The National Preconception Health + Health Care Initiative                                                                     December 2018
As we close our books for 2018, we hope your holiday celebrations are peaceful and we meet you in the new year with invigorated passion for our shared mission to improve the health of women, babies, and families in our country. 
In our final 2018 issue, you'll find resources, upcoming events, and inspiration to continue building our momentum in 2019. Thank you to our excellent consultants who share their time and talents with us - you'll get to learn all about them here as well!
Get to know  Deborah | Kay | Rachel | Vanessa | Dan | Milt
Register before December 14th!

January 17-18, 2019 -  Please hold this date for the 2019 Preconception IM CoIIN In-Person Meeting. Registration is now open.

Meeting Purpose:
- Share Preconception CoIIN progress and preconception health best practices;
- Engage in learning and dialogue on implicit bias and on women's health policy;
- Create opportunities for project site collaboration and targeted technical assistance;
- Review human-centered design and PDSA cycles as well as data metrics, collection, and submission processes;
- Connect and engage within and across states and part
Using Preconception Health and Preconception Care Indicators to Improve Pregnancy Outcomes and Women's Health Status

Did you miss the IM CoIIN Quarterly Update  webinar? The webinar included updates from the four IM CoIIN backbone organization awardees as well as a presentation on  Using Preconception Health and Preconception Care Indicators to Improve Pregnancy Outcomes and Women's Health Status.  The speakers discussed the systematic processes used to evaluate preconception health and preconception care indicators and how these indicators can be used to reduce disparities and improve programs. 

F ollow this link for a recording on the webinar.
"Racism is the Risk Factor" 
Dr. Joia Crear-Perry's 2018 Momentum
Dr. Joia Crear-Perry, MD, FACOG, Founder & President of the National Birth Equity Collaborative, has been demanding media, advocates, policymakers, and our entire country to take action against and understand racism in maternal health and birth outcomes. Recently, Dr. Crear-Perry was featured in Essence :
" Understanding that racism-structural, personally mediated, and internalized, as well as implicit bias, causes inequities in birth outcomes and maternal morbidity is imperative. Once we start with some historical truths, that Black women were enshrined in the U.S. Constitution with explicit devaluation based on race and gender, we can build policy and culture that, finally, values us all." Keep reading

Dr. Joia Crear-Perry has coined the line, " race isn't the risk factor, racism is." She explains  this historic line here (and  here). At the HRSA Maternal Mortality Summit, she discussed how social determinants of health can lead to psychological stress/unhealthy behavior, thus creating disparity in distribution of disease, illness & wellbeing. Watch her here

Also, learn more about the recent bills and initiative's Dr. Crear-Perry has been involved in: Preventing Maternal Death Acts and Merck for Merck Mothers' Safer Childbirth Cities Initiative.
Black Women's Health Policy Toolkit 

Black Women's Health Imperative launched the first-of-its-kind National Health Policy Agenda and Report Card. Download and read the "Black Women Vote: 2018 National Health Policy Agenda." The Agenda is a foundational policy blueprint to be  executed by Black women. It offers evidence to  both policymakers and practitioners as to why
the health and wellness of more than 21 million
Black women matters in the United States. Topics include: * Reproductive health and justice * Maternal mortality and morbidity * Cardiovascular disease and hypertension * Breast, lung, colorectal and cervical cancer * Diabetes * HIV/AIDS * Mental health. Each of these topics is also broken down with information and resources here. Subscribe to their newsletter for the 2019 updates and an alert for their 2018 annual report.

Be sure to check out B lack Women's Health Imperative's 
#CYL2PreventsType2 Prediabetes Awareness initiative, and their  #MomsPreventType2 campaign.
Building Equity in Health and Communities
From Institute for Healthcare Improvement, here are a few posts about building health equity across systems:
Health Equity Starts When Your Organization Gets Uncomfortable - Facing up to inequities in your organization is painful, but necessary to achieve the Triple Aim for all. Also read:  IHI white paper -  Achieving Health Equity: A Guide for Health Care Organization.

Go Upstream to Pursue Health Equity - A growing number of health systems are investing in upstream efforts to address the major social, economic, and environmental drivers of health inequities in their communities.

The Role of Health Care Institutions in Building Community Wealth and Addressing the Economic Determinants of Health - Forward-thinking health care institutions are changing their mission from "be the best in patient care" to "improve health.

Use Social Marketing to Make Care More Patient-Centered  - Using digital and social media, organizations are improving patient engagement, reaching more populations, and enabling more authentic dialogues with care teams.

Research shows that providers are more likely to rely on implicit associations when under time pressures, have a high cognitive load (i.e., have a lot on our minds at once), and when situations are ambiguous (i.e., lack of complete information). From the Kirwan Institute at The Ohio State University, a great resource on implicit bias in health care, read, " Aligning Outcomes with Intentions: Mitigating Implicit Bias in Health Care." 

In this issue, Dr. Dan Frayne references the Racial Equity Institute, click here to view their studies and resources. 
January Birth Defects Prevention Month Toolkit 

January is National Birth Defects Prevention Month. The CDC has created a toolkit in an effort to raise awareness of birth defects, their causes, and their impact!

Not all birth defects can be prevented. But you can increase your chances of having a healthy baby by managing health conditions and by adopting healthy behaviors before and during pregnancy. Taking care of yourself and doing what's best for you is also best for your baby! 

Click to view FIVE social graphics and posts.

PCHHC is hosting the 2019 Birth Defects Prevention Month Bilingual Tweet Chat on January 23rd with the March of Dimes, Mother to Baby, and others.  Details forthcoming. Email Suzanne to join the panel or get more information.
Screening for Unhealthy Alcohol-Use for All Young Adults 

From a November 2018 JAMA statement, the US Preventive Services Task Force (USPSTF) recommends screening for unhealthy alcohol use in primary care settings in adults, including pregnant women. Learn more
Preconception Health  CME 
Modules Updated and Available

Thanks for the Albert Einstein School of Medicine in New York, the Preconception Health Modules on BeforeandBeyond have been reviewed and updated! 
The five modules are short, engaging and filled with practical information to make continued learning quick and easy. The modules can be used for CME credit by physicians, nurse midwives, nurse practitioners and physicians' assistants.
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: 
Get to Know our Preconception IM CoIIN Consultants
Deborah Frazier, CEO, National Healthy Start Association
What has inspired you in 2018? Young people organizing and marching on Washington in March was inspiring. I'm also inspired by women of color organizing and speaking their own truth about their health and demanding to be heard via their own voices. This brings me hope particularly coming on the heels of the release of the 50 year follow up of the Kerner Commission Report.  

What has kept you motivated as you work to improve preconception health behavior and care?  The passion and success of our Healthy Start family as they work with communities with at least 1.5 times the national infant mortality and then reduce the rate to below the national average through dedication, commitment and solid, evidence-based community public health. I am also motivated by the awakening and advocacy of women of color who want their stories told through their own voices and who are demanding change in their health outcomes and change in the way they are perceived and treated. 
What are some key learnings you've discovered during this process? 
In some ways we take two steps forward and three backward; as public health professionals, we need to protect the gains we make in ensuring and protecting the health of families, especially fragile families. Also, equity and the social determinants of health can't be public health buzzwords or a funding opportunity; it is a human rights issue that demands action.  
What are you most excited about learning over the next few months?  I want to learn something new- and outside of public health-- master gardening or playing a piano or perhaps a new language!
What is your favorite public health campaign?  Favorite campaigns are those for social justice which is the root of inequity and of health care disparities. Under this umbrella we can find organizations that have been doing this work for a long time nationally and internationally with more recent work on maternal mortality by Black Mammas Matter and equity work by the March of Dimes. 
What is your favorite way to stay on top of advancements in your area of expertise?  Periodicals, Internet and research; I get daily updates from several sources but I learn so much from research and practitioner colleagues who are immersed in this work and with whom I am fortunate to have them share their thoughts, ideas, and work. This includes my Healthy Start Family.
Kay Johnson
President, Johnson Group Consulting, Inc.
What has inspired you in 2018?
The renewed national emphasis on maternal health has inspired me. If we are clear in our messaging to the public, policymakers, and one another, the opportunity exists to clearly describe how preconception and interconception health are a key part of the solution to maternal morbidity and mortality.  If not, then federal data systems and hospital-based interventions will be seen as the primary solutions.  A focus on the interconception period of 12-24 months following pregnancy for women who had adverse outcomes or postpartum risks is central to this work, including health coverage, medical care, and support to shift negative social determinants of health.  I am excited about learning how we can advance our work through this lens over the coming months.  States are leading the way and this project can share lessons from across the nation.   
Rachel Berkowitz, MPH, 
Doctor of Public Health (DrPH) candidate, 
University of California, Berkeley
What has inspired you in 2018?  One concrete and new source of inspiration for me in 2018 has been author Roxane Gay, particularly her book Hunger. I related strongly to her naked vulnerability and her relatable reflections on the realities of moving through the world as a larger woman. This book, along with other talks and texts by her, has inspired me to be present with myself as well as others' journeys and to strive always to incorporate vulnerability, honesty, humility, and deep listening into my work and my life. 
What has kept you motivated as you work to improve preconception health behavior and care?  Honestly, getting to work with and learn from those doing this work on-the-ground right now. As a doctoral candidate, much of my current reality revolves around learning and writing, and I am immensely grateful for that opportunity. But it is the work of this network, of warriors for reproductive justice, and of researchers, practitioners, advocates, and activists fighting for equitable opportunities to health and well-being for all people across the life course, which keep me motivated and inspire me to try to find ways of contributing to those fights in the midst of my program and moving forward (accordingly, the opportunity to work with this network has been very meaningful for me). 
What is your favorite way to stay on top of advancements in your area of expertise?  Webinars, events, and personal conversations remain my favorite ways to continue to learn about advancements in areas such as the impact of place on health, addressing racial inequities in health outcomes and community-based and -driven research and programmatic work. From learning about and being inspired by work happening around the world to having the chance to hear someone share their expertise in a public forum (or over a cup of coffee), I have found more conversational and, at times, less formal interactions to be the best way to stay current with how work is happening on the ground.
Vanessa Lee, MPH, Infant Mortality CoIIN Coordinator, Division of Healthy Start and Perinatal Services, Maternal and Child Health Bureau, Health Resources & Services Administration (HRSA)
What has inspired you in 2018?  All of the women in my life - from family and friends, to colleagues and co-workers - they're all amazing!
What has kept you motivated as you work to improve preconception health behavior and care?  The state teams participating in the Preconception CoIIN. Their passion and commitment, and collaboration with each other, is motivating.
What are you most excited about learning over the next few months?
What works well to engage end-users and what does it take to let them be true co-creators with us.
What is your favorite way to stay on top of advancements in your area of expertise?   Chatting over a cup of coffee or lunch with my grantees or contractors - I learn so much from them and am grateful for the opportunity to work with them.
Daniel J. Frayne, MD, President, Mountain Area Health Education Center, Associate Professor, Department of Family Medicine
What has inspired you in 2018?  Building true relationships in my community with leaders working to dismantle racism.

