Dear Preconception IM CoIIN Teams, 
Once a quarter our regularly scheduled CoIIN newsletter will be combined with the PCHHC national newsletter. However, there are a few CoIIN-specific resources and updates to share with you all. 
Our newsletter topics each month are focused around concepts important to consider as you work with patients, community and health care stakeholders in developing a screening and warm referral source. Read below for more about this month's focus and resources for your teams.
Almost five months into the year, how are your teams progressing?  As always, don't hesitate to reach out to your coaches, or ask to be connected to any technical assistance supports! 
Preconception CoIIN Activity Updates:
The IM CoIIN DATA Contractor (Abt Associates) have TA webinars coming up! For details, contact the CoIIN DATA Team ( ). 
  • April 25th from 3:30-5pm ET: "Engaging and Partnering with Families and Constituents in IM CoIIN" 
  • May 30th from 3:30-5pm ET: "Human Centered Design"
PCHHC  "Preconception in Progress" webinar: if you are able,  please join the May 9th, 1pm ET webinar. The topic is "Sexual Health Advocacy from the Margins." Details here.
Preconception CoIIN virtual conference: All state team members joining together to share and learn about the progress each state team has made since our December meeting.
  • This all-states team members call will take place in June (logistical details coming soon).
Preconception CoIIN Year Two In-person Meeting: We will join back together in the Washington, DC-area. As soon as we can confirm a Winter 2018 meeting date, we will send an official save the date. 
  • Tentative dates are: Nov. 29-30, Dec. 3-4, or Dec. 10-11.
This month's newsletter and webinars focused on applying health equity and the science behind preconception health to our outreach and communications strategies. The Institute for Healthcare Improvement has many tools that are relevant and applicable to this CoIIN work, including resources focused on health equity. Below are several short clips about creating, promoting, leading in health equity from IHI:

All the best,  
Sarah, Katherine, Erin, and Suzanne

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UF3MC31239-Providing Support For The Collaborative Improvement and Innovation Network (CoIIN) To Reduce Infant Mortality. The grant amount totals $1,494,993. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government .

The National Preconception Health + Health Care Initiative                                                                                                                                              May 2018
Communications  Corner
May is a busy month for health-related campaigns. Our goal is to elevate the preconception health-related components of these different initiatives. For example, we know that tobacco use can decrease fertility, cause pregnancy complications, and lead to chronic disease and behavioral issues for children. Please join in!

We will be celebrating National Women's Health Week on #WellnessWed at 2pm ET for a #NWHW18 Tweet Chat (save the date forthcoming). In the meantime, join the NWHW Thunderclap and #WhatIWishIdKnown Challenge.
We will be creating templates for our partners to re-purpose and add their logos. Stay tuned! 
National Women's Health Week (begins on Mother's Day)
  Physical Activity & Women's Health
Every Woman Southeast newsletters are a great source of information on a wide variety of health topics - from body art to menstruation and more

This month's issue covers the topic of physical fitness. 

Mark Your Calendar! 

Amarachi Anakaraonye , MSPH, Host, Executive Producer of The Fragmented Whole , will build our collective understanding about working with marginalized people. Listen to her podcast for a sneak peek into her work. Many thanks to Amarachi for headlining our newsletter this issue .

Missed our  "Community Engagement Strategies," 
Preconception CoIIN Corner 
Teams in California, Delaware, North Carolina, and Oklahoma have been focusing on the understanding phase in designing their preconception projects. Groups are asking the really tough questions - how do we go beyond the technical fix of developing new or better screening instruments to the bigger adaptive challenge of creating a meaningful, woman-centered clinic encounter that leads to improved health.

Oklahoma is exploring testing a short check list with a space for women to write in and identify THEIR top concern for the visit. North Carolina is investing resources in doing full human centered design processes in their three clinics. Delaware is spending time learning more about women's needs and clinic staff needs through "chat and chew" gatherings. California is finishing up clinic recruitment and preparing for HCD as well.

