Every Woman Southeast

Transcription

1 Every Woman Southeast Region IV Compendium of Preconception Activities and Resources Compiled through a partnership between the March of Dimes Florida Chapter and the Center for Maternal and Infant Health June 21, 2010

2 Contents I. Background II. Methods III. Regional Information A. On-line Survey Results B. Title V C. Title X D. March of Dimes E. State Plan Comparison F. Folic Acid G. Preconception Councils H. Regional Network for Data Management IV. State information A. Alabama B. Florida C. Georgia D. Kentucky E. Mississippi F. North Carolina G. South Carolina H. Tennessee V. Next Steps A. Executive Summary B. Next Steps VI. Appendices A. Policy Activities B. Research Interests C. Leadership Group Involvement 2

3 I. Background The Southeastern Region of the United States, including Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee, historically has had high rates of infant mortality and morbidity, chronic disease, sexually transmitted infections, obesity, unplanned pregnancy, and poverty. Minority women in the South, particularly African American women, suffer disproportionately from these conditions. Over the years, progress has been made, yet the South continues to lag behind the nation in the health and well-being of its women and children. Data analysis and scientific study have demonstrated that additional progress in infant mortality and morbidity prevention demands an expanded approach to include women s health before, during and after pregnancy. This paradigm shift puts preventive health for woman of childbearing age in the forefront. The Every Woman Southeast initiative was started with the goal of developing a multi-state consortium to share and develop expertise on preconception / interconception health projects, policies, research, service delivery, awareness, and evaluation strategies in order to improve the health of women and infants in the Southeast region of the United States. The consortium will disseminate information about projects that have demonstrated success, create research and program opportunities among systems and states, share lessons learned from programs underway, maximize limited resources, provide local capacity building, increase the amount of grant funding attracted to Region IV, and stimulate new ideas and products for moving the preconception health agenda forward. The timing for this work is important for several reasons. First, given budget cuts and challenging economic conditions, it is time to be proactive not complacent. Secondly, there are a growing number of projects, plans and products being developed in this region on preconception health. By coming together now, the region can capitalize on this work and energy, harnessing it and using it to help each other. Further, the Region IV Network for Data Management and Utilization is developing and tracking regional indicators for preconception health. There is an opportunity to participate in this process as well as to benefit from the work. Finally, the era of health care reform brings new opportunities both for increased service provision as well as for guiding services to be inclusive of health and wellness messages for women of childbearing age. Working collaboratively, states in this region can leverage and monitor the process to insure that change moves forward in a manner that will positively impact this population of women, with a special emphasis on health equity. Assessing the different activities underway in the region as well as the interest in preconception health is an important first step in the Every Woman Southeast Initiative. This compendium reflects 3

4 many, but not all, of the preconception health activities underway. As the preconception movement is growing quickly, this report offers only a simple snapshot in time and a starting point for future collaboration. II. Methods The information shared through this compendium illustrates the diversity of activity to support preconception health. It also underscores the need for continued collaboration to build on the successes of on-going initiatives and learning from missteps. This compendium does not reflect everything that may be happening in Region IV, but does reflect the commitment of the region in embracing a multidisciplinary, comprehensive approach to well woman care for preconception health. The information in the compendium came from several resources. These include: a) an online survey, b) correspondence with state team members, c) personal interactions with team participants, d) information shared by states at the March 2, 2010 regional meeting, and e) web sources. This information was collected as part of the preparation for the first Every Woman Southeast Regional Planning meeting. Additionally, it is being used to guide the Initiative s next steps. The collection of the information included in this report was largely a voluntary endeavor. Thanks are due to many partners including: the Association of Maternal and Child Health Programs, the March of Dimes, the regional Department of Health and Human Services, and key leaders from each state who participated in preparations for the March 2010 meeting. III. Regional-level information A. On-line survey The online survey was made available through a link distributed to a variety of contacts and partners who in turn disseminated the survey to their networks. Nearly 300 surveys were completed. The primary objective of the survey was to collect state specific information on preconception activities (i.e. populations served, services provided, research interests and activities). The survey also provided an opportunity for respondents to identify needs that could be served by the consortium as well as to express an interest in becoming more involved in the Initiative. All eight states were represented in the responses. The survey respondents represented a wide variety of organizations and institutions. Florida and North Carolina had the largest number of respondents. This is likely due to the fact that these two states have developed networks of individuals and agencies engaged in preconception health with listservs, which facilitated survey dissemination. As the Every Woman Southeast Initiative grows, it will be interested to conduct a second survey in the future to assess increased engagement within states. 4