What has kept you motivated as you work to improve preconception health behavior and care? 
Motivation comes from a firm belief that this work is fundamental to real change in the health of our society.

What are some key learnings you've discovered during this process? Implementation of new forms of care delivery is very challenging - but persistence pays off!

What are you most excited about learning over the next few months? 
How to engage patients more in their own care and advocacy for their informed decisions.
What is your favorite public health campaign?  I am learning a ton from the Racial Equity Institute - the analysis they teach has changed my life.
What is your favorite way to stay on top of advancements in your area of expertise?  Participating in workgroups and conferences where a diverse group comes together to share and connect around a common vision,
Milton Kotelchuck, PhD, MPH, Maternal and Child Health at the Center for Child & Adolescent Health Research and Policy, MassGeneral Hospital for Children, and Professor of Pediatrics at Harvard Medical School
What has inspired you in 2018?  Two things have inspired me in 2018. First, despite this being a difficult period for MCH programs and policy, important new local state MCH initiatives can be implemented. In 2018, the Massachusetts legislature passed a generous Paid Parental and Medical Leave Act, that will provide 12 weeks paid newborn leave for both mothers and fathers. This bill provides an important opportunities for the public health community to ensure better post-partum/interconception health care for all new families. Second, a personal inspiration from my family (see below).
What has kept you motivated as you work to improve preconception health behavior and care?  As a grandfather, I am motivated (and inspired) to work on preconception health and behavior. I watch (and support) my own children - both daughters and sons - as they try to ensure and optimize their own health by consciously attending to preconception (and now often) interconception health care practices to assure the health and well-being of their children (and my grandchildren), themselves and their partners. They inspire and motivate my professional (and personal) life.
What are you most excited about learning over the next few months?  I am very motivated and excited to directly involve fathers, and prospective fathers, as men, into our preconception world - to make our MCH preconception programs truly welcoming of fathers, and to encourage men to embrace preconception, prenatal, and post-conception health care and health behaviors to improve the health of their infants, their partners, their families and (importantly) themselves!! 
What is your favorite way to stay on top of advancements in your area of expertise?  I keep up with advances in preconception health, one of my main areas of expertise, through reading the bi-weekly CDC summary of preconception and interconception health literature, written by Cheryl Robbins.