Improving the Health of Women Before Pregnancy
A Key Strategy to Reduce Infant Mortality
Preconception care: care a woman gets before she becomes pregnant, prior to conceptionInterconception care: care for women who have had a prior adverse pregnancy outcome to address risks
Care Prior to Pregnancy= Well Woman’s Health Care
Consensus Definitionof Preconception Care
“A set of interventions that aim toidentify and modify biomedical, behavioral, and social risksto a woman’s health or pregnancy outcome throughprevention and management,emphasizing those factors which must be acted on before conception or early in pregnancy to have maximal impact.”CDC’sSelect Panel on Preconception Care, June2005
Many risk factors for infant mortality, preterm birth, and other adverse pregnancy outcomes are related to maternal health.Experts have identified a wide array of evidence-based interventions that would benefit pregnancy woman and/or infants particularly if provided prior to pregnancy (Jack et al. 2008)
Why focus on woman’s health before pregnancy to prevent infant mortality?
High quality prenatal care is essential but care during pregnancy cannot :ameliorate risks associated with women’s health status when not pregnantAmeliorate risks associated with pregnancies with shortinterpregnancyintervalAmeliorate risks associated with unintended and unplanned pregnancies
Why focus on women’s health before pregnancy?
Reduce unintended pregnancyIncrease appropriate birth spacingIncrease contraception accessGiven that half of all pregnancies are unplanned, preconception/interconception care is critical to enhancing the likelihood of a healthy pregnancy outcomeAccording to theGuttmacherInstitute, for every $1 spent on family planning, $3.74 is saved
A focus on women’s health = Opportunity to plan pregnancies
HypertensionDiabetesSTIs and UTI and other infections including bacterialvaginosisImmunization statusFolic Acid and other micronutrientsTeratogens (e.g., prescription medications, household exposures)Mental Health
A focus on women’s health = Opportunity to Reduce Risks
Strength of Recommendations and Quality of Evidencefor Preconception Clinical Interventions –A’s (Best Evidence,35)
Jack,Atrash, et al., 2008
Strength of Recommendations and Quality of Evidence Preconception Clinical Interventions –B’s (Fair evidence, 25)
Jack,Atrash, et al., 2008
A focus on women’s health = Opportunity to Change Behavior
Prevalence of Risk, Medicaid and Total, PRAMS, 26 Reporting Areas, 2004
Source: Centers for Disease Control and Prevention.D’Angeloet al.Preconception and Interconception Health Status of Women Who Recently Gave Birth to a Live-Born Infant .MMWR. 2007; Vol. 56 /SS-10.
Preconception health and well-woman health concepts have been advance but our commitment and investments:Have not been fully transformed into a national strategy to ensure every woman has a medical / health care home.Are limited with 4 in 10 low-income women having no health insurance public or private.Need a commitment to access for women’s clinical and community preventive services as in ACA.
It is Time for a Reinvestment in Women’s Health when Not Pregnant
ACAcoverageACApreventive benefits, including well-woman visits and preconception careFamily Planning –Title X:vital infrastructuremust be supported and expanded even in the face of coverage expansionMedicaid coverage -women’s postpartum coverage must be extended beyond 60 daysFamily Planning –Medicaid Family Planning waivers and State Plan Amendments
We Can and Should Build on Prior Investments
ACA requires all health plans (except those grandfathered and Medicaid) to cover certain preventive services without cost-sharing.As of Aug. 1, 2012,estimated 47 millioninsured women enrolling in new health plans or renewing their existing policies will have coverage for preventive health services without cost-sharing:Well-woman visits (annual preventive visit including preconception care)Gestational diabetes screeningHPV DNA testingSTI counselingHIV Screening and counselingContraception and contraceptive counselingBreast-feeding support, supplies, and counselingInterpersonal and domestic violence screening and counselingPlus immunizations and other services recommended by theU.S.TaskForce on Clinical Preventive Services.
ACA Women’s Clinical Preventive Services Coverage
Recommendations for Risk Assessment and Health Promotion In Preconception Care(Adapted from Moos et al, 2008)
We need a national campaign to ensure women take advantage of the preventive health visit.Women need to know about their “right” to preventive health careHealth care providers need training/education in well-woman health care across the life course.Develop and implement clinical guidelines for well-woman visitDevelop systems of care in which women do not fall through the cracks (e.g., medical care home; link between prenatal, postpartum and well-woman health care) – Key Role for Title V
We need to take the next step…