5 Figure 1: State representation of survey respondents Figure 2: Organizational representation 5

6 Respondents serve a wide variety of audiences. The majority of survey respondents indicated their work focused on pregnant women, post partum women, low-income women and women of childbearing age. Participants could select all that apply with many organizations serving multiple populations. Table 1: Populations being served by survey respondents Service Population of Survey Respondents Response Percent Response Count Agencies in the Southeast U.S.A. 8% 20 Legislators / Elected Officials 10% 25 Women in the military 11% 28 Men (in any category above) 16% 41 Women who are American Indian 22% 56 Fathers (in any category above) 27% 68 Women who are Asian 29% 74 Health care providers 33% 84 Children 34% 86 Women in college 42% 107 Women in the workforce 46% 115 Women living in rural areas 51% 130 Women living in urban areas 52% 132 Adolescents 54% 136 Women who are Hispanic 55% 140 Women who are African American 66% 168 New mothers 71% 179 Pregnant women 74% 188 Low income women 75% 189 Women from 24 to 45 years of age 75% 190 Young Women(18-24) 76% 193 Other 10% 25 The scope of work for most respondents focused on access to care issues, family planning, healthy lifestyles, infant mortality and preconception health. Fewer respondents indicated that they focused on genetics, infertility, and cancer. Again this may be more likely due to the method used to disseminate the survey link as opposed to the work underway in individual states. Seventy percent of survey respondents indicated that they had participated on a council, committee, or task force that addressed women s health, preconception, and/or infant mortality. The specific committees and councils are described in the appendices of this report. Interestingly, most survey respondents indicated that they had not participated in conference calls that included representatives from other states. This finding underscored the necessity and value of the Every Woman Southeast Consortium in developing a mechanism for cross-state sharing of ideas with respect to preconception health. 6

7 Figure 3: Respondent focus area(s) In addition to their professional work, many respondents indicated that they engage in volunteer work to support women s wellness, primarily faith-based activities (72%), but also mentoring programs (28%), sororities (13%), Girl Scouts (8%), coaching/sports teams (18%), and PTA/PTO school-related activities (22%). Survey respondents were provided the opportunity to indicate their interests and needs with respect to consortium activities. In order of preference, respondents indicated a need for a website to collect information about on-going preconception activities and resources in the region (77%), webinars on specific topics related to preconception health (72%), a regional symposium for skill-building (72%), collaboration opportunities for identifying funding sources (64%), and technical assistance with data collection activities (44%). 7

8 B. Title V support for preconception health Most states have at least some discretionary funding that they receive through Title V that they use to support preconception health. Many of these focus on the interconception period, on women who are at highest risk of a poor birth outcome. Many of the Healthy Start programs are engaged in a three year Interconceptional Care Learning Collaborative, which pilots short-term change projects. The core focus areas include: interconceptional care case management and risk screening, healthy weight, and maternal depression. Every state in Region IV has at least one Healthy Start project. Given that over 23 projects are currently funded in this Region, Healthy Start is an important partner for any interconception-focused project in these states. Table 2: Grantees for Title V funding for preconception health State Grantee Project Note: Alabama s Title V needs assessment highlights preconception health as a key area. Alabama Mobile County Health Department Healthy Start: Eliminating Racial/Ethnic Disparities (Mobile TEEN Center) Note: Florida adopted the following priority as identified in its Title V Needs Assessment - Improve preconception and interconception health and well-being Florida Department of Health and Human Services Northeast Florida Healthy Start Coalition University of South Florida Center for Health Equity, Inc. Pinellas County Health Department Prevention Partnerships for Children, Inc. First Time Motherhood/New Parent Initiative Healthy Start: Eliminating Racial/Ethnic Disparities (Magnolia Project) Healthy Start: Eliminating Racial/Ethnic Disparities Healthy Start: Eliminating Racial/Ethnic Disparities Healthy Start: Eliminating Racial/Ethnic Disparities (St. Petersburg Healthy Start Federal Project) Healthy Start: Eliminating Racial/Ethnic Disparities (Women's Health Initiative Program - WHIN) Note: Georgia adopted the following priority as identified in its Title V Needs Assessment - Promote preconception health Georgia Center for Black Women's Wellness, Inc Laurens County Board of Health MCG Health, Inc Healthy Start: Eliminating Racial/Ethnic Disparities (Atlanta Healthy Start Initiative) Healthy Start: Eliminating Racial/Ethnic Disparities (Heart of Georgia Healthy Start Initiative) Healthy Start: Eliminating Racial/Ethnic Disparities (Enterprise Community Healthy Start Initiative) 8

9 Two additional projects Healthy Start: Eliminating Racial/Ethnic Disparities Kentucky Whitley County Health Department Louisville/Jefferson County Metro Government Healthy Start: Eliminating Racial/Ethnic Disparities Healthy Start: Eliminating Racial/Ethnic Disparities (Louisville Metro Healthy Start Project) Mississippi Mississippi State Department of Health Tougaloo College Closing the Health Gap: African American Infant Mortality Healthy Start: Eliminating Racial/Ethnic Disparities (Delta Health Partners) Note: North Carolina adopted the following priority as identified in its Title V Needs Assessment - Improve the health of women of childbearing age North Carolina North Carolina Department of Health and Human Services North Carolina Department of Health and Human Services University of North Carolina at Pembroke North Carolina Department of Health and Human Services Healthy Start: Eliminating Racial/Ethnic Disparities (Baby Love Plus Program) First Time Motherhood/New Parent Initiative Healthy Start: Eliminating Racial/Ethnic Disparities State Systems Development Initiative Note: Currently Title V s major focus in South Carolina is on preconception health South Carolina South Carolina State Office South Carolina State Office Pee Dee Healthy Start, Inc Closing the Health Gap: African American Infant Mortality Healthy Start: Eliminating Racial/Ethnic Disparities Healthy Start: Eliminating Racial/Ethnic Disparities (Pee Dee Healthy Start) Tennessee Shelby County Government Healthy Start: Eliminating Racial/Ethnic Disparities 9

