Policy and Financing Issues for Preconception and Interconception HealthTranslating Policy to Practice and Back Again: Implementing a Preconception Program in Delaware
Introduction
In response to an increasing infant mortality rate in Delaware when compared with the national rate (Delaware Vital Statistics Annual Report, 2007) the Governor of Delaware made reducing infant mortality a state priority. In 2005, she convened an Infant Mortality Task Force (IMTF) to assemble recommendations aimed at reversing the trend (Reducing Infant Mortality in Delaware, 2005). The IMTF provided the governor and state legislature with 20 recommendations to reduce infant mortality in Delaware. Several of the recommendations of the IMTF aimed to improve the health of women before pregnancy and called for increased access to preconception health care for Delawarean women, including providing increased access to preconception services for women with a history of poor birth outcomes; requiring that insurers cover services included in standards of care for preconception, prenatal, and interconception care; and improving comprehensive reproductive health services for all uninsured and underinsured Delawareans up to 650% of poverty. During 2005, the state legislature provided $1 million in funding to develop project and policy initiatives designed to impact infant mortality (Table 1).
In 2006, the core of the preconception care program was developed based on the Centers for Disease Control and Prevention (CDC) published recommendations for preconception health and health care in the United States (Johnson et al., 2006). The state legislature awarded >$0.5 million to develop a pilot program. The Delaware Division of Public Health (DPH) was tasked with developing the preconception program requirements, estimating program cost, and releasing a Request for Proposals to fund local agencies to implement the defined program and services.
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Background
Much of the existing literature on preconception health focuses on current evidence for the impact of risk specific interventions on future pregnancy outcomes (Floyd et al 2007, Kendrick 2004, Korenbrot et al 2002, Moos et al 1996, Ray et al 2001). Earlier research describes the barriers to preconception care such as the inability to reach those at greatest risk, fragmentation of services, limited support for treatment of high-risk behaviors, unmotivated women, and a lack of provider skills in
Defining the Target Population and Services
In 2006, the DPH began development of the preconception care program by defining the target population and program services. Using available vital statistics data, evidence-based program inclusion criteria for participants were established. DPH staff examined infant death data and zip code of residence to determine high-risk areas throughout the state, enabling targeting of specific regions in Delaware for program implementation. Further analysis of state vital records data indicated that short
Next Steps
In subsequent years of the preconception program, the DPH plans to evaluate the effectiveness of the current program, establish outcome measures for the program and data collection protocols for annual visits, complete needs assessments of the pilot sites, begin a dialogue with state insurers to cover and reimburse the additional services, partner with other state agencies for provision of more comprehensive additional services, and expand preconception awareness through a media campaign for
Conclusion
Although the concept of preconception care was difficult to define, practically apply, integrate into the existing system, and argue for continuous political support, the achievements of the DPH and the state of Delaware provider networks present a promising model of care and illustrate a method for translating policy into action and back again at the state level.
Charlan Kroelinger, PhD, is the State Maternal and Child Health Epidemiologist for Delaware and the Director of the Delaware Division of Public Health Center for Excellence in Maternal and Child Health and Epidemiology. She is a Senior Scientist assigned to Delaware by the U.S. Centers for Disease Control and Prevention.
References (29)
- et al.
Preventing alcohol-exposed pregnancies: A randomized controlled trial
American Journal of Preventative Medicine
(2007) Full circle: The evolution of preconception health promotion in America
Journal of Obstetric, Gynecologic, and Neonatal Nursing
(2003)Preconceptional wellness as a routine objective for women's health care: An integrative strategy
Journal of Obstetric, Gynecologic, and Neonatal Nursing
(2003)Preconception health: Where to from here?
Women's Health Issues
(2006)- et al.
Preconceptional health: Risks of adverse pregnancy outcomes by reproductive life stage in the Central Pennsylvania Women's Health Study (CePAWHS)
Women's Health Issues
(2006) - et al.
Women's perceived control of their birth outcomes in the Central Pennsylvania Women's Health Study: Implications for the use of preconception care
Women's Health Issues
(2008) - et al.
Prevalence of risk factors for adverse pregnancy outcomes during pregnancy and the preconception period—United States, 2002–2004
Maternal Child Health Journal
(2006) - Centers for Disease Control and Prevention (CDC) (2006). Preconception Health and Care, 2006: State Title V Priority...
- et al.
Do we practice what we preach?A review of actual clinical practice with regards to preconception care guidelines
Maternal Child Health Journal
(2006) - et al.
Preconception and interconception health status of women who recently gave birth to a live-born infant—Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 reporting areas, 2004
Morbidity and Mortality Weekly Report Surveillance Summaries
(2007)
Design of the Central Pennsylvania Women's Health Study (CePAWHS) Strong Healthy Women Intervention: Improving preconceptional health
Maternal Child Health Journal
National recommendations for preconception care: The essential role of the family physician
Journal of American Board of Family Medicine
Disparities in rates of unintended pregnancy in the United States, 1994 and 2001
Perspectives on Sexual and Reproductive Health
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Charlan Kroelinger, PhD, is the State Maternal and Child Health Epidemiologist for Delaware and the Director of the Delaware Division of Public Health Center for Excellence in Maternal and Child Health and Epidemiology. She is a Senior Scientist assigned to Delaware by the U.S. Centers for Disease Control and Prevention.
Deborah Ehrenthal, MD, FACP, is Assistant Professor of Medicine at Thomas Jefferson Medical College and Medical Director of Women's Health Programs for the Department of Obstetrics and Gynecology at Christiana Care Health Services. She is the Medical Director of Women First, the Christiana Care Community Center of Excellence in Women's Health, and the Healthy Beginnings Program.
The authors have no direct financial interests that might pose a conflict of interest in connection with the submitted manuscript.
The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.