An interview with Mary A. Balluff, Division Chief, Community Health and Nutrition, Douglas Co. Health Dept. 

By now we realize that enhancing a woman's health before planning and conceiving a pregnancy reduces the risk of adverse health effects for both herself and her baby. But optimizing women's health before and between pregnancies is an ongoing process that requires the full participation of all segments of the public health and health care systems. In Omaha, Nebraska the Douglas County Health Department has prioritized preconception health to not only increase positive birth outcomes, but to also promote the health of all of its county's women, infants and children.

Mary A. Balluff, Chief of the Community Health and Nutrition Services Division within the Douglas County Health Department, has worked for many years to improve maternal and infant health in her locale. One of these areas of improvement involves sexually transmitted infections (STIs). In 2004, Omaha's rates of STIs reached epidemic levels, and the area has since continued to exhibit some of the highest rates of STIs in the nation. With a $2.5 billion investment from the Sherwood Foundation, the Division is initiating a media campaign to urge appropriate prevention methods and testing. This campaign will eventually transform into one focusing on teen pregnancy - another area of concern.

Utilizing personal interviews and the Fetal Infant Mortality Review (FIMR) process, Mary and her staff have realized that intervening during pregnancy is too little too late. These data revealed that women are going into pregnancy both uninformed and unprepared, so the Division asked "How can we make sure women are ready for pregnancy?" To answer this question, the Division focused its attention on adolescents. Though the surrounding community was concerned that any program addressing adolescent preconception health would highlight discussions about sex, the community agreed that implementing Wyman's Teen Outreach Program (TOP) was an acceptable approach to take. The evidence-based nature of the TOP Program exposes youth to 10 key developmental assets that relate to preconception health through three areas: 1) educational peer group meetings, 2) positive adult guidance and support, and 3) community service learning. Through this program, Omaha's highest-risk low-income adolescents are learning to develop life goals, understand their decision-making processes, and ultimately delay parenthood.

The final area of focus involves postpartum women. FIMR data indicate that many women, especially women who have lost their infant, miss their six-week postpartum visit. To address this issue, the Division is in the process of initiating two projects, both within the WIC program. The first of these is a survey designed for WIC-enrolled women to assess why they are missing their postpartum visits. With an understanding of the underlying reasons, WIC staff should be better able to service these women and encourage proper postnatal health. Still, when a woman does arrive for her final postpartum visit, the final WIC visit in particular, the topic of discussion is often focused on the baby. There is little dialogue about her health or the issues that are most important or pressing for her. The second WIC project addresses this dearth with a survey of two WIC sites that inquires about women's specific postpartum needs. These results should promote among WIC staff an understanding of the information that is most wanted and needed by postpartum mothers.

Overall, optimizing women's health requires a multifaceted approach - much like the one Mary and her staff are implementing within the Douglas County Health Department. With a focus on STIs, adolescents and postpartum women, the Division is developing new ways to think about maternal and infant health in Omaha's highest-risk communities. For more information about the Fetal and Infant Mortality Review (FIMR) process within the Douglas County Health Department, view their 2013 annual report.