10 C. Use of Title X funding to support preconception health Several states have waivers that expand the use of Medicaid funding for the purposes of providing family planning to women (and some men) who meet state-specific criteria for eligibility. These states include Florida, Alabama, South Carolina, North Carolina, and Mississippi. Of these states, only North Carolina also serves men. North Carolina and Alabama are limited to serving women over the age of 18. In South Carolina while there is no direct funding for preconception care, clinics do provide general well woman care services to include health messages concerning diet and smoking cessations. Multivitamins are also provided through the family planning clinics. Georgia has submitted a request for a Medicaid Family Planning waiver that would cover interconception care and case management services for women with an infant born at very low birth weight. North Carolina is participating in a National Preconception Health Peer-to-Peer Learning Project led by Kay Johnson and supported by the Commonwealth Foundation. This project is bringing together seven states across the country that expressed an interest in expanding health care services to women, particularly mothers who had a poor birth outcome or high-risk pregnancy. The group is working together to develop benefit packages, cost/benefit data, and fact sheets to support state efforts to expand care. Each state has a representative from their state Medicaid office on their team. In Florida a preconception Keeping Tabs is a wallet-size educational booklet being developed to accommodate preconception health information in an easy to read format. The creation and printing of the booklet is being funded jointly by the Title V MCH Block grant and the Title X Family Planning grant. Title X has funded travel for attendance at March of Dimes hosted meetings which preconception health has been the primary focus of discussion; funds an FTE within IMRH where the PCH project resides and provides funds to the community health departments (CHDs) where family planning clients are educated to the importance of PCH. Title V funds contribute to the Healthy Start program wherein PCH education occurs with Healthy Start clients; assists with funding a temporary University of Florida intern to develop a PCH report for Florida; and assists with funding personnel within IMRH who work on PCH related activities such as CHD program monitoring. Also in Florida, the Family Planning Program (Title X) continues to incorporate the provision of preconception health education and counseling services during clinic visits to all Family Planning clients. The Family Planning waiver eligibility staff and supervisors are trained on preconception health issues. In July 2003, county health department preconception education and counseling technical assistance guidelines were developed and disseminated to all 67 counties. 10

11 In North Carolina there are a number of efforts underway to integrate preconception health across Title V and Title X programs. These include: a) BMI calculation and healthy weight counseling required during family planning, prenatal and postpartum visits; b) 5A s tobacco cessation counseling required for pregnant and postpartum women; recommended for family planning clients; c) Referral of all women receiving Medicaid prenatal case management to postpartum clinic visit; d) Follow-up with pregnant women interested in contraception/sterilizations per ACOG recommendations; e) Three recommended ACOG screening questions for domestic violence for pregnant and postpartum women; f) Educational materials provided to health departments and other community based organizations receiving Title X funding include healthy weight brochures and reproductive life planning brochures individualized for men and women; g) Counseling provided in Title X programs to delay pregnancy 18 months after previous delivery; and h) Assessment for rubella and tetanus/diphtheria immunity and provision of vaccine where indicated (Tdap or Td) in Title X programs. D. March of Dimes supported activities Each state chapter of the March of Dimes supports a community grants program. Preconception health related programs and activities are currently one of the March of Dimes funding priorities. Grants are awarded each year. Below is an example of some of the grants funded in To learn more about March of Dimes grants go to their main website at and visit each chapter s website for details. State Grantee Project Three Centering Pregnancy programs including a financial incentive for providers if they implement a successful CP program. Alabama Alabama Department of Public Health Provides preconception and interconception education to consumers and health professionals Florida Collier County Health Department Florida Department of Health Healthy Mothers Healthy Babies of Broward County Macedonia Missionary Baptist Church Distribution of preconception, interconception, and prenatal March of Dimes education materials for outreach efforts to pregnant women and women of childbearing age. Preconception and interconception education and distribution of multivitamins to Hispanic women Cooperative agreement for the development of a Preconception Health Council in Florida Preconception and interconception wellness for women through outreach and education on risk factors for prematurity, low birth weight, and infant mortality. Interconception services for high-risk women and adolescents with infants in the Neonatal Intensive Care Unit or who experienced fetal or infant loss Provides education and support to African American women by providing women with workshops on topics such as nutrition, use of folic acid, preconception health, and risk factors for prematurity and infant mortality 11

