Learning Objectives


  1. 1 Reproductive Life Plan
  2. 2 Consumer awareness
  3. 3 Preventive Visits
  4. 4 Interventions for Identified Risks
  5. 5 Interconception Care
  6. 6 Prepregnancy Checkup
  7. 7 Health Insurance Coverage for Low Income Women
  8. 8 Public Health Programs and Strategies
  9. 9 RecommendationResearch
  10. 10 RecommendationMonitoring Improvements

1 Reproductive Life Plan

Objective

Women of childbearing age, men, and couples should be encouraged to have a reproductive life plan.

Action Steps

  • Develop, evaluate, and disseminate reproductive life planning tools for women and men in their childbearing years, respecting variations in age; literacy, including health literacy, within a cultural context.
  • Develop, evaluate and disseminate individual health education materials for women and men regarding preconception risk factors, including materials related to biomedical, behavioral, and social risks known to affect pregnancy outcomes.

2 Consumer awareness

Objective

Increase public awareness of the importance of preconception health behaviors and preconception care services by using printed and electronic media this is sensitive to literacy, including health literacy, and cultural values.

Action Steps

  • Develop and age-appropriate educational curricula and modules for use in schools' health education programs.
  • Integrate reproductive health messages into existing health promotion campaigns (e.g. campaign to reduce obesity and smoking)
  • Conduct consumer-focused research necessary to identify terms the public understands and develop messages for promoting preconception health and reproductive awareness.
  • Develop messages for promoting preconception health knowledge and attitudes and behaviors among men and women of childbearing age.
  • Engage media partners to assist in depicting positive role models for lifestyles that promote reproductive health (e.g. Delaying initiation of sexual activity, abstaining from unprotected sex, and avoiding alcohol and drug use).

3 Preventive Visits

Objective

Provide risk assessment and educational health promotion counseling to all women of childbearing age as a component of primary care visits, to reduce reproductive risks and improve pregnancy outcomes.

Action Steps

  • Increase health care provider awareness regarding the importance of addressing preconception health among all women of childbearing age.
  • Develop and implement curricula on preconception care for clinical instruction, and for continuing education of health care professionals.
  • Develop a recommended screening and health promotion package.
  • Develop a practical screening tool for primary care settings, which emphasizes preconception risk assessment (e. g. reproductive history, genetic, and environmental risk factors)
  • Develop evidence-based models for integrating components of preconception care to facilitate delivery of and demand for prevention and intervention services.
  • Establish benchmarks, provider training, and self audits to improve provider knowledge attitudes, and practices to reduce missed opportunities for screening and health promotion.
  • Use federally funded collaboratives for community health centers and other Federally Qualified health Centers to improve the quality of preconception risk assessment, health promotion, and intervention provided through primary care.
  • Develop fiscal incentives for screening the health promotion.

4  Interventions for Identified Risks

Objective

Increase the proportion of women who receive interventions as follow-up to preconception risk screening, focusing on those interventions with evidence of effectiveness and greatness potential impact.

Action Steps

  • Increase provider awareness concerning importance of ongoing interventions for chronic conditions and identified risk factors.
  • Implement modules on preconception care for specific clinical conditions for use in clinical practice, and for continuing education credits.
  • Disseminate existing guidelines related to evidenced-based intervention for clinical conditions and risk factors.
  • Disseminate evidenced based interventions that address risk factors that can be used in a primary care setting (i.e alcohol misuse; antiepileptic drugs, diabetes, folic acid deficiency hepatitis B, HIV/AIDS, hyperthyroidism, PKU, rubella seronegativity, obesity, oral anticoagulant, STD and smoking.
  • Apply quality improvement techniques and tools, establish benchmarks, self audits, and participate in quality improvement collaborative groups.

5 Interconception Care

Objective

Use the interconception period to provide additional intensive interventions to women who have had a previous pregnancy that ended in an adverse outcome (i.e. infant death, fetal loss, birth defects, low birthweight, or preterm births).

Action Steps

  • Monitor the percentage of women who complete postpartum visits.
  • Develop, evaluate and replicate intensive evidenced-based interconception care and coordinate models for women at high social and medical risk.
  • Enhance the content of postpartum visits to promote interconception health.
  • Use existing public health programs serving women in the postpartum period, to link them to other sources of interventions (e.g. Family flanning, home visiting, WIC).

6 Prepregnancy Checkup

Objective

Offer one prepregnancy visit for individuals planning pregnancy, as a component of obstetric care.

Action Steps

  • Review and revise existing professional guidelines to develop the recommended content and approach for such a visit.
  • Recommend modification in payment regulations to permit payment for a prepregnancy visit.
  • Educate women and couples regarding the value and availability of prepregnancy planning visits.

7 Health Insurance Coverage for Low Income Women

Objective

Recommend and advocate of increase public and private health insurance coverage for women with low incomes to improve access to preventive women's health and preconception and interconception care.

Action Steps

  • Improve the design of family planning waivers by permitting options to offer interconception risk assessment, counseling and intervention along with family planning services.
  • Increase health coverage among low income women of child bearing age by using federal options and wavers under public and private health insurance systems and the State Children's Health Insurance Program.
  • Increase access to healthcare services through policies and reimbursement levels for private and public health Insurance systems to include a full range of clinicians who care for women.

8 Public Health Programs and Strategies

Objective

Integrate components of preconception health care into existing local public health "well women's health care" and related programs, including emphasis on interconception interventions for women with previous adverse outcomes.

Objectives

  • Use Federal and local community support to encourage more integrated preconception health practices in clinics and programs. Provide support for CDC programs to develop, evaluate, and disseminate integrated approaches to promote preconception health.
  • Evaluate the preconception care activities used by other programs, and support replication projects.
  • Use local task forces, coalitions or communities to discuss opportunities for promotion and prevention in preconception health at the community level.
  • support public health practice collaborative groups to promote shared learning and dissemination of approaches for increasing preconception health
  • Include content related to preconception care in educational curricula of schools of public health and other training facilities for public health professionals.

9 Recommendation
Research

Objective

Increase the evidence base and promote the use of the evidence to improve preconception health.

Action Steps

  • Prepare evidenced-based systematic review of all published reports on programs, and policy through the Agency of Healthcare Research and Quality.
  • Support evaluation of model programs and projects, including integrated service delivery and community health promotion projects.
  • conduct studies to advance knowledge of preconception risks, clinical and public health intervention, including knowledge of more integrated practice strategies and interconception approaches.
  • Design and conduct analysis of cost benefit and cost effectiveness as part of the study of preconception interventions.
  • Examine factors that results in variation in individual use of preconception care (i.e., barriers and motivators that affect healthcare.

10 Recommendation
Monitoring Improvements

Objective

Monitor selected preconception health indicators (i.e., folic acid supplementation, smoking cessation, alcohol misuse, diabetes, and obesity).

Action Steps

  • Use pregnancy Risk Assessment and Monitoring System to monitor individual experiences related to preconception care.
  • Target preconception health programs and interventions to areas where high rates of poor health outcomes exists for women of reproductive age and their infants.
  • Use perinatal records of risk to measure and monitor the proportion of risk attributable to the health of women before pregnancy,
  • Include preconception, interconception, and health status measures in population-based performance monitoring systems (e.g. Title V programs).
  • Include a measure of preconception care services delivery in the Healthy People 2010 0bjectives.
  • Develop and implement indicator quality improvement measures for all aspects of preconception care, example, use the Health Employer Data and Information Set Measures to monitor the percentages of women who complete preconception care and postpartum visits or pay for performance measures.