Appendix 2
Arizona Preconception Health Strategic Plan 2011-2015 Plan Diagram

Arizona Preconception Health
Strategic Plan
2011-2015

Arizona Department of Health Services
December 2010

Background
Preconception Health
What Is Preconception Health?
Preconception health relates to the health of women and couples before
conception, whether it is the first or a subsequent pregnancy.
Improving preconception health can contribute to improvement in
pregnancy-related outcomes. Furthermore, improving the health of
mothers and fathers is a benefit in itself. With preconception health,
everyone wins.
Preconception health is an important component of the life course
perspective model. The life course perspective model recognizes that
the health of an individual affects not only themselves but future
generations as well. This model takes into account cumulative
protective and risk factors in several domains, including physical, mental, environmental, economic,
and spiritual health, in understanding health and disease patterns. Because critical periods of
development are known to impact long term health, preconception health is woven into the life
course perspective. As an example, studies conducted by Dr. David Barker1 support a link between
low birth weight babies and an increased risk for developing cardiovascular disease as adults.
While it is generally accepted that smoking increases the risk of being diagnosed with lung cancer,
more studies are pointing to a link between the mother’s health behaviors long before pregnancy,
the environment in the womb, and the long term effect on the health of the child as they age.
Implementation of the strategies contained in this plan should reflect an understanding of the life
course perspective as we move forward in improving the health of women, children, and their
families.
What Is Needed to Achieve Preconception Health?
Achieving preconception health requires a multi-faceted approach. The goal is to identify and
reduce behavioral, social, and biomedical risks through prevention and management, with an
emphasis on those factors that are best addressed before conception or early in pregnancy.
The U.S. Department of Health and Human Services, Centers for Disease Control and Prevention
(CDC) published “Recommendations to Improve Preconception Health and Health Care” in the April
21, 2006 issue of the Morbidity and Mortality Weekly Report (MMWR). CDC developed these
recommendations based on a review of published research and the opinions of specialists from the

Barker, D.J.P., Osmond, C., Golding, J., Kuh, D., & Wadsworth, M.E.J. (1989). Growth in Utero, Blood Pressure
in Childhood and Adult Life, and Mortality From Cardiovascular Disease. British Medical Journal, (298), 564-7;
and Barker, D.J.P. (1990). The Fetal and Infant Origins of Adult Disease. British Medical Journal, (301), 1111.
1

2/11/11

Page 2

CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. The
report identifies four goals:
Improve knowledge and behaviors among men and women regarding preconception health.
Assure all women of childbearing age receive preconception care services.
Reduce risks associated with a previous poor birth outcome.
Reduce disparities in adverse pregnancy outcomes.
In addition, the report outlines 10 recommendations that focus on changes in consumer knowledge,
clinical practice, public health programs, healthcare financing, and data and research activities. The
recommendations are as follows:
Individual responsibility across the lifespan. Each woman, man, and couple should be
encouraged to have a reproductive life plan.
Consumer awareness. Increase public awareness of the importance of preconception health
behaviors and preconception care services by using information and tools appropriate
across various ages; literacy, including health literacy; and cultural/linguistic contexts.
Preventive visits. As part of primary care visits, provide risk assessment and educational and
health promotion counseling to all women of childbearing age to reduce reproductive risks
and improve pregnancy outcomes.
Interventions for identified risks. Increase the proportion of women who receive
interventions as follow-up to preconception risk screening, focusing on high priority
interventions.
Interconception care. Use the interconception period to provide additional intensive
interventions to women who have had a previous pregnancy that ended in an adverse
outcome.
Prepregnancy checkup. Offer, as a component of maternity care, one prepregnancy visit for
couples and persons planning pregnancy.
Health insurance coverage for women with low incomes. Increase public and private health
insurance coverage for women with low incomes to improve access to preventive women’s
health and preconception and interconception care.
Public health programs and strategies. Integrate components of preconception health into
existing local public health and related programs, including emphasis on interconception
interventions for women with previous adverse outcomes.
Research. Increase evidence base and promote the use of evidence to improve
preconception health.
Monitoring improvements. Maximize public health surveillance and related research
mechanisms to monitor preconception health.

Arizona’s Response
Since the release of the CDC’s recommendations to improve preconception health in 2006, the
Arizona Department of Health Services (ADHS) and its partners across the state have made steady
progress in improving awareness about preconception health and increasing access to

