Transcript Document

Promoting Healthy Birth Outcomes:
Moving Science into Practice
Sarah Verbiest, DrPH, MSW, MPH
UNC Center for Maternal and Infant Health
October 28, 2009
“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
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
National Leadership & Structure
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National Select Committee
National Symposiums (I and II)
MMWR article & MCH Journal Supplement (2006)
Active Work Groups:
– Clinical
– Public health
– Policy & Finance
– Consumers
– Research
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.
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
National Resources
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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
– AJOG, 199: 6, Supp B (Dec 2008)
North Carolina:
birth place of
modern
preconception
health
The Early Years
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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
Current Events
• Breastfeeding Initiatives
• NC Medical Journal Issue – coming soon!
• Southeast Regional Consortium – planning
phase
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
Socio Ecological Framework
WiseWoman Project Manual, Chp 6, p 90, Developed by the UNC Dept. of Health Education and
Health Promotion
Opportunities for Intervention
Pre-Pregnancy
Population
Pregnancy
Delivery
Postpartum
Prevention
e.g.
Diabetes
Obesity
Smoking
Childbearin
g complete
Source: Burstin, Helen [2009] Policy Issues in Perinatal Quality Improvement [Powerpoint Slides] Retrieved from Symposium Quality Improvement to Prevent Prematurity
Social Services
Physical
Environment
Clinical Care
Behaviors &
Lifestyle
Healthy
Women
Economic
Environment
Family & Social
Support
Schools
Community &
Cultural
Environment
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.
Approaches to Consider
• Low hanging fruit
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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)
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
Strategies for Action
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
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
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.
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
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Child Fatality Task Force (Perinatal Health Committee)
March of Dimes
Advocacy for Children
Groups in your community – there are many
Think outside the box
THE
BOX
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
Acknowledge the complexity
and move forward anyway!
Questions?
Center for Maternal and Infant Health
919-843-7865
www.mombaby.org
Sarah Verbiest, DrPH, MSW, MPH
[email protected]
Resources
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www.EveryWomanNC.org
www.beforeandbeyond.com
www.getfolic.com
www.nchealthystart.org