1. Promoting Healthy Birth Outcomes: Moving Science into Practice Sarah Verbiest, DrPH, MSW, MPH UNC Center for Maternal and Infant Health October 28, 2009

2. “It is time for a comprehensive approach to improving newborn health, one that respects the complex epidemiology of childbearing and the pragmatic requirements of constructing a strong, collective commitment to women’s health.” Paul Wise, 2008

3. Women’s Health Movement Share the spotlight – its not just about the baby Use the word preconception sparingly – women are more than their reproductive capacity. Think comprehensively not categorically about prematurity Focus on creating health equity

4. National Leadership & Structure National Select Committee National Symposiums (I and II) MMWR article & MCH Journal Supplement (2006) Active Work Groups: –Clinical –Public health –Policy & Finance –Consumers –Research

5. National Goals Improve the knowledge, attitudes and behaviors of men and women related to preconception health. Assure that all women of childbearing age in the US receive preconception services that will enable them to enter pregnancy in optimal health. Reduce risks indicated by a previous adverse pregnancy outcome through interventions, which can prevent or minimize health problems for a mother and her future children. Reduce disparities in adverse pregnancy outcomes.

6. National Recommendations Individual responsibility across the lifespan Consumer awareness Preventive visits Interventions for identified risks Interconception care Prepregnancy check up Health insurance coverage for low income women Public health programs and strategies Research Monitoring improvements

7. National Resources Population based measures & indicators Practice Collaboratives & Curriculum Changes Message Bundling NICHD Research Meeting in March 2008 Preconception Policy & Financing Issues –Women’s Health Issues, 18:6, Supp (Nov-Dec. 2008) Clinical Content of Preconception Care, 199: 6, Supp B (Dec 2008) –AJOG, 199: 6, Supp B (Dec 2008)

8. North Carolina: birth place of modern preconception health

9. The Early Years Preconception Health Care: A Practical Guide Preconception health risk appraisal Title X Special Initiative New Beginnings & Babies and Business: A Partnership for the Future – worksite programs Smart Planning…Healthier Babies – school health curriculum Fetal Alcohol Syndrome Education

10. Current Events Breastfeeding Initiatives NC Medical Journal Issue – coming soon! Southeast Regional Consortium – planning phase

11. Let’s Get Real Women can manage multiple health messages. Many women define health holistically and have a feeling about what it means to be well. There is a big gap between “knowing” and “doing”. Women are very busy and pulled in many directions. Their needs often come last. We have to address: stress, time, money and energy

12. Socio Ecological Framework WiseWoman Project Manual, Chp 6, p 90, Developed by the UNC Dept. of Health Education and Health Promotion

13. Opportunities for Intervention Pre-Pregnancy Population Pregnancy Delivery Postpartum Childbearin g complete Prevention e.g. Diabetes Obesity Smoking Source: Burstin, Helen [2009] Policy Issues in Perinatal Quality Improvement [Powerpoint Slides] Retrieved from Symposium Quality Improvement to Prevent Prematurity

14. Healthy Women Physical Social Cognitive Emotional Social Services Clinical Care Economic Environment Community & Cultural Environment Schools Family & Social Support Physical Environment Behaviors & Lifestyle Borrowed from Merry-K Moos. Used with permission of The Nemours Foundation, Division of Health and Prevention Services. Adapted from the 2005 Delaware Children’s Health Chartbook.

15. Approaches to Consider Low hanging fruit –Women who want to become pregnant –Women who have health insurance –Women who are postpartum –Women who are already receiving care coordination High risk populations –Prior poor birth outcome –Chronic conditions –Low socio economic status (environment / stress)

16. Approaches to Consider Health behavior / issue specific (e.g. folic acid, smoking cessation, family planning, weight) Mix and Match Groups (e.g. college age African American women, women over 35 planning a first pregnancy) Zip code focused – where are the most at risk communities? Consider health inequities within each approach

17. Strategies for Action

18. Promote Reproductive Life Planning Educate youth, men and women about their fertility Life choices Contraceptive options and availability Ask the questions Appropriate across the reproductive life spectrum

19. Advocate for continuous and comprehensive health care for the whole woman Stop thinking of women by body part Access to health care – respect, options, insured Complete care – nutrition counseling, mental health services, dental care, etc Medical home Clear communication Developmentally appropriate

20. Integrate & Collaborate Preconception messages include a wide range of health issues – pull together stakeholders from those different issues and TALK. Consider who else is reaching your population of choice and TALK. NOW is the time to reach across the hall ~ building ~ town ~ county to find creative ways to partner to achieve goals.

21. Policy Look globally to determine the bigger picture issues that are presenting barriers to women in achieving their health goals. –Healthy Youth Act, Smoking Ban, Interconception Care Waiver, Health care reform, worksite issues Find partners who can help you develop strategies to tackle one policy at a time –Child Fatality Task Force (Perinatal Health Committee) –March of Dimes –Advocacy for Children –Groups in your community – there are many

22. Think outside the box THE BOX

23. Road Blocks & Solutions Overwhelmed Silo thinking Can’t change paradigm Economic & resource crisis Start small Build bridges Be intentional Be strategic, data driven, creative and loud Believe we will make change happen

24. Acknowledge the complexity and move forward anyway!

25. Questions? Center for Maternal and Infant Health 919-843-7865 www.mombaby.org Sarah Verbiest, DrPH, MSW, MPH Sarahv@med.unc.edu

26. Resources www.EveryWomanNC.org www.beforeandbeyond.com www.getfolic.com www.nchealthystart.org