2/11/11

Page 3

preconception health services. The ADHS Bureau of Women’s and Children’s Health (BCWH)
assessed internal programs serving women and children to identify opportunities for integrating
preconception health education and services into program policies and procedures. This process
resulted in policy revisions for the following programs: Health Start, High Risk Perinatal
Community Health Nursing, Family Planning, and County Prenatal Block Grant. In addition,
community grants were awarded to address the BWCH priority area of reducing preventable infant
mortality rates and the services provided ranged from educating women of child-bearing age and
nurse home visitors on preconception/interconception health to combating obesity by holding
classes that focused on improving nutrition and physical activity levels.
In the summer of 2008 a task force was convened to review and adapt Every Woman educational
materials, originally developed in California and subsequently updated by the Florida State Health
Department, to make them specific to Arizona. The materials have been provided to WIC clinics,
BWCH contractors, Preconception Health Care Summit attendees, all county health departments,
and Healthy Start consortium members. The materials are available at the BWCH website and use
of these materials continues to be promoted as appropriate.
In September 2008, the BWCH was awarded the First Time Motherhood/New Parents Initiative
grant to: 1) develop a social marketing campaign targeting African American men and women ages
18-30 to increase awareness about preconception health and the life course perspective; 2) conduct
educational sessions for African Americans residing in Maricopa County, Yuma, Tucson, and Sierra
Vista; 3) train barbers
and beauticians about
preconception
health so they can provide
accurate information
to their clients; 4) provide
information on
preconception care and the
life course
perspective to health
professionals/physicians
through Grand
Rounds at Level II hospitals,
conferences, and
workshops; 5) host a
Preconception
Health Care Summit; and 6)
integrate the
preconception/life course
perspective message
into other related ADHS social
marketing campaigns where possible. As a result of this funding, the award winning
LiveitChangeit.com campaign was launched in October 2009; all Level III hospitals in Arizona
offered Grand Rounds on preconception health care; community-based education was provided;
and a very successful Preconception Health Care Summit was held on April 30, 2010. Although the
grant funding has ended, the community presentation information developed is available on-line
for others who want to continue increasing awareness in the African American community. DVDs of
the Summit are also available as a resource for continuing education among health care providers,
program staff, and policy makers.
During the past several years, the Arizona Chapter of the March of Dimes has funded a variety of
preconception/interconception health efforts. A community health center in northern Arizona
received funding to provide preconception health education to young parents. The Arizona Family

2/11/11

Page 4

Planning Council is currently in the process of developing and coordinating preconception health
care training for Title X family planning providers. A hospital-based preconception/interconception
education program is being offered to young people. The Maricopa Integrated Health System
(MIHS) Internatal Care Project offers clinical services and case management to women who deliver
at Maricopa Medical Center and whose babies are admitted to the Newborn Intensive Care Unit.
The March of Dimes funds supported the MIHS Internatal Care Project from its inception and the
program has grown with funding from First Things First, Arizona’s early childhood development
and health agency. The MIHS Internatal Care Project is the only model of its type in Arizona. The
March of Dimes also promotes utilization of National March of Dimes preconception health
materials across the state.
National preconception health experts, Dr. Hani Astrash with the CDC and Dr. Michael Lu, Associate
Professor of obstetrics and gynecology at UCLA, have visited Arizona several times to speak at
Grand Rounds and other educational venues. Dr. Lu was a keynote speaker at the Arizona Public
Health Association 2008 Fall Conference, as well as the 2010 Preconception Health Care Summit.
Arizona recently added improving the health of women prior to pregnancy as one of its top
maternal and child health priorities, in recognition of the critical nature of this health concern and
in response to public input. Preconception health addresses many aspects of health, including
reproductive health, nutrition, physical activity, tobacco use, substance abuse, and mental health, as
well as access to and utilization of quality health care.
Arizona recently added improving the health of women prior to pregnancy as one of its top
maternal and child health priorities, in recognition of the critical nature of this health concern and
in response to public input. In establishing this priority, it was noted that preconception health
addresses many aspects of health, including reproductive health, nutrition, physical activity,
tobacco use, substance abuse, and mental health, as well as access to and utilization of quality
health care.
These activities led up to the creation of Arizona’s Preconception Health Strategic Plan. The plan
will serve as a guide for ADHS and its partners as we continue to improve the health of babies and
subsequent generations by improving the health of children, youth, and adults of childbearing age.

Current Health Status
(Source: Arizona Department of Health Services, Arizona Maternal
Child Health Needs Assessment 2010)
Attention to preconception health has been growing nationally and in
Arizona because of its impact on the health status of the whole
population. Indicators influenced by preconception health include
prematurity and low birth weight. Prematurity is the leading cause of
infant death in the United States and infants who survive often face
lifelong health problems such as breathing and respiratory difficulties,
cerebral palsy, vision and hearing loss, feeding and digestive problems,
and intellectual disabilities. Premature infants frequently require

2/11/11

Page 5

specialized care in neonatal intensive care units for weeks or months and the associated first year
medical costs for a preterm birth are about 10 times that for a full-term baby. In Arizona, while the
percentage of babies born preterm does not appear to be trending upward, it is still greater than
the Healthy People 2010 goal and there are significant health disparities. Preterm birth is the
strongest risk factor for low birth weight. While the percentage of Arizona births at low and very
low birth weights has remained below the national average for several years, Arizona is not
meeting the Healthy People 2010 goal and rates are significantly higher in certain demographics.
The infant mortality rate in Arizona has fluctuated over the past decade and has typically been in
alignment with the national rates, but Arizona will likely not meet the Healthy People 2010 goal
unless some significant disparities are addressed.
Data on determinants of health, including risks and protective factors, also point to the importance
of addressing preconception health in Arizona. In recent years, Arizona women ages 