Preconception Health Services in Title X Settings · O FFIC E O F TH E. ASSISTANT SECRETARY FOR...
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OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH Preconception Health Services in Title X Settings July 19, 2019
Transcript of Preconception Health Services in Title X Settings · O FFIC E O F TH E. ASSISTANT SECRETARY FOR...
O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H
Preconception Health Services in Title X Settings
July 19, 2019
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H
PRECONCEPTION HEALTH SERVICES
Preconception health services should be offered to female and male clients
Priority populations:• Individuals/couples trying to achieve pregnancy• Clients seeking basic infertility services• Clients at risk for unintended pregnancies• Clients at increased risk for infertility or impaired fecundity
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H
PRECONCEPTION HEALTH SERVICES DEFINITIONS
Infertility – are not pregnant after at least 12 consecutive months of unprotected sexual intercourse
Impaired fecundity – difficulty getting pregnant and carrying the pregnancy to term
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H
INFERTILITY AND IMPAIRED FECUNDITY RATES (2011-2015)
8.7 11
2326.2
15.4 17.9
40.1 38.9
0
25
50
75
100
15-29 years 30-34 years 35-39 years 40-44 years
Infertility Impaired Fecundity
% of Married,Childless Women
15-44 years
https://www.cdc.gov/nchs/nsfg/key_statistics/i.htm#impaired
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H
PRECONCEPTION HEALTH SERVICES FOR WOMEN AND MEN
• Discussion of reproductive life plan• Medical history• Sexual health assessment• Screening and referral/treatment for:
Alcohol and drug use Tobacco use Sexually transmitted infections Height, weight, and body mass index (BMI) Blood pressure Diabetes
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H
A CROSS-SYSTEMS APPROACH TO ADDRESSING MATERNAL MORTALITY
Office on Women’s HealthDorothy Fink, MD
Deputy Assistant Secretary for Women's HealthDirector, Office on Women's Health
Office of Minority Health CAPT Felicia Collins, MD, MPH
Deputy Assistant Secretary for Minority HealthDirector, Office of Minority Health
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H
MATERNAL MORBIDITY AND MORTALITY DEFINITIONS
• Maternal mortalityDeath of a woman during pregnancy or within one year post-partum from any cause related to pregnancy
• Severe maternal morbidityUnexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health
• Pregnancy-related mortality ratio (PRMR)Estimate of the number of pregnancy-related deaths for every 100,000 live births
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PREGNANCY MORTALITY SURVEILLANCE SYSTEM (PMSS)
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CDC: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H
MATERNAL MORTALITY REVIEW COMMITTEE (MMRC) Multidisciplinary committee at the state or city-level that identifies and reviews deaths that occur during or within one year of pregnancy
- Public health, obstetrics and gynecology, maternal-fetal medicine, nursing, midwifery, forensic pathology, mental and behavioral health, patient advocacy groups, and community-based organizations
- 2018: 37 state-based and 2 city-based MMRCs
• Questions addressed:- Was the death pregnancy-related?
- What was the underlying cause of death?
- Was the death preventable?
- What were the factors that contributed to the death?
- What are the recommendations and actions that address those contributing factors?
- What is the anticipated impact of those actions if implemented?
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H
DISTRIBUTION OF PREGNANCY-RELATED DEATHS BY TIMING OF DEATH IN RELATION TO PREGNANCY
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Source: CDC Foundation, Report from Nine Maternal Mortality Review Committees, 2018
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MATERNAL MORTALITY: 3 OF 5 PREGNANCY RELATED DEATHS ARE PREVENTABLE
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Source: CDC Foundation, Report from Nine Maternal Mortality Review Committees, 2018
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H 12
MMWR, Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017
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42.8
32.5
14.211.4
0
5
10
15
20
25
30
35
40
45
White Black AmericanIndian/Alaska
Native
Asian/PacificIslander
Hispanic
Race/Ethnicity (N=3,400)
PREGNANCY-RELATED DEATHS IN THE US, 2011-2015
# of DeathsPer 100,000Live Births
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H 13
MMWR, Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017
11.3 12.1 13.2 15.3
28.7
76.5
0102030405060708090
< 20 20-24 25-29 30-34 35-39 40 +
Maternal Age (N=3,409)
PREGNANCY-RELATED DEATHS IN THE US, 2011-2015
# of DeathsPer 100,000Live Births
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PREGNANCY-RELATED DEATHS IN THE US, 2011-2015
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19.8
24.2
14.8
9.4
0
5
10
15
20
25
30
Less than HS HS graduate Some college College graduateor higher
Level of Education (N=2,938)
# of DeathsPer 100,000Live Births
MMWR, Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H
PREGNANCY-RELATED DEATHS IN THE US, 2011-2015
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MMWR, Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017
# of DeathsPer 100,000Live Births
13.1
22.8
0
5
10
15
20
25
Married Unmarried
Marital Status (N=3,371)
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H
