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Pre and Interconception Health, Intentionality and Birth Spacing: Emerging Issues

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Pre and Interconception Health, Intentionality and Birth Spacing: Emerging Issues PRE AND INTERCONCEPTION HEALTH, INTENTIONALITY AND BIRTH SPACING: EMERGING ISSUES Monday, May 21 1:30 PM - 3:00 PM #prematuritycollab Pre- and Interconception Health, Intentionality, and Birth Spacing: Emerging Approaches Prematurity Prevention Summit Building a Birth Equity Movement Welcome • Co-chairing the Prematurity Collaborative Clinical and Public Health Practice Workgroup ‣ With Vanessa Lee, MPH (HRSA) • Great group of people; very dedicated • Focus on 3 main topics: ‣ 17-P ‣ LDASA ‣ Intentionality and birth spacing Background • Approximately half of pregnancies in US are unintended ‣ Better in teens, but still unacceptably high • Intentionality is important ‣ Unintended pregnancy associated with adverse maternal and child outcomes ‣ Negative impact on physical and mental health ‣ Disproportionate impact › Higher rates in lower SES and lower levels of achieved education ‣ Expensive… › 2010 estimate: $21 billion in public expenditure for unintended pregnancy Background – Birth Spacing • Based on data suggesting short interpregnancy intervals associated with worse outcomes ‣ Including prematurity ‣ Others: fetal growth restriction, NICU admission, perinatal death • Intervals “debated”…. ‣ < 24 months, especially < 18 months • “Recommendations” to avoid short intervals ‣ Healthy People 2020 objective: 10% reduction in pregnancies within 18 months ‣ WHO: minimum birth-to-pregnancy spacing of 2 years ‣ ACOG: short intervals mentioned as a risk factor for preterm delivery and adverse neonatal outcomes • Widespread emphasis ‣ Made sense for the Workgroup… Birth Spacing - Challenges • 2014 study from Norway – different design ‣ More “longitudinal”… “within woman” design › Women serves as their own controls ‣ Adverse outcomes not directly associated with intervals • 2014 retrospective cohort study from Australia ‣ Women served as their own control ‣ Within-mother analysis – much weaker effect of short interval on odds of preterm birth and LBW • 2017 study – case-crossover analysis, longitudinal ‣ Short interval – NO increased risk of preterm birth, SGA, LBW, NICU admission ‣ Also considered “conventional design” and able to replicate increased risk › Showed that population was representative but design made a difference Birth Spacing - Challenges • 2017 prospective cohort study form Sweden ‣ Analysis included cousin and sibling comparison ‣ Familial confounding explained most of the association between short intervals and adverse outcomes • Two other studies: case-crossover design ‣ Very short intervals (< 6 months) associated with risk › But not longer intervals • Conclusion: if pregnancies uncomplicated and women are in good health, decision regarding timing should be based on personal desires ‣ Not an “arbitrary” interval So What Now??? • A bit of a “curve ball”…. ‣ How do we handle spacing??? • After discussion – still fits with goal of reducing preterm birth and adverse outcomes • Bottom line: more important to focus on the “what” then the “when”… ‣ Focus on optimizing pre/interconception health and not just on an arbitrary time period So What Now??? • Example: a women with HTN and uncontrolled DM who gets pregnant at 25 months will not have a “magically better” outcome than if she became pregnant at 23 months • More important to focus on optimizing health ‣ Less important to “draw a line in the sand” interval • The message and effort remain: ‣ Important to address intentionality and “spacing” but focus on health optimization Today’s Panel • Thank you for attending!! • Superb panel: ‣ Ginny Erlich, D.Ed., MPH, MS: CEO, Power to Decide ‣ Monica Simpson: Executive Director, Sister Song ‣ Sarah Verbiest, DrPH, MSW, MPH: Executive Director, UNC Center for Maternal and Infant Health ‣ Diana Ramos, MD, MPH: CA Department of Public Health and Keck USA School of Medicine HOW MIGHT WE… Build a culture that values and provides a system of support making it possible for every person to achieve reproductive well-being? A culture in which all people—no matter who they are or where they live—to have the power and services necessary to determine if, when, and under what circumstances to have a child and to support a healthy start for the next generation. OUR COLLECTIVE IDENTITY • Real Women Real Stories, Real Women OUR CHALLENGE Information Access Opportunity BY AGE 45, MORE THAN HALF OF ALL AMERICAN WOMEN WILL HAVE EXPERIENCED AN UNINTENDED PREGNANCY. 