All of the teams are working to live in to the opportunities offered by the "innovation" in the CoIIN process. Materials and resources are being posted to the website.

Please not the addition to yesterday's newsletter: there is a fifth topic for the IM CoIIN TA webinars on May 30th from 3:30-5pm. The focus will be "Human Centered Design."
IM CoIIN "Universal" Webinar SeriesThe sixth topic in for technical assistance by the Abt Associates DATA Team, Understanding Your Current State with Structured Observation and Process Mapping will take place on June 27th from 3:30-5pm ET. Questions? Contact  or 888-239-2048.

Missed the " Family and Consumer Engagement" Webinar on April  6th? Click here for the recording.
HUGE Congratulations to the Black Mamas Matter Alliance on a VERY successful inaugural #BlackMaternalHealth
We are thrilled to see our partners' extremely hard work and carefully executed movement make waves!  
It is up to us to help keep the momentum rolling! Support Black Mamas Matter Association as they plan their #BlackMaternalHealth December 2018 conference & training. Follow them on social and pay attention to what they are saying - it is imperative. 
The Case for Preconception Surveillance  

In the April 2018 Journal of Women's Health paper titled,
The Importance of Using 10 Key Preconception Indicators in Understanding the Health of Women of Reproductive Age, scientists from the CDC highlight ways that data can drive decisions and change. The preconception indicators provide an opportunity for leaders to set priorities, revise and develop programs and policies, implement system changes, and better allocate resources to support interventions to improve the health of women of reproductive age.

You can also learn more about disparities in preconception health through this MMWR report. See how indicators can improve understanding about the receipt of preventive health services here.
Preconception Health Bi-weekly Updates
Sign up for the  CDC's bi-weekly updates on preconception and interconception health by  emailing Cheryl Robbins  ( A great resource for everything happening in the industry, across the country - and world!
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Stay connected! Follow along and join the conversation: 
Scientists Call for a Renewed Focus on Preconception Health
Let's be real, sometimes championing preconception health and wellness feels like pushing a boulder up a hill. After all, we are trying to shift a paradigm. As such, it is always exciting to see mainstream media covering the importance of preconception health. Three excellent articles were just published in The Lancet, one of the globe's most respected medical journals, about preconception health. Access and read the articles here(1), here(2), and here(3). The papers make a clear, scientific case for the necessity of improving preconception health for women and men. Across the three manuscripts, the authors center their arguments for preconception health in low, middle and high income countries on life course theory and research.

Largely from the UK, Australia, and the Netherlands, the authors' perspective underscores our own, that "interventions to improve women's nutritional status and health behaviours at all preconception action phases should consider social and environmental determinants, to avoid exacerbating health and gender inequalities, and be underpinned by a social movement that touches the whole population." (Barker et al., Paper 3) The authors underscore that preconception interventions must be supported by "political will which requires skillful engagement with powerful commercial interests."  

CNN picked up coverage of these articles with an interesting article that highlighted men's role in preconception wellness and the way that women's and men's health can have a profound impact on their future offspring. Time is short and everyone is busy, but we'd recommend at least reading the key messages for each of the papers and starting a conversation at work. For example, a robust lunch time conversation could follow on the heels of Stephenson, et al., who suggest that "identification of people contemplating pregnancy provides a window of opp ortunity to improve health before conception, while population-level initiatives to reduce the determinants of preconception risks, such as obesity and smoking, irrespective of pregnancy planning, are essential to improve outcomes." (Paper 1). 
As we lift the global attention given to preconception health as a critical intervention for improving the lives of womens and their children, we want to reintroduce and highlight the work done in 2012 from the World Health Organization. Read their Preconception Care Report, here , which includes policy briefs and slides. 

