MCH Leaders in the Southeast: North Carolina

This month's featured leader is Amy Mullenix, MSW, MSPH, Statewide Coordinator at the March of Dimes North Carolina Preconception Health Campaign. We recently asked her a few questions about her work and why she is involved with Every Woman Southeast.

Why are you involved in Every Woman Southeast?

Every Woman Southeast is unique in that it brings together states that share strong historical and cultural connections. I’m involved because we also share historically poor health outcomes that influence what I care about most – the health of women and their children. We in the Southeast fare poorly on national measures of chronic disease, sexually transmitted infections, obesity and infant mortality and morbidity. These challenges impact African-American women disproportionally and result in inequities in health outcomes. Every Woman Southeast gives us the opportunity to grapple with our history and its consequences, pushing us to find solutions to age-old problems that expand how we attempt to improve health. Our proposed life course approach provides a framework to think about how we can support women (beginning even before their own birth!) to achieve their fullest health potential as adults. Every Woman Southeast also affords us the opportunity to consider solutions that build on our shared strengths, such as strong extended family structures and faith communities. It allows us to meet with our peers from other states and think big about how to enhance services and social structures so that women and families can access meaningful opportunities to achieve their best health potential. It is sometimes difficult work, but I continue to participate because we need to leave a new legacy of equity for all of our citizens in the Southeast. In so doing we will achieve our other goals – improving birth outcomes and educational outcomes, for example – and cause a domino effect that reaches down through generations to come.

How long have you been in your current position?

I have been working for the March of Dimes since 2005. When I was hired, our Campaign was called the North Carolina Folic Acid Campaign, and it had already documented successes in decreasing neural tube birth defects in one part of the state. Our team expanded the Campaign across the state and incorporated social marketing and a dedicated Spanish-language campaign. Over the past several years we’ve seen a continued steady decrease in neural tube defect rates and a simultaneous refocusing on the health of women prior to and in between pregnancies as a way to improve women’s health and birth outcomes. Because folic acid consumption is one of the “flagship” preconception health messages, it was a natural progression to broaden our mission and include additional preconception health messages like healthy weight and reproductive life planning. In 2010 we changed our name to the March of Dimes North Carolina Preconception Health Campaign and updated our strategic plan to reflect our broader focus.

Tell me about one or two of the projects you are working on now.

One project that I am really excited about is our “Healthy Before Pregnancy” curriculum. We started developing a preconception health curriculum for high school students after realizing that the current curriculum fell short when it came to educating young people about infant mortality, healthy pregnancies and preconception health. The curriculum was released this year after extensive testing and features five lesson plans. It follows the NC Standard Course of Study and uses messages and activities that we tested with students throughout the state. Over the next few months our regional coordinators will be entering high schools to present the “Healthy Before Pregnancy” curriculum and talking with teachers about how they can incorporate it into their classrooms going forward. The ultimate goal is to have preconception health taught consistently in middle and high schools throughout the state. This will increase the number of young people entering adulthood with awareness of how their health is related to their future and that of their children.

Another project that we are working on is expanding our health care provider program in which our regional coordinators train health care providers about preconception health topics in their own clinical settings. We make the case for “every woman, every time” and connect the dots between women’s wellness and preconception health. This program has been proven to change provider counseling behavior about folic acid consumption; we’re currently expanding it to include trainings on healthy weight for women, reproductive life planning and tobacco cessation.

What is your favorite thing/task/part of your work?

I have two. First, the staff that work on our Campaign are consummate professionals who are a team in every sense of the word. I end many of my days thinking about how lucky I am to get to work with them. Second, North Carolina is extremely fortunate to have a large number of dedicated public health and medical professionals who work on preconception health issues. I love collaborating with individuals from other agencies and organizations who share common goals. I also enjoy working with our board and my role on the leadership teams of the North Carolina Preconception Health Coalition and North Carolina Birth Equity Council.

What is your biggest challenge?

Funding for preconception health programs such as ours is never certain, so the question for us is always…If our Campaign ceased to exist because of budget cuts, how would our messages continue to reach women? For every project we plan and program we work on, we always think about sustainability. We’re constantly looking for ways to integrate our messages into other programs and agencies so that preconception health becomes a core component of public health and medical practice rather than something that is the work of a particular campaign or agency. Sustainability is our greatest challenge but potentially our greatest accomplishment, too.

To find out more about what is happening in North Carolina, visit everywomansoutheast.org/partners/north-carolina and everywomannc.com.

What Happens in New Orleans Should NOT Stay in New Orleans

Last week myself and several other Every Woman Southeast leadership team members had the opportunity to attend an Infant Mortality Summit in New Orleans. The meeting was sponsored by the Health Resources and Services Administration (HRSA) in collaboration with the Association of Maternal and Child Health Programs (AMCHP), the Association of State and Territorial Health Officials (ASTHO) and the March of Dimes. The meeting was specifically for states in the Department of Health and Human Services Regions IV and VI - 16 states that have historically had among the worst rates of infant mortality in the nation. The objectives for the meeting were ambitious and included to understand strategies to improve birth outcomes; create synergy among State Health Officials, MCH Directors, Medicaid and State partners; identify clear strategies and outcomes for each state (completed by state teams); investigate a common strategy for the states in the region; and create a unified message that builds on best practices. From the North Carolina perspective, I thought that the meeting went very well. I feel very hopeful that this may well be the significant push many of us have been waiting for to finally shine the light on infant mortality and move forward with some new energy and innovation. I'll post the proceedings on our website as soon as they become available.

And on a side note, I must say that I had a chance to taste my first Beignets at Cafe du Monde in the French Quarter. All I can say is "YUM". We Southerners may have our challenges but we also have some great food!