12 University of Miami/Jackson Memorial Hospital ACORN, Inc Escambia County Health Department Healthy Start Coalition of Hillsborough County Healthy Start Coalition of Osceola County Orange County Healthy Start Coalition Increases access and quality of care for African American and Hispanic women and infants. Provides March of Dimes Stork s Nest educational materials and augments Healthy Start interconception services provided to women whose infants are admitted to the Neonatal Intensive Care Unit Educates and provides multivitamins with folic acid to women of childbearing age Community baby shower to provide all families an opportunity to attend a full day of presentations on safe sleeping, interconception care, parenting, breastfeeding, and other topics HelpUGrow Interconception Care Program provides comprehensive services to infants admitted to the Neonatal Intensive Care Unit while also providing interconception care services to the infant s mother Provides preconception educational materials to the Woman and Infants Life Line Program Provides preconception education materials and train volunteers to provide preconception education materials in their community Georgia East Metro Health District University of Georgia Cooperative Extension Bibb County Clayton County Board of Health Fannin Regional Hospital Birthing Center Lowndes County Board of Health/South Health District Southeast Georgia Hospital System Provides folic acid vitamins to women of childbearing age who receive services in 5 county area Produce and distribute folic acid game to be used as a teaching aid in the Teenage Mothers Curriculum for the Expanded Food and Nutrition Education Program at the University of Georgia Increases access to healthcare, provides prevention/risk reduction services and education to African American women Purchases March of Dimes educational materials to distribute through birthing classes, health airs, inpatient units, perinatal units, and postpartum units Provides case management services to African American women Baby LUV program Provides services to women identified to be at risk for poor birth outcomes due to obesity Mississippi University of Mississippi Medical Center Department of Pediatrics Provides Resource Mothers to women who deliver very low birth weight infants North Carolina Migrant Benevolent Association Martin-Tyrell- Washington District Health Department UNC Center for Maternal and Infant Health Provides folic acid educational materials and multivitamins Provides folic acid education to women receiving services at family planning clinics Provides interconception health services, including medical services, education, and support, to women identified to be at risk of a poor birth outcome. Provides education to stakeholders on components of interconception care, service gaps, and importance of expanded care for women identified to be at high-risk for poor birth outcomes 12

13 Cabarrus Health Alliance Duplin County Health Department Hertford County Health Authority Mecklenburg County Health Department Pitt County Health Department West Greenville Regional Resources Haliwa-Saponi Tribe Ensures women diagnosed with gestational diabetes have access to education and treatment options Provides continued support services for up to 6 months for women who received services through the CenteringPregnancy Program Supports Preconception health Council with health promotion and education, interventions to address identified risks, and development of reproductive life planning materials Provides health education materials to community health ambassadors to support faith-based communities in providing health education materials to minority populations Implements a community preconception health awareness campaign that targets healthcare providers, employees within the local workforce, and community members of childbearing age Hosts educational sessions for women of childbearing age at risk for poor birth outcomes. This program reaches out to pregnant and preconceptional/interconceptional women to reduce barriers to healthcare and improve birth outcomes. Provides educational sessions, home visits and calls, and a transportation voucher program to 70 pregnant American Indian women and more women of childbearing years between the ages of that live in the Haliwa-Saponi territory. South Carolina Nurturing Center Perinatal Systems, Palmetto Health Foundation Augment services provided through Teen Parenting Program to include preconception and prenatal health education Offers individualized interconception counseling to post partum women with a previous poor birth outcome Tennessee Tennessee Folic Acid Council Nashville Metro Public Health Department Middle Tennessee State University Did u know what s good 4u is good 4 ur future baby? campaign utilizing textmessaging and Web technology to educate college women on important lifestyle issues. Pamper Me Well program that provides pampering and spa parties to African American women Provides folic acid education to Girl Scouts and their leaders E. Summary of state plans submitted to the Office of Women s Health In June 2008, the Office of Minority Health, Office of Women s Health and Office of Family Planning/ Title X met in Atlanta to strategize about how to increase collaboration among these offices in each state. As part of this work in October 2008, states in Region IV were asked to submit a multi-office strategic plan for reducing infant mortality. Six of the states in the region submitted a plan. The table below compares the goals of the different states. While ongoing efforts to encourage these three Offices to partner have been slow, this initial attempt suggests an ongoing need and interest to find collaborative projects to further link these important functions. The table below only reflects the areas of interested reported by six of the eight states in this one particular report in