Continue the conversation AND know that you are part of an important group of early adopters of this critical work!
Preconception Health Equity IN CONTEXT 

 "How can we be culturally responsive in our message that what a person does before pregnancy matters?" is a question our team has been asking recently.
"Look to artivism", says  Cornell Wright, MPA, Executive Director of the Office of Minority Health and Health Disparities at North Carolina DHHS. "Art can lift up the topics that are difficult for us to message." During his webinar presentation this month, 
Cornell relates our preconception health outreach to Lauryn Hill's lyrics and work as a musician. In preconception health, he suggests, people tend to focus on "that thing" - as Lauryn Hill sings; we focus on a siloed health message. We need to take a step back, lean on our partners for insight and perspective, and see these young adults from all aspects of their lives, " those things." We don't live our lives in black and white, so our messages should reflect the various circumstances that affect the well-being of young adults and their (possible) future children. 
He explained that, while we aren't necessarily delivering our preconception health educational messages incorrectly, we aren't doing it COMPLETELY. When we deliver messages surrounding pre-pregnancy health, we need to focus on being more inclusive and frame each message from a life course lens. This will include multi-generations, addressing barriers and biases, understanding and acknowledging mistrust and historical trauma, deepening our messages to include significant others, and fully understanding the young adults we are trying to reach - IN context.
To learn more:
Getting It Right  
Given the many nuances, preconception health is a challenge to message boldly. Coverage of the Lancet articles in the United Kingdom's The  Daily Express "Unhealthy lifestyles of mothers-to-be could wreck the lives of future generations, " was not a way that we would frame the messaging. While we know there is evidence that what happens before conception has implications for an embryo, fetus, baby, and child, we suggest that finger-wagging, shame and blame will never change a behavior.  Thoughtful communication around the "pre-conception period" is crucial, or it will not resonate and could cause harm. How would you re-write this headline to  keep the boldness but present the research in a less paternalistic way?
CityMatCH Reproductive Justice Action Group developed a must-watch webinar that provides three case studies that demonstrate the importance of testing messages and images, overall campaign goals, and checking our work with the end user. Email Regan Johnson if you'd like to join or have questions about the Action Group.
Virtual Reality & mHealth to Advance Preconception Health
During our "Preconception Health in the Netherlands" webinar in April, Professors Dr. RĂ©gine P.M. Steegers-Theunissen and Dr. Eric A.P. Steegers, shared evidence-based (and extremely innovative) work being done to understand the impact of preconception health from a life course perspective. Drs. Steegers presented the science of preconception care, as well as the importance of placing pre-pregnancy health messages in the context of the social environment. In the city of Rotterdam, as in communities across the world, there are pockets of poor birth outcomes where poverty and lack of opportunity continue to affect health and well-being. It is imperative to consider not just the health of the woman (mother-to-be) at this point in time, but the health of her mother and her partner and his family as well.   
Using technology that can be easily adapted and fairly inexpensive to implement, scientists and health providers in the Netherlands are learning a lot about the early conception period. Their embryo studies (measured with 3D and 4D technology) are making a renewed and clear case for the importance of preconception wellness.  
It was interesting to see how the Netherlands is using Virtual Reality to scan the size of a fetus and to compare how smaller fetuses are related to specific preconception health behaviors that put a pregnancy and a baby at risk. Research was presented that suggested that embryos with smaller mass have an increased risk of complications during pregnancy, including aneuploidy, miscarriage, low birth weight, small for gestational age, and prematurity. At six years of age, the child resulting from that smaller embryo can have increased risk of cardiovascular risk factors, such as a higher total fat percentage, higher diastolic blood pressure, and higher total cholesterol. See how it works in this video.  
The Steegers go on to showcase consumer campaigns and resources available in the Netherlands, including mobile apps, a texting campaign, online surveys, and community programs. They also presented preliminary research on behavior change resulting from digital resources - resources that are now being translated into English. We learned about their " KLAAR VOOR EEN KIND," a  public campaign that trains peer group and health educators and holds educational "Tupperware Parties."  We also learned about the resource,  Healthy Pregnancy 4 All, where they re cruited Perinatal Health Educators, Midwives, GP, Child Welfare Services, Municipality for a large-scale survey and data collection on preconception services. 
Check out their digital resources for consumers: 
Here are some key lessons to keep in mind as we work with our own teams to advance women's health care: