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Preconception Health and Health Care Update
Greetings
This is a monthly communication for individuals interested in improving the health of women and infants through preconception health and health care. We welcome your readership and contributions. |
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Health Reform and Women
Improving health coverage is an essential step toward improving the health and well-being of women. In 2007, 11.4 million women were uninsured. Among uninsured women, 71% are low income. Over 20% of all women of childbearing age (ages 18-44) and in that age group nearly 4 in 10 of low income women (below 200% of the federal poverty level) do not have health coverage -- public or private. (The graph shows the health insurance status of low-income women, US, 2007. Data courtesy of Kaiser Family Foundation) Women who are younger, women of color, and those who have low income are particularly at risk for being uninsured.
Millions of non-pregnant women lost coverage in the past decade as a result of welfare reform policies, even before the current recession and growth in unemployment. Providing universal access to health care would be a major step toward improving preconception health and health care.
The combined health reform legislation in the U.S. House of Representatives, H.R. 3200, would assure coverage for all over the coming years. If successfully combined, the bills approved by the Senate Committees on Finance and on Health, Education, Labor and Pensions (HELP) would offer mechanisms to cover the uninsured. Many more negotiations and Congressional votes are ahead before any bill becomes law. If a bill becomes law, much implementation work would be required.
For women of childbearing age, policies related to coverage rules, benefits structure, and cost are all critical issues. Even insured women of childbearing age experience problems today, particularly in terms of the coverage for reproductive health services to prevent or optimize pregnancy.
On October 15, the Senate HELP Committee held a hearing on: What Women Want: Equal Benefits for Equal Premiums. Hearing chair, Senator Mikulski (D-MD) stated: " When it comes to health insurance, women are discriminated against. We pay more - in higher premiums - and get less. Often we are denied care, whether it's because pregnancy is considered a pre-existing condition, or because we're not covered for preventive and wellness initiatives. The good men of America are on our side. They want to end discrimination against women, who are their mothers, daughters and wives."
Results of a recent report from the National Women's Law Center were discussed by Marcia Greenberger, founder and copresident. "We found even some 25-year-old women are charged up to 84 percent more than men of the same age for individual health plans that exclude maternity coverage." Karen Ignagni, president and chief executive of America's Health Insurance Plans, told Senators that " prohibiting premium variation based on gender is a critically important step towards providing security and peace of mind to women."
Senator Franken (D-MN) stated: "Health insurance companies consider pregnancy a pre-existing condition... and we permit this discrimination under current law... [this practice] sends a message that we don't want women to receive prenatal services and high quality maternity care... as if we don't all benefit from healthy mothers and healthy babies... Fortunately when we pass national health reform... all women will have access to comprehensive benefits including maternity care... It's also top priority for me that health reform includes a crucial women's health service - access to affordable family planning services."
Senator Burr (R-NC) added: "Furthermore, any discussion about affordable health care for women must include medical malpractice reform. If we care about making sure women have access to OB/GYNs, we cannot ignore the fact that high malpractice insurance is driving doctors out of this specialty and, even worse, closing practices or forcing them to migrate to urban areas only."
The hearing, "What Women Want: Equal Benefits for Equal Premiums," featured testimony from the following witnesses: James Guest, President and CEO of Consumers Union; Marcia Greenberger, Founder and Co-President, National Women's Law Center (NWLC); Karen Ignani, President and CEO of America's Health Insurance Plans (AHIP); Amanda Buchanan, Patient/Health care consumer; Peggy Robertson, Patient/Health care consumer; Janice Shaw Crouse, Director and Senior Fellow, Concerned Women for America; and Diana Furchtgott-Roth, Senior Fellow, Hudson Institute, Director, Center for Employment Policy.depression. |
Shifting the Paradigm in MCH to a Life Course Perspective
A new report, Making a Paradigm Shift in Maternal and Child Health: A Report on the National MCH Life Course Meeting, (Pies, Parthasarathy, Kotelchuck, and Lu) is available at The report a broad, new vision statement for the field would include changes in health care practices, policy, re-search, and advocacy at the federal, state, and local levels, as well as the strategies that will reconfigure services to integrate this perspective into maternal and child health (MCH) practices.
The Life Course Perspective looks at health, not as disconnected stages (infancy, latency, adolescence, adult, old age) unrelated to each other, but as a continuum. It takes into account a complex interplay of biological, behavioral, psychological, social, and environmental factors that contribute to health across the course of a person's life. It builds on recent medical, social science, and public health research which suggests that each life stage influences the next.
In 2006, Michael Lu, Milton Kotelchuck, Cheri Pies, and Padmini Parthasarathy formed a "Life Course Work Group" to examine the application of the Life Course Perspective to the field of MCH. This group initially explored the topic, then convened a meeting of national experts to explore how the MCH field would have to change in order to adopt, integrate, and apply the Life Course Perspective theory in research, practice, policy, and education and training. With funding from The California Endowment and Contra Costa Health Services, the National MCH Life Course Meeting took place in Oakland, California, on June 9-10, 2008.
 In Contra Costa County, California, the Life Course Initiative, was launched in 2005.This local Life Course Initiative is to reduce disparities in birth outcomes and change the health of the next generation in Contra Costa County by achieving health equity, optimizing reproductive potential, and shifting the paradigm of the planning, delivery, and evaluation of maternal, child, and adolescent health services. The utilizes the 12-Point Plan to Close the Black-White Gap in Birth Outcomes.
For more about the national or local work, contact Padmini Parthasarathy at or visit Life Course Initiative. |
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Adding Weight to Preconception Care
Many women are unaware that they are overweight or obese, and of the risks this poses to current or future potential pregnancies. Two recent articles published in the Medical Journal of Australia (MJA2009; 191(8): 421-422) address aspects of weight in relationship to preconception and pregnancy.
Callaway and colleagues surveyed women about the preconception weight management advice they received, their self-perception of weight before pregnancy and their success with weight reduction. The survey found:
- 30% of women had been overweight or obese before pregnancy; however, 36% of those overweight categorized themselves as being of normal weight.
- Only 16% of women with BMI in the obese range considered themselves to be obese.
- While 57% of the overweight and obese women had a preconception health check with a doctor, only 17% of the overweight and obese women recalled being advised by a doctor to lose weight.
"Our findings highlight the importance of calculating BMI and advising women about the increased risk of adverse pregnancy outcomes associated with overweight and obesity when they present for preconception care," Callaway said.
Jeffries and colleagues conducted a randomized controlled trial of an intervention to limit maternal weight gain during pregnancy. They found that regular self-measurement of weight was effective in reducing pregnancy weight gain only in women who were overweight, but not obese, at the start of pregnancy. There was a statistically significant reduction in gestational weight gain in the overweight group (BMI, > 26.0, ≤ 29.0 kg/m2).
An extensive body of literature points to the negative effects of excessive weight on conception rates (natural and assisted), pregnancy complications (gestational diabetes, pre-eclampsia and operative delivery, and others), and fetal wellbeing (increased rates of miscarriage, congenital malformations, stillbirth and perinatal death). Postpartum obese mothers postpartum experience more failure to initiate and sustain breastfeeding, and postpartum depression.
In an accompanying editorial , Marc Keirse, points out that the nine months of pregnancy is the wrong time and too short a time for much to be achieved in terms of healthy weight, especially for those at greatest need. He calls for a shift to preconception care, among an array of providers.
For more on this subject, see: Institute of Medicine and National Research Council. Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines |
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Thinking about women in health reform?
Visit these web sites to learn more:
White House healthreform.gov
Jacobs Institute of Women's Health
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