14 Alabama Florida Kentucky Mississippi North Carolina South Carolina Pregnancy Intention X X X X X Reduce short birth intervals X X Reduce adolescent pregnancy X X Interconception care for women who had adverse pregnancy outcomes Health screenings for women of childbearing age Trainings for providers (including public health staff) X X X X X X Reduce disparities X X X X X X Reduce death rate from uterine / cervix cancer X Increase preconception health awareness X X Access to health care issues X X X Continue to enhance partnerships among 3 offices X X Media campaign of some type to promote family X X X planning / folic acid / preconception health Address environmental and policy changes needed to promote healthy living X X South Carolina also is focusing on a safe sleep campaign as well as partnering with a Healthy Baby Begins With You program through the Office of Minority Health. They also have their Care Line distribute folic acid information and vitamins. While Florida does not have an "Official" state preconception plan, preconception health (PCH) planning and program implementation resides within the Department of Health (DOH), Family Health Services, Infant, Maternal and Reproductive Health (IMRH) Unit. Preconception health is woven throughout the Family Planning and Healthy Start programs. Beginning in 2007, North Carolina began an 18-month collaborative strategic planning process to develop a 5-year State Preconception Health action plan. The plan includes guidelines for approaching the topic of preconception health and focuses on promoting pregnancy intendedness and healthy weight. Workgroups have been formed to address other key objectives, which include: increase consumer & community awareness about preconception health; ensure quality PC and practice among providers; expand access and affordability of PC; and advocate for environmental and policy changes that support preconception health. These goals are reflected in the table above, although they were not part of the 2008 plan submitted to the Office of Women s Health. F. Folic acid campaigns Educating women about the importance of taking a multivitamin with folic acid BEFORE pregnancy was one of the first major preconception health campaigns in this region. With strong support from the March of Dimes, CDC and state health departments as well as others, Region IV has worked very hard to promote this key message in many ways. Several states including Florida, North Carolina, Tennessee, and Kentucky have distributed multivitamins to low-income women at some point in time. Other states including: Kentucky, Tennessee and North Carolina have Florida, North Carolina, 14

15 South Carolina have very strong folic acid councils in place. Florida and South Carolina also have had very strong campaigns and out reach. The KY Folic Acid Partnership had 50 members, including 29 health departments or districts, health insurance companies, the Division of Public Health, and the March of Dimes. They serve 120 different counties, which is very challenging. They maintain a blog where partners can enter any activities they may be offering. This creates high transparency and visibility. In Florida, one of the first March of Dimes collaborative projects to specifically speak to preconception health was the Vitagrant initiative, which began in The Vitagrant initiative was a three-year grant ( ) funded through the March of Dimes to improve preconception health of childbearing age women through provision and distribution of preconception health educational materials and multivitamins with folic acid. The outcome evaluation indicated knowledge that multivitamins and folic acid prevents birth defects increased from 3% to 92 %. During this campaign Multivitamin consumption increased from 6 % to 88 % (p<= 0.01). The Tennessee Folic Acid Council is a collaboration between the Tennessee Chapter of the March of Dimes and the Department of Health. The council, through a variety of activities, provides education and advocacy regarding the benefits of folic acid to the general public, health care providers, and local policymakers so that the incidence of preventable neural tube defects is reduced. Folic acid work continues statewide. The NC Folic Acid Campaign is developing incorporation of additional preconception health messages into its strategic plan. Existing health care provider and consumer outreach programs are being modified to address healthy weight for women, and the campaign will take on additional messages as funding allows. The Campaign will continue to focus on folic acid for Spanish-language women in order to address the NTD disparity. March of Dimes and Divison of Public Health Women s Health Branch collaborating on a statewide multivitamin distribution program based on successful model in western NC. March of Dimes is providing training to 130 health agencies statewide and the state will ship a one-year supply of vitamins for low-income women of childbearing age seen at these clinics. For more information visit their website These activities have provided a firm foundation for future preconception health messages and have demonstrated the significant capacity within states to bring together diverse groups of stakeholders and to reach consumers, health care providers, legislators and business/industry. It has also provided experience and lessons learned in segmenting consumer populations and reaching out to different groups of women. All of the campaigns are facing funding challenges as original sources of support (Vitagrant settlement, tobacco settlement money, legislature, etc) are dwindling. This puts their strong infrastructure and partnerships at risk but also provides an opportunity for possible message 15

16 expansion, possibly to include additional preconception health messages. Of note, the folic acid movement in the South gained significant momentum when the March of Dimes declared neural tube defect prevention as its primary public health issue. G. Preconception councils Each of the eight states is in a different place in terms of building a coalition or council to focus on preconception health. In Florida, members of the former Every Woman Florida Preconception Health Council were merged with March of Dimes Prematurity Workgroup. Members work with the March of Dimes on many different initiatives to raise awareness of the importance of preconception health, working to improve the health of babies by preventing birth defects, premature birth, and infant mortality. North Carolina has a listserv of over 230 individuals from around the state who participated in the planning process or have expressed an interest in being part of a larger consortium. There is currently a leadership team made up of partners from state, academic and community-based nonprofits who provide support to this consortium. Several states including Georgia, South Carolina and Tennessee are interested in developing preconception councils, likely in partnership with March of Dimes Program Services Committees. Other states are thinking to add preconception health to other existing perinatal workgroups. H. Regional data The Region IV Network for Data Management and Utilization (RNDMU) was formed in 1983 to maintain and strengthen the state MCH agency s capacity to identify factors that contribute to the high infant mortality rate in Region IV, strengthen the MCH agency s leadership role in planning, promoting, coordinating and providing health care to address the problems identified and foster coordination and cooperation between state MCH agencies and state statistical agencies. In 1990 this work was expanded to include family planning and Title X providers in Region IV. In 1997 the database was expanded again to encompass women s health directors and consultants with new indicators added that related to women s health. In 2002 additional data points were added to collect better information for the growing Latina population in the region. In 2010, the data set is expanding once again to add indicators to allow the region to monitor and plan for its efforts to promote preconception and interconception health. For more information (and to view the data) please contact Julie DeClerque at Julie_DeClerque@unc.edu or visit Additionally, Florida and North Carolina are partners with six other states in a "Core State Preconception Health Surveillance Indicators 16