PREGNANCY MORTALITY SURVEILLANCE SYSTEM (PMSS) 2006-2015: PREGNANCY-RELATED MORTALITY RATIO
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Source: Pregnancy Mortality Surveillance System (PMSS) & Unpublished CDC Data
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H
CONCEPTUAL MODEL
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Howell, Elizabeth. Clin Obstet Gynecol. 2018 June ; 61(2): 387–399 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915910/pdf/nihms927630.pdf
Factors Impacting the Cycle of Maternal Health
• Race/ethnicity• Social Determinants of Health
• Patient • Community/Neighborhood• Provider• System
• Health Status
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ADDRESSING MATERNAL MORTALITY
Issue: During and after pregnancy, women in the U.S.— especially African-American women, American Indian/Alaska Native women, and women age 35 and older — experience higher rates of maternal morbidity and mortality than women in any other industrialized nation
Actions: • Individual HHS agencies are enhancing their focus and activities on
addressing maternal mortality and morbidity• HHS is ensuring a coordinated, a cross-agency approach to improving
maternal mortality
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H
The Office of the Assistant Secretary for Health (OASH) is uniquely positioned to convene, coordinate and communicate HHS interventions addressing maternal health, morbidity and mortality
• Office on Women’s Health is convening a group of senior-level HHS experts to develop a plan to enhance and coordinate existing efforts addressing maternal mortality across the Department, via the Coordinating Committee on Women’s Health
• Office of Minority Health will be bringing state and community stakeholders together to review racial and ethnic disparity data, HHS activities and emerging/best practices for sustaining and spreading disparity-reducing policies programs and practices
ADDRESSING MATERNAL MORTALITY
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EXAMPLES OF OASH EFFORTS TO ADDRESS MATERNAL MORTALITY
• Prevention Awarding a grant to support adolescent girls’ participation in sports to promote
healthy weight and prevention of hypertension
• Cardiovascular Health Promoting implementation of the new physical activity and nutrition guidelines Focusing on preventable causes of cardiovascular disease
• Cultural Competence Creating tools to support/enhance cultural competence in clinical encounters
for all women of color
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TITLE X OPPORTUNITIES TO IMPACT MATERNAL MORTALITY
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Opportunities for Impact Identify risk factors, provide counselling and provide/refer for servicesExamples Hypertension Diabetes Weight Depression Tobacco use Age of pregnancy (counseling) Social support
Howell, Elizabeth. Clin Obstet Gynecol. 2018 June ; 61(2): 387–399 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5915910/pdf/nihms927630.pdf
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A S S I S T A N T S E C R E T A R Y F O R H E A L T H
Perspectives from the Title X Community
Kami GeoffrayChief Executive Officer
Women’s Health and Family Planning AssociationTexas
Nomsa Khalfani Executive Vice President Essential Access Health
California
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whfpt.org @WHFPTX #ReproAccess4TX
Addressing Maternal Mortality & Morbidity Within WHFPT’s
Title X Project
Why This Matters• The rate of maternal mortality in Texas is
8.9 per 100,000 live births• For Black women in Texas, the rate
increases to 13.9 per 100,000 live births—2.3 times higher than the rate for Non-Hispanic White women (6.0 per 100,000 live births)
• The Texas Maternal Mortality and Morbidity Task Force recommends that we increase access to health services during the year after pregnancy and throughout the interconception period to improve the health of women, facilitate continuity of care, enable effective care transitions, and promote safe birth spacing
• Family planning providers have a key role to play in improving the health and lives of mothers
What We Have Prioritized• Raising awareness through presentations and
media interviews• Most recently, opened 2019 Annual Conference
with A Panel Discussion on Maternal Mortality in Texas to highlight importance of issue
• Serving as a thought partner and participating in statewide and local coalitions to improve maternal health
• Steering Committee member of Improving Maternal Health Houston, a community-based initiative in Harris County where rates of maternal mortality and morbidity are rising, and outpacing state and national trends
• Supporting sub-recipients in leading initiatives in their own communities
• Avenue 360 Health and Wellness serves as the hub for Healthy Women Houston, a new system of care that offers community-based support for pregnant women
This presentation was supported by the Office of Population Affairs (OPA) of the Department of Health and Human Services under award number FPHPA006401-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of OPA.
Black Infants & Families Los Angeles
The Crisis
The Solutions Quality health care delivered with respect and dignity Sister circles and prenatal groups providing encouragement and support Mommy visits at home Connection to resources and programs Birthing coaches and advocates Laws that place power in the hands of families and address unfair treatment Birth plans with the mom's wishes at the center
http://www.blackinfantsandfamilies.org/
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