Literature Review Tewanda Terry Health 634 Health Communication and Advocacy April 6, 2014

Introduction The United States infant mortality rate for 2013 was 6.17 deaths per 1,000. Even though the rate has since declined more change still needs to be made.3 Low birth weight is one of the leading causes of infant mortality, which can be dealt with if more steps were taking to increase healthy behaviors before and during pregnancy. The costs of babies who are born with a low birth weight are high. On average if a baby does not survive the first year the average medical bills estimate to be around $90,000. Expenses for a baby born with a low birth weight averages around $270,000 per baby.4 More advanced technology has been made which can keep low birth weight babies alive and decrease rate of infant mortality, but other measures need to be done to reduce the percent of babies who are born with low birth weights. By reducing infant mortality less money will have to be used for the hospitalization of newborns as well as other economic cost that could later come like special education expenses and other medical cost. Although the rate of infant mortality has decreased the gap between African Americans and whites has not closed. In 2010 the African American population made up for 13.6 % of the Unites States population. The infant mortality rate for the Unites States

for all mothers was 6.8 deaths per live 1,000 live births with white mothers having a 5.6 death rate while African American mothers had a 13.2 death rate per 1,000 live births.5 A proposed solution to this problem would that African American women have the same opportunity to receive the same quality and level of preconception care that white women do. A government funded program could be created where African American females who are of reproductive age receive care before becoming pregnancy which involves, screenings, education, and interventions to negative health behaviors they may be experiencing. This program would be accessible to all African American women regardless of socioeconomic status. Because African American women are less likely to be insured this program would be able to provide treatment to women who may be experiencing health problems that could lead to negative birth outcomes. There are several benefits that can be anticipated from a Your Healthy Baby Begins with You The first thing would be knowledge of preconception care and how important it can be when determining if a mother will deliver a healthy baby. In the program more African American women will gain knowledge and awareness of predisposing risk factors that could interfere with a healthy pregnancy and baby. By knowing this information they will be able to know if they are at risk as well as healthy behaviors that need to be implemented before pregnancy. With a program put into place for preconception care African American women are given the opportunity to identify risk factors that are only seen in the African American community that could be targeting risk factors for infant mortality.

This program will be a success because it will raise the awareness of African American women about their preconception risk as well as medically treat women who may already be facing these risks. By implementing the program more women will be motivated to receive preconception care and practice key preconception health behaviors. Body of Evidence Studies and guidelines are actively being created and used which are making preconception health better to understand for providers. Improving pregnancy outcome does not only require clinical care or women. The knowledge and awareness related to reproductive health and preconception care among women and men is needed to improve preconception health.8 The CDC developed ten recommendations for improving preconception health. The recommendations are aimed at four goals that are based on personal health outcomes. Goal one of the CDC recommendations is: Improve the knowledge and attitude and behaviors of mean and women related to preconception health.6 The primary beneficial of preconception care is a couples child, but men and women can also benefit and be able to improve their overall health. Improving the knowledge and behavior of both partners will directly benefit them and the future of the child being born and health promotion and education that is easily understood by men and women is the key to increasing their knowledge.8 The American Academy of Pediatrics and the American College of Obstetricians and Gynecologist created four categories of intervention. One of the four categories classified is risk screening and assessments. Research has shown that risk factors for adverse outcomes during preconception should be started and completed before conception occurs. Eight areas that are screened for in the women are reproductive

awareness; environmental toxins and teratogens, nutrition and folic acid; genetic; substance abuse; medical conditions and medications; infectious diseases and vaccination; and psychosocial concerns.9 Women who receive these assessments are able to find out risk factors for which preconception care could benefit them, pregnancy, and their child. In 20th century, family planning has become one of the 10 greatest public health achievements. Guidelines have been created to incorporate practical tools that address family planning which include contraception and birth spacing; the promotion of health education and health literacy; weight management and nutrition; substance abuse; domestic violence; stress reduction and risky sexual behaviors.9 The CDC recommends women and men to create a reproductive life plan, which is used to create goals for people about having or choosing not to have children. A reproductive life plan helps impact contraceptive and medical decision-making. The plan would allow women to make decisions on when they would want children. The CDC Select Panel Recommendations have made it known that developing life planning tools and health education materials about preconception risk have been known to affect pregnancy outcomes.10 Summary There are several benefits that can be anticipated from a Your Healthy Baby Begins with You The first thing would be knowledge of preconception care and how important it can be when determining if a mother will deliver a healthy baby. In the program more African American women will gain knowledge and awareness of predisposing risk factors that could interfere with a healthy pregnancy and baby. By knowing this

information they will be able to know if they are at risk as well as healthy behaviors that need to be implemented before pregnancy. . With a program put into place for preconception care African American women are given the opportunity to identify risk factors that are only seen in the African American community that could be targeting risk factors for infant mortality. This program will be a success because it will raise the awareness of African America women about their preconception risk as well as medically treat women who may already be facing these risks. By implementing the program more women will be motivated to receive preconception care and practice key preconception health behaviors. Changes are being made everyday for the improvement of public health strategies. The issue of preconception health is one that should be looked at as important to all women. Promoting a health lifestyle and behavior is needed to improve preconception health for women. To improve preconception health it will not only take the efforts of medical professionals and their knowledge of prevention measures, but a change in awareness, knowledge, behaviors, and attitudes of preconception health in women.10