17 Development Initiative" to identify PCH indicators that can be measured utilizing several populationbased data systems. The article Where Are the Data to Drive Policy Changes for Preconception Health and Health Care? published in the Women s Health Issues 18S (2008) S81-S86, by Samuel F. Posner et al provides an overview about this effort. IV. State-level summaries Each state provided a report of on-going preconception activities in their state at the meeting that convened on March 2, Furthermore, some states elected to provide additional information beyond that which was provided in their March 2, 2010 report. This information is also provided. These summaries are in no way a comprehensive list of activities of what is happening in each state, rather a reflection of the intense interest and diversity of approach in addressing preconception health. A. Alabama Alabama has a very strong perinatal program structure. This structure was established by their legislature, therefore has permanence, even if it isn t always funded. There are five perinatal regions, established around a Regional Perinatal Center, a structure that works very successfully in AL. This also includes a state Perinatal Advisory Committee. AL has a State Preconception Plan that is particularly relevant to the issues of the people who are willing to come to the table at present, such as providers from university-based clinical settings. Private providers being still being missed and the AL team would like suggestions about better ways to reach them. They have expanded FIMR to be statewide, using their state perinatal program structure. A key preconception health issue that was identified through this process was maternal obesity. There is a Short Birth Interval Project underway in 7 counties. The project includes messages about folic acid, birth intervals, and lifestyle behavior changes. There is also a study of women with repeated drug use in pregnancy in process. Smoking cessation products are now covered by Medicaid formulary. The Alabama Breastfeeding Committee is currently working on Baby Friendly Hospitals and Breastfeeding in the Work Place projects. The state also has a Health Disparities Plan which includes areas such as SIDS, infant mortality and obesity. B. Florida Florida has a significant number of preconception related activities underway. Most recently, the Department of Health was recently awarded a new March of Dimes grant to raise awareness and garner support from healthcare providers to encourage the integration of preconception health services into their professional practices. This will be achieved through the hosting of speakers at grand round type presentations, which will be offered to healthcare providers and staff at a minimum of six hospitals throughout the state. In 2004, Florida passed legislation establishing the Department of Health Officer of Women's Health Strategy with the charge to direct public policy to address the distinct health needs of women across the life span. The law also specifies that an Officer of Women's Health Strategy chairs the Interagency 17

18 Committee on Women's Health and oversees the work. This committee is charged with other tasks as well that are outlined in the legislation, including coordinating a Governor's statewide conference on women's health. The Maternal Child Health program through Healthy Start, Family Planning, Office of Minority Health, and the Women s Health programs all focus on the importance of preconception education and counseling. Recently, the Florida Chapter of the March of Dimes consolidated their grant-making at state level around preconception health focusing on women with a baby in the NICU. Florida received HRSA state women s health integration grant looks at women s health across funding streams to see how to integrate better. Unfortunately, this work is currently stalled because of organizational issues. The Every Woman Florida Preconception Health Council was established in 2009 but is no longer a separate entity. The council was merged into the existing March of Dimes Prematurity Workgroup. The March of Dimes Florida Chapter s Prematurity Workgroup-Promoting the health and wellness of women and couples before pregnancy improves birth outcomes. The March of Dimes, the U.S. Centers for Disease Control and Prevention (CDC), and partner organizations are working together to educate health providers, women and men about the importance of preconception health and care. PAMR-The Pregnancy Associated Mortality Review project is a population based surveillance and selective case review process aimed at reducing Florida s maternal mortality rate. The PAMR project seeks to monitor trends in pregnancy associated deaths and identify gaps in care, systemic service delivery problems, and areas in which linkages between community resources can be improved to facilitate improvements in the system of care. The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and well-being of mothers, babies, and families The Diabetes Advisory Council is a governor-appointed group that advises the Governor and the Department of Health Secretary on emerging diabetes issues effecting care, treatment, and quality of life. The guidance of and recommendations made by the Council improves policy and legislation efforts, as well as influences the strategic planning of the Diabetes Control Program. The Interagency Collaborative is made up of representatives from the Departments of Education (DOE), Health (DOH), and Children and Families (DCF). The groups meet quarterly to identify opportunities to collaborate on student health initiatives. The group utilizes the Coordinated School Health Approach to impact the physical, mental, and psychosocial health of students in grades K-12. Components include health education; nutrition; physical activity; health services; counseling, psychological, and social services; school environment, including the social environment, bullying and safety; staff wellness; and parent and community involvement. Members frequently blend funding and other resources to support joint projects such as conferences, webinars, and provision of resources to schools. The Office of Positive Youth Development coordinates and initiative that providedsa network of community-based support to help adolescents succeed as they move into adulthood by focusing on the "assets" of individual youth and their families. Programs reinforce positive attitudes, healthy behaviors and activities, and reduce risk-taking behaviors, such as sexual activity, substance abuse, suicide and behaviors that increase risk of unintentional injury and chronic disease. 18

