Baby Maybe? A Focus on Preconception Healthcare to Improve the Health of Childbearing Women and Pregnancy Outcomes

The health of childbearing women has been a longstanding focus in the United States. Though we are a well developed, industrialized country, we rank poorly when compared against similar countries in the rest of the world for the rate of infant mortality. Therefore, it remains a major public health issue. When searching for causes for infant mortality, there has previously been a focus on obtaining early and continuous prenatal care1. Studies have supported this theory, showing a much higher rate of infant mortality for those who never obtained prenatal care during their pregnancy, and also proportionally higher rates of infant mortality depending upon how late in the pregnancy prenatal care was initiated. Although this was supported as one cause for infant mortality and could also predicate pregnancy complications, many in public health suspected that this was not the entire picture. There were many women becoming pregnant who were unprepared for the experience, both physically and mentally. Although there was widespread availability of contraception, statistics showed that even those who were not planning a pregnancy were also not using contraception, at an alarming rate2. Therefore, a strong argument could be made for going back in time to prepare a woman for pregnancy - from the very beginning of the time that she was able to conceive. Focusing on preconception health meant focusing on the health of all women of childbearing age, from 15-44 years old. This meant that education and information would start being disseminated in adolescence, in a school health class or from a healthcare provider. That information would be augmented as the woman became older and sexually active, to incorporate ways to use contraception effectively to be sure that she could plan her pregnancies according to her life goals, if she wanted to conceive at all. If a woman could be assessed and screened early and regularly during her 3 reproductive years, she may be less likely to have an unplanned pregnancy and she may also be able to obtain treatment interventions for any medical issues that she manages before she conceives, in order to reduce the possibility of pregnancy complications or a poor birth outcome. By controlling for these risk factors with consistent preconception health care, the goal is that the health of women of childbearing age across the nation will consistently improve. This paper will support the increase and widespread practice of preconception health and healthcare for the population of childbearing or reproductive age (15-44) by all healthcare providers at every clinical contact. The formalized recommendations that were published on the topic by the CDC in 2006 will be discussed in detail, as well as a sample of individual state efforts to meet those recommendations. Separately, this paper will discuss the state of preconception health in North Carolina, and a sample of programming efforts that are in place to improve birth outcomes by increasing this type of care. Funding sources will be addressed as parts of preconception health care are considered to be preventive care, while some interventions fall under the umbrella of clinical care. Lastly, we will look at the direction of preconception care at this time, looking forward to where it may lead in the future.Master of Public Healt