What is Preconception Health?
Preconception health is the state of a woman's health prior to becoming pregnant. Preconception health seeks to set the stage for a healthy pregnancy and a full-term birth by promoting the best possible physical, mental, and behavioral environments for a woman before she conceives. This includes family and community support and safe home and work environments.
With over half of the pregnancies in the United States unplanned, it is important to educate women who are sexually active about the importance of preconception health. This isn't just a consideration for first time mothers either, but also mothers who may become pregnant again (interconception health).
Factors to Consider
The goal of preconception health is healthy birth outcomes, both for the mother and the child. There have been significant advances in public health, medicine and research toward understanding the complexity of what contributes to healthy birth outcomes. With all this progress, however, the United States is still behind many other countries in healthy birth outcomes, and Milwaukee is even worse off.
City of Milwaukee Health Commissioner Bevan Baker recently announced a 20% decline in the infant mortality rate for Milwaukee, to a rate of 11.9. This rate, the number of infant deaths per 1,000 live births, is the gold standard indicator for healthy birth outcomes. Although the decrease is encouraging, Milwaukee rate still represents 111 babies who died before their first birthday in 2007 - more than the 105 homicides the city had in the same year. Moreover, racial disparities still exist in infant mortality, with black infants being more than twice as likely to die (14.1/1000) than white babies (6.2/1000) before their first birthday. To put it into perspective, the National Association of County and City Health Officials reported in 2007 that Milwaukee ranks 7th out of 53 comparably-sized cities for the highest rate for infant mortality and 15th out of 54 cities for most babies born with low birth weight, which is another indicator for healthy birth outcomes.
Healthy birth outcomes including infant mortality and birth weight are influenced by many factors, including the mother's age, health status and behavior during and after pregnancy. Research has identified several risk factors that contribute to poor infant survival:
- Poverty
- Racism
- Late Prenatal Care
- Smoking
- Substance Abuse
- Poor Nutrition
- Obesity
- High Stress
- Domestic Violence
- Low Maternal Weight Gain
- Preterm Labor
Reproductive Life Plan
It is no surprise that many factors that contribute most to infant survival can be addressed by good preconception health. The Center for Disease Control (CDC) has recommended that both men and women consider a reproductive life plan and make a concerted effort in the preparation and planning of their family.
A reproductive life plan can include the discussion and choice of effective contraception but it also includes a plan for how to address any of the known risk factors that exist in their lives, thus clearing the way for a healthy and full-term pregnancy. A reproductive life plan is yet another opportunity for men and women to understand the complexity of life choices and empowers them with the ability to choose the future for themselves and the future of their children.
Local Initiatives
With Milwaukee ranking poorly in healthy birth outcomes, there are important initiatives currently taking place in Milwaukee to address and understand the situation and support better preconception health.
Center for Urban Population Health & Aurora Health Care
Pre and Inter Conception Health Care Taskforce
A planning grant to develop culturally appropriate strategies for enhancing access to preconception and prenatal care and improving birth outcomes among at-risk women. The Center is providing coordination and evaluation of the project. Funded to Aurora Health Care by the Wisconsin Partnership Fund.
Catalog of Initiatives Addressing Healthy Birth Outcomes
A reference list of programs, projects, interventions and/or research that the Center maintains to facilitate communication among all partners
Trends in Teen Births in the City of Milwaukee: Setting a Feasible Goal to Reduce Births for Young Teenagers Aged 15-17 Years Old
A paper describing the methodology used to assist the Milwaukee Health Department and United Way in setting a goal.
City of Milwaukee Health Department
MAPP Action Group: Improving Birth Outcomes and Healthy Development
With a shared vision for Milwaukee to be a model community with healthy, safe, hopeful and empowered residents, the Milwaukee Health Department is leading public health leaders and community members through a nationally recognized community health assessment model, MAPP. Results of the assessments and community group's discussion informed the Steering Committee of nine comprehensive issues that concern Milwaukee's residents. One of those issues is Improving Birth Outcomes and Healthy Development.
FIMR Fetal Infant Mortality Review
The Fetal Infant Mortality Review (FIMR) is designed to learn what can be done to prevent fetal and infant deaths occurring in the City of Milwaukee. The FIMR team is concerned with both infant deaths (babies who are born alive but die within the first year of life) and fetal deaths (babies who die before they are born, but after the 20th week of pregnancy).
The purpose of these reviews is to identify the factors associated with these deaths, and develop recommendations for change. To date, the FIMR project has produced four reports summarizing the FIMR findings and recommendations. These reports have been distributed to local leaders, to hospitals, to healthcare providers and to the community.
The United Way of Greater Milwaukee
United Way of Greater Milwaukee has spearheaded an effort to bring the issue of teen pregnancy to the forefront of public attention. Despite the hard work and dedication by many individuals and organizations within the community to address teen pregnancy, most efforts have not provided significant results. To address the teen pregnancy crisis, United Way has sponsored and authored a comprehensive report, invested in targeted programming, initiated the first phase of a social marketing campaign, and created a web presence accessible to teens and others on the effects of teen pregnancy.
University of Wisconsin -School of Medicine and Public Health
Special Initiative: Disparities in Infant Mortality
The UW-Madison School of Medicine and Public Health has launched a special long-term funding initiative to investigate and ultimately reduce the high incidence of African American infant mortality in Wisconsin.
As a first step in addressing the problem, the program produced a white paper report "Elimination of Racial and Ethnic Disparities in Birth Outcomes in Wisconsin." With the recommendations, the Wisconsin Partnership Program joined with the Johnson Foundation and the UW School of Medicine and Public Health for a two-day conference on May 22 and 23, 2008, entitled "The Wisconsin Infant Mortality Summit" where state and national experts in the field convened at the Wingspread Conference Center in Racine, Wisconsin. The purpose of the conference was to discuss infant mortality and create a coalition of partners to support an action plan for improving birth outcomes among African American women in Wisconsin.
Following the conference, the Wisconsin Partnership Program will begin extensive planning for a comprehensive, multi-year strategy based on evidence-based, best practice public health and self-sustaining community-based interventions intended to produce better African-American birth outcomes.
Medical College of Wisconsin - Center for the Advancement of Underserved Children
The Center for the Advancement of Underserved Children's faculty and staff is engaged in a number of community-academic initiatives with a mission to improve the health and well being of underserved children through research, education, clinical care, advocacy, and community partnerships. Dr. Emmanuel Ngui, Center faculty, has a number of research initatives that look to shape the local knowledge and recommendations in preconception health:
A Quantitative Analysis of Factors Associated with Adverse Birth Outcomes in Milwaukee
Investigating Neighborhood Effects on Birth Outcomes in Milwaukee
A series of analyses examining and mapping effects of neighborhood factors including area-level deprivation on birth outcomes.
Study of African-American Infant Loss (SAIL)
A qualitative study using focus groups to examine disparities in neonatal mortality from the perspective of African American women in Milwaukee who have lost a baby due to complications of prematurity and low birth weight.
A Qualitative Study Examining Smoking During Pregnancy among African-American Women in Milwaukee
Focus groups of pregnant African American women in Milwaukee who smoke or recently quit smoking, examining their knowledge, attitudes, barriers, and perceived benefits regarding smoking cessation, perspectives on availability and adequacy of programs.
Office of Minority Health
The Wisconsin Office of Minority Health, in support of the national campaign, has created a calendar of statewide events. Although the national campaign is launched in April, healthy birth outcomes is a high priority for the Wisconsin office year round and leads a team of multidisciplinary academic and community leaders in addressing it.
References and Resources
Center for Disease Control - Preconception
A Healthy Baby Begins with You brochure
Big Cities Health Inventory: The Health of Urban America, 2007, National Association of County and City Health Officials, Benbow, N. editor. Washington, DC. 2007