19 The Florida Leadership Council for Tobacco Control - The Leadership Council worked with the Florida university system to develop updates to the Tobacco-Free Florida Plan, a resource document summarizing tobacco use, impact statistics, and information about tobacco economics, policy, and prevention and control programs in Florida. Every Woman Florida (EWF) is a collaborative project between the March of Dimes (MOD) and the Florida Department of Health (DOH) that specifically speaks to preconception health. This initiative was modeled after California s Every Woman, Every Time campaign on preconception health. The EWF statewide campaign aims to raise awareness, increase knowledge of and screening for risk factors that could lead to adverse birth outcomes. This initiative is responsible for garnering support from healthcare providers and promoting the integration of preconception education into their professional practices. This will be achieved through the provision of grand rounds type presentations offered to a minimum of six hospitals throughout the state. The EWF initiative includes a social marketing / awareness campaign which includes marketing materials and the development of a website. The website was launched in spring 2009 and can be accessed in one of three ways: or This website serves as an information portal for providers and consumers on preconception health. Department of Health-FOGS Cesarean Section Study Workgroup -The Florida Department of Health and the Florida Obstetrics & Gynecological Society are partner s is the lead agency in a seven state collaborative to establish standards for measuring preconception health. Society for Maternal Fetal Medicine (SMFM) - members serve as preconception health speakers at hospital grand rounds statewide. Florida Association of Healthy Start Coalitions (FAHSC) - Provides interconception health education and counseling as an enhanced service. The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and well-being of mothers, babies, and families. American College of Obstetricians and Gynecologists (ACOG)- Serving as a strong advocate for quality health care for women. Additionally, their members have agreed to serve as preconception health speakers at hospital grand rounds statewide. American Academy of Pediatrics (AAP) - Committed to the attainment of optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults. Healthy Start Coalition of Escambia-This healthy start coalition has produced and distributed the "Your Reproductive Life Planning Guide", which serves as a preconception health counseling and educational tool. Department of Health s Healthy Homes initiative - The Healthy Homes initiative is responsible for providing training, education, counseling and referral in identifying environmental household hazards. This initiative mission is to protect the health of children and adults living in Florida by preventing exposure to environmental household hazards. Florida's Lead Poisoning Prevention Program - The mission of Florida's Lead Poisoning Prevention Program is to protect the health and cognitive development of children and adults living in Florida by preventing exposure to all lead hazards. 19

20 The Pinellas CHD Healthy Start program has developed a series of pamphlets entitled All Women Need to Know. which contains information on a variety of women s health topics such as baby spacing, nutrition, physical activity, healthy relationships, female infections, and depression. They are used to provide interconceptional education and counseling. The 13 pamphlets give brief information in three sections: statistics, risk factors, and ways to reduce the risk. The information matches the information provided in the women s health kiosks, which are located in clinic waiting areas. C. Georgia Georgia s most current project is the development of a preconception health toolkit developed for health care providers. They are currently developing an dissemination program for the toolkit. Initially Family Medicine providers gave significant input in the development of the tool kit. The Georgia Ob/Gyn Society is now involved as well. HRSA is supporting a study to evaluate the implementation of the toolkit. While Georgia does not have a family planning waiver at present, they are currently working with their legislator to pass legislation to make this possible. There are several Centering Pregnancy programs around state, including at Grady Memorial Hospital where it is included as part of a larger interconception program. Grady hospital under the leadership of Dr. Anne Dunlop developed and studied an interconception program focusing on mothers of medically fragile infants. Georgia has several Title V programs, which include perinatal planners who address preconception health through education and case management. There continues to be a lot of work to be done in terms of breaking down silos and working in a more coordinated fashion. The Georgia Children s Health Care Alliance is working on interconception and preconception health. Children s Advocacy Network has a low birth weight prevention initiative and Head Start has a healthy mother / healthy weight program. There is also a preconception program in Augusta that is funded by CDC and MOD. D. Kentucky Recently, Kentucky was able to hire a family planning coordinator at the state level who will also be involved in women s health. The state is also working on a strategic plan to address teen pregnancy. The state has a number of innovative programs. The HANDS program (Handling All Neonatal Deliveries Safely) provides home visits until child is two. This program also provides interconception counseling. Tobacco use among women of childbearing age (including pregnant women) is very high, with half of all pregnant women reported to be smokers. The GIFTS (Giving Infants and Families Tobacco-Free Starts) program has produced a 20% quit rate (compared to a normal 10%). The state developed a family planning brochure that includes information about anatomy, birth control, GYN visit specifics, and preconception counseling. Channing Bete is currently planning to produce this brochure and add it to their inventory. 20