Mark Your Calendars for our Next Webinar

We are really excited about our upcoming webinar on February 9, 2012 from 12-1:30 est. This webinar will focus on the Life Course Theory. This theory is a conceptual framework that helps explain health and disease patterns - particularly health disparities - across populations and over time. It points to social, economic and environmental factors as underlying causes of persistent inequalities in health. This theory is grounded in social determinants and social equity models and is also a community or "place based" approach. While the concept is innovative and for most public health professionals somewhat intuitive, the application in practice is a lot more complex.

In other words, while many of us may be interested in changing the way we approach our work in maternal and child health, there are not many existing models and programs to refer to as best practice for how to actually make it happen! This means that we need to be the change agents to begin to build these new models. But first, it is helpful to make sure we understand the concept and have guidance as to how some programs have made this happen.

Both of our speakers are national experts on the life course model. Our first speaker is from Florida and will provide us with an overview of this model and some resources and examples for application. Our second speaker is not from the South but is leading a very successful and growing MOVEMENT in New York City to reframe his entire perinatal partnership to be in line with the life course theory.

We hope you will register and then join us in a few weeks. To register click here https://www1.gotomeeting.com/register/402200873

Happy New Year!

Day three of the New Year and I've managed to keep many of my resolutions...take a vitamin (check), bring a healthy lunch to work (check), remember to breathe (check - I'm serious - don't you sometimes get so busy you forget to breathe?), and start writing a proposal for funding to make 2012 the year Every Women Southeast becomes a force for change (check)! I love the first week of January and I love making resolutions. There is something beautiful about a fresh start and setting intentions for the year. Even if we don't achieve them, putting them forward and giving them a name is important. This is a dynamic time - for health care and for social change. I can't imagine a better year for us to move forward together and make things happen!

National Preconception Health Planning Meeting

It is hard to believe that the holidays are upon us! Where has the year gone? In true New Year's Resolution style, a group of about 40 professionals from across the country convened in New Orleans for a one day meeting to set plans for preconception health for 2012. The focus of the meeting was to bring together leadership from the five different national workgroups - consumers, public health, policy/advocacy, health care professionals, and research/surveillance - to review the progress of the national campaign to date, think about issues that cut across the workgroups and to plan for the upcoming year. It was very encouraging to look at all the work that has taken place over the years - most of it completed through the work of volunteers with very limited fiscal resources. We will be posting a slide presentation that summarizes the campaign to date on our website along with meeting proceedings as soon as they are released. I think that everyone left inspired and focused - a great way to end the year. Are you interested in serving on a national workgroup? If so, please let us know!

Food for Thought from North Carolina

On November 15, 2012, the Forsyth County Infant Mortality Reduction Coalition in partnership with the March of Dimes, Healthy Start Baby Love Plus Network and Forsyth Medical Center hosted a conference called Taking the Life Course Perspective to Promote Preconception Health and Health Care: Towards the Promise for Equity in Birth Outcomes. Speakers included Merry-K Moos who presented on the Life Course Perspective and Vijaya Hogan who presented on the Impact of Social Disadvantage on Preconception Health. Both speakers provided important insights on these two major schools of thought in preconception health. Dr Hogan spoke about the necessity of recognizing the intersectionality of race, gender, history and class in our work - particularly as these impact African American women. We have many challenges ahead in addressing health inequities for African American women who have five risk areas: historic, acccumulated disadvantage, current social disadvantage, structural embodiments of inequity and epigenetic risks (changes in a woman's biology and that of her women due to impact of other risks).

In the afternoon Judy Ruffin spoke about North Carolina's successful Peer-to-Peer Preconception Health Educator program. Two energetic and dedicated college students from Winston Salem State University shared their experiences with the program. I left convinced that our best allies in reaching young women are young women themselves! Alvina Long Valentin provided an excellent overview of North Carolina's preconception activities and strategic plan as well as our achievements from the past few years. And I had the chance to end the conference by sharing information about Regional and National Preconception Health activities. I included information about the National Preconception Workgroups as well as work and resources from other states. As always I had a chance to showcase Every Woman Southeast and remain so encouraged at the enthusiasm people in the field, doing the work, have for our Coalition.

Sound interesting? The great people in Forsyth County have agreed to make pdfs of the speaker slides available to us. Just click here to access their presentations. I was reminded me that we have made strong progress over the past 7 years in moving preconception health forward in creative and comprehensive ways.

With my favorite holiday just a few days away, I have to say that I'm thankful that I have the chance to do this work in this time and place with amazing colleagues from across the Southeast. Thank you!

Postpartum Visit Webinar is Almost Here

We are looking forward to our next Every Woman Southeast webinar which will focus on the postpartum visit - an important opportunity for interconception care. It seems that this is another topic of great interest in the Southeast - we have over 370 people registered! While we like to feature home grown programs, we're reaching over to the West Coast to learn from Dr. Jeanne Conry, MD, PhD who has provided leadership to work in California where our innovative colleagues have reconsidered and improved the postpartum visit.

Why is this visit important? For many women, this may be one of their last encounters with a health care professional - for their own care - for a long time. While Health Care Reform has the potential to provide ongoing access to health coverage for all women, our current system of care leaves low income mothers without coverage once they are about 6 weeks postpartum. In our region over 12% of new mothers find themselves pregnant again within 6 months of giving birth. The risk of preterm birth increases with short birth intervals.

Interested? Please join us for the webinar on October 13th from 12-1:30 EST. You can register on our website. We will post the slides in case you miss it. You can also start a conversation on this topic - add a comment to our blog!