160 140 120 137 100 112 80 92 85 60 79 79 40 58 58 Rate per 1000 Rateper 20 38 20 26 33 0 <100% 100-199% >=200% Non-Hispanic Non-Hispanic Hispanic 2011 2008 White Black Income to Poverty Ratio Race/Ethnicity LACK OF KNOWLEDGE 0 Contraceptive Deserts WOMEN’S HEALTH CARE IS SILOED • Women expect to have to go to 2 different providers for their care • Health care delivery is separated into primary care and reproductive/sexual health • Women are approached as pregnant or not pregnant with little effort to integrate care in between. • Women’s health care is episodic, uncoordinated and fragmented. Emotional Well-Being Spiritual Well-Being Social Well-Being Physical Well-Being Reproductive Well-Being Income and social status Personal health Social support practice and networks coping skills Employment Health Services and working Social conditions Determinants of Health Biology and Physical genetic environment enowment Healthy child Education development TRANSFORMING WOMEN’S HEALTH • Build a shared vision for ensuring that women are surrounded by a culture that supports their overall reproductive health and well-being. • Create a collective shift in the narrative to support a new definition of what a Culture of Health looks like for women. • A culture in which all sectors recognize and support woman-centered approaches support the health of women – and by extension – the health of families. INTENTIONALITY MOVEMENT APPROACH We recognize that no singular organization or sector can achieve our vision on its own. It will take a multi-pronged and multi-sectoral effort to make this all possible. Thus, we will build a collective impact network that supports the culture and systems change necessary, which includes: • Enculturating a collective narrative that promotes the vision and principles of the movement. • Working towards and monitoring shared measurements on short-, medium-, and long-term progress. • Aligning our assets to optimize our efforts to transform the culture and to build a system of support to meet our vision. By aligning our efforts, we will maximize our impact and reduce duplication. • Ensuring that all of our efforts are developed, implemented, and measured in a culturally-responsive and linguistically-appropriate way. INTENTIONALITY MOVEMENT APPROACH • Advocating for and advancing policies, regulations, consensus statements, and national recommendations that support various systems and practices that ensure that all people can determine if, when, and under what circumstances to have a child and to support a healthy start for the next generation. • Building the capacity of places to establish a broad-based system of support to ensure that people have what they need determine if, when, and under what circumstances to have a child and to support a healthy start for the next generation. • Leading and building the capacity of our constituents and stakeholders towards adopting this integrated and supportive approach in their practice. • Establishing a learning community that builds the evidence-base, shares best practices at the national, regional, and local levels, and fosters innovation. GUIDING PRINCIPLES • We value first and foremost the overall health, well-being, and self-determination of all people, and in particular, women and girls. • We recognize that there is not currently equity when it comes to deciding if, when, and under what circumstances to have a child, and thus these issues must be considered from an intersectional and broader social determinants of health lens. • We recognize and respect that not everyone will, or will be able to, make a decision about if, when, and under what circumstances to have a child. We will work to build a culture in which all individuals will be treated with respect and be cared for without judgment. GUIDING PRINCIPLES • We value the voices and lived experience of the people whom we aim to serve. In developing solutions, we will center our work on their lived experience, which will help us ensure that these solutions are culturally-responsive and linguistically- appropriate. • We recognize the complexity of decision-making and intentions about family formation, and support individuals, couples, families, and communities in seeking reproductive autonomy, health and well-being. • We will work tirelessly to ensure that everyone has the information, access to services, and other supports necessary to have a child if and when they want to and to support a healthy start for the next generation. • We will use best available science, evidence, and guidance from the community to develop our solutions. ASSUMPTION & CONSIDERATIONS • Not everyone believes they have autonomy or choice. • Not everyone possesses the same level of decision making power. We want to change this. • There is a need to acknowledge and respect ambivalence or deliberate decisions to not plan pregnancy. • It's important to meet our audiences (e.g. women and families) where they are. • This culture change will require us to address the socioecological factors, not just individual behavior. • A policy systems approach will be essential, and we cannot assume that current policies
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