Should we transform folic acid programs into preconception health campaigns?

1. Should we transform folic acid programs into preconception health campaigns? The North Carolina experience Amy Mullenix, MSW, MSPH 3rd National Preconception Health Summit June 14, 2011 Tampa, FL

2. Acknowledgements • Preconception health leaders • N.C. Attorney General’s Office • N.C. Division of Public Health, Women’s Health Branch • Sarah Verbiest at UNC Center for Maternal & Infant Health • March of Dimes • The “fairy dust” team

3. Continuous folic acid leadership and committee in NC since 1994 • Infusion of funding in 2004 from Vitagrant; housed at March of Dimes; additional funding from other sources • Large, comprehensive statewide campaign since 2005

4. And now what?

5. 2006 • CDC releases preconception health recommendations • NC Folic Acid Campaign begins to plan for end of Vitagrant funding • Board discusses potential role of Folic Acid Campaign in preconception health efforts • Campaign commissions inventory of past & current preconception health activities

6. Looking Back Moving Forward • North Carolina’s Path to Healthier Women and Babies

7. Possibilities of expansion Folic Acid Multivitamins Providing leadership / applying our expertise statewide in preconception health Adding some preconception health messages Full preconception health campaign

8. Considerations + • Compelling need for a preconception health campaign in NC • Documented success in addressing one preconception health risk • Infrastructure in place • Impending loss of folic acid funding ? • Narrow program focus had achieved results (39% drop in NTDs) • All programs evaluated for promotion of folic acid vs other preconception health risks/issues • Loss of brand identity

9. 2007 • State begins preconception health planning process • Folic acid campaign pauses its transition • Folic acid team provides leadership for state process • 1 year process: 30+ organizations, needs assessment, multiple workgroups, identification of priorities • Release of State Plan in 2008

10. North Carolina Preconception Health Strategic Plan

11. 2008 • Campaign develops strong relationships with potential collaborators in the NC preconception health “world” during state planning process • As new preconception projects begin, Folic Acid Campaign is invited to contribute folic acid content, program expertise, etc. • Campaign identifies portions of state plan relevant to its work & in light of its own strengths: health care provider education, lay health education, media & printed materials

12. 2009 • Campaign reaffirms desire to expand & examines potential messages • Board approves the addition of healthy weight to folic acid campaign, with reproductive life planning as third message. • Reaffirms emphasis on folic acid promotion for Hispanic women

13. Opportunities • With additional funding, the Folic Acid Campaign can continue & grow • Infrastructure & relationships already in place – can add new message without extensive “building” phase • Grants provide opportunities to implement innovative programs without “starting over” (hiring new staff, developing new relationships, etc.)

14. Why healthy weight? • Natural link between nutrition, folic acid & weight • Health care providers consistently express desire for training on this topic; health care provider education is our specialty • Potential for funding

15. 2010 • Active involvement by Campaign staff in the NC preconception health coalition • Review of evidence-based healthy weight programs for women of childbearing age • Development of new healthy weight curriculum & materials • Development & testing of high school preconception health curriculum • Development of new logo & brand identity

17. 2011 • Healthy weight trainings for health care providers, focusing first on public health providers (~500 trained YTD) • Partnership with state (on federal grant) to develop provider trainings & resource guides for local communities on 5 topics: healthy weight, reproductive life planning, tobacco cessation, early entry into prenatal care, interconception medical home • High school preconception health curriculum • New website, tagline, materials, etc.

18. Lessons learned • Current initiatives can be expanded within the broad framework of preconception health • Collaborative, inclusive process can be time-consuming but reduces “ownership issues” and results in broad support and partnerships • Strategic planning improves focus • Traditional stop/start funding cycles maintain silos in both preconception health care delivery & public health programs • Multi-year, multi-partner projects can actively leverage resources to sustain & transform public health programs

19. Who has capacity to expand? • Folic acid councils • Healthy Start programs • State women’s health/interconception programs or agencies • Adolescent health programs or agencies • Infant mortality coalitions • March of Dimes state chapters • State Office of Women’s Health • State Office of Minority Health

20. Questions to consider • How do our strengths and programs align with identified preconception health needs in our state? • Who are the partners that need to be at the table for effective transition to preconception health? • Which organization(s) in our state can provide: a high-functioning board, commitment, patience, leadership, & institutional support?

21. What’s next for you?

22. Thanks! Questions… Thoughts… Ideas… Amy Mullenix amullenix@marchofdimes.com 919.424.2158 EveryWomanNC.com