21 National Women s Health Week 2010 featured a Walk Across Kentucky event, with state legislators, first and second lady, etc leading the way. There were information booths for women s health topics along the way. This created high visibility and some political buy in for women s health initiatives. Healthy Babies are Worth the Wait is a major preterm birth prevention initiative supported in part by the March of Dimes. One legislative issue that people are watching with concern relates to a bill introduced by one senator and one representative to make it a Class E felony if you use drugs or alcohol while pregnant. This is not likely to move forward but it is problematic. E. Mississippi Mississippi is just starting to move toward preconception programs. The MINE (MS Infant Mortality Elimination) and the DIME (Delta Infant Mortality Elimination women who have a baby in the NICU at UMC) are two major initiatives underway. These programs seek to decrease infant mortality in the Mississippi Delta by filling gaps in healthcare services for women and infants, increasing efficiency and utilization of available healthcare services, and enhancing knowledge and skills of healthcare consumers and providers in the Delta. The DIME program will include infant death review conferences. Both have strong evaluation plans and publications will be forthcoming. The goal for these projects is to provide preconception health information to the women to help them make a reproductive plan and follow it for better outcomes. Data initiatives are underway to document the need for preconception health programs. State EPI working on study to determine prevalence of preconception care, using folic acid questions from BRFSS, and comparing with other Delta states (like TN, AR, LA). MS also has the Healthy Mamas Make a Healthy Delta program which targets diabetic female heads of households. They also have the MIHOW (Maternal Infant Health Outreach Worker) program to stimulate the birth and growth of low-cost parent to parent interventions. F. North Carolina North Carolina has been working on issues related to preconception health for more than two decades. A summary of those activities is available in the Looking Back, Moving Forward booklet available online The state has a preconception plan, which includes several workgroups focusing on the top three goals. The September/October 2009 issue of the North Carolina Medical Journal focused exclusively on the topic of preconception health. The Journal can be reviewed online free of charge at In October 2009 a two-day Healthy Birth Outcomes conference was held. The conference was funded by a grant from the CDC and hosted by the Forsyth County Health Department. The main focus of the conference was preconception health. More information about this conference as well as links to some of the speaker presentations is available online at click on plans and programs. 21

22 NC s First Time Motherhood/New Parent program has developed a social marketing campaign using radio and TV advertisement. The campaign promotes reproductive life planning and utilization of the state s Title V hotline. Curriculum, toolkits and pamphlets have been development for preconception health training of health care providers, faith-based communities and community outreach workers. More information is available at with products available for review at Funded with Title V funding has fostered a partnership between the Division of Public Health and the N.C. Healthy Start Foundation in development and updating of materials that promote preconception health. These materials are available in bulk without charge to organizations in N.C. Materials include topics of HIV/STIs, healthy weight, reproductive life planning, folic acid, mental health, and substance use cessation. To learn more go to The North Carolina Folic Acid Campaign is currently in the process of shifting its mission and identity to encompass a larger mission and become the North Carolina Preconception Campaign. Issues related to tobacco use during and after pregnancy are getting renewed attention in North Carolina, in part due to funding provided to the You Quit. Two Quit program by the NC Health and Wellness Trust Fund. For more information about this program go to There are also several studies and projectsunderway / recently completed in North Carolina. The NC Division of Public Health and NC Healthy Start Foundation have conducted focus groups to explore issues among women related to Unintended Pregnancy and communication between Latina mothers and daughters on reproductive health issues. The NC Folic Acid Campaign has been studying the impact of social marketing on folic acid consumption as well as the impact of their Latina outreach work. The UNC Center for Maternal and Infant Health has a partnership with Wake County Human Services (funded by the John Rex Endowment) to implement a program to improve postpartum visit utilization and content of care. This project is expanding to include a 12 month postpartum group program for mothers who were diagnoses with gestational diabetes mellitus during pregnancy. The Center is also completing data analysis on a major three year project that focused on providing services to mothers of infants in the intensive care nursery. G. South Carolina South Carolina also has a strong regionalized perinatal program. This program has created a network of people who can be quickly organized to make things happen. South Carolina also has six nurse-family partnership programs. The South Carolina Chapter of the MOD focuses their spending on grants to start programs addressing interconception and preconception health in several parts of the state. Currently, South Carolina is very interested in learning from other states as they develop a vision as to how to address preconception health in their state in the future. 22