitudes, and behaviors of men and women related to preconception health. Goal 2 - To assure that all U.S. women of childbearing age receive preconception care services - screening, health promotion, and interventions - that will enable them to enter pregnancy in optimal health. Goal 3 - To reduce risks indicated by a prior adverse pregnancy outcome through interventions in the interconception (inter-pregnancy) period that can prevent or minimize health problems for a mother and her future children. Goal 4 - To reduce the disparities in adverse pregnancies outcomes.

9. Themes - areas for action Social marketing and health promotion for consumers Clinical practice Public health and community Public policy and finance Data and research

10. Unique issues to preconception care Preconception – descriptive yes but doesn’t play well with many women Reproductive Life Planning – has some resonance but what does it mean in practice? Lots of research on pregnancy / prenatal care issues. Some information on folic acid. A dearth of information on this topic

11. Preconception Health in North Carolina There have been many efforts to address preconception health for women. Current health leaders may not be aware of the sum of these efforts, their impact and lessons learned. We need to build on history. Currently, there are many groups working on different elements of preconception health. There are a variety of products, perspectives and approaches. Challenge: Preconception health is multi-faceted and complex. There are many elements and a broad target population.

12. Why does it matter in North Carolina? We rank 45 th in the nation for high rates of infant death One out of 8 babies is born preterm 3,000+ babies are born with anomalies each year African American babies have a 2.5 fold greater risk of death than Caucasian babies Over $310 million a year spent for the cost of NICU care in our state 45% of pregnancies are unplanned

13. Why does it matter in North Carolina? For women of reproductive age: 24.4% of women smoke 21.8% of women are uninsured 6.8% report binge drinking in the past month 6.1% of women have asthma 9.3% are diabetic, 3.4% have cardiac disease and 3% are hypertensive High numbers of Chlamydia cases (617.9/100,000)

14. Why does it matter in North Carolina? 28% of women of all ages don’t engage in physical activity 52% of all NC adults are overweight or obese African American women are disproportionately affected by poor health and are at greater risk for all the conditions mentioned Women’s wellness care is highly fragmented

15. Focusing on the women in the middle Women ages 18-44 Many programs in our state address the needs of children and adolescents. Others address the needs of women as they age and face the impact of chronic disease. Many others care for pregnant women and new mothers What’s missing are the women in between!

16. The story of the booklet In June 2006 the Folic Acid Council were among the first responders to the CDC Recommendations and “commissioned” an inventory. Master Document was written (150+ pages) Detailed info about the evidence, current best practice models, impact Listed the challenges around messaging and audience segmentation Specifics of 3 decades of NC preconception health projects Comprehensive recommendations and ideas for North Carolina

17. Downsized Comprehensive – yes Readable by anyone but preconception junkies? – no Culled back to 50 pages and sent to meet with Crittenden Advertising team What is the purpose? What images are required to portray this concept? Who is the audience?

18. Polished and published The purpose of this booklet is to provide an overview of the issue, begin discussion, and provide resources We hope it will be used as a tool to initiate conversation and prompt collaborative action www.mombaby.org is set up to collect feedback and ideas and offer them back to our larger community www.mombaby.org

19. Recognition Merry-K Moos Our national pioneer for preconception health Leaders of successful programs who have set the bar high Voices who have kept the paradigm shift concept alive and engaged Expertise that exists among us on this topic

20. Thank you NC Prevention Partners for the meeting space March of Dimes for lunch & printing the booklet NC Folic Acid Council for the facilitator & the booklet’s design Crittenden for their beautiful work and patience CMIH and review team for the booklet’s content Planning team for their time and energy You for assisting with next steps and distribution

21. For the rest of the day we will be working through a process to begin to create a preconception action plan for North Carolina. We commit to seeing the ideas today through to an action plan – and the action plan through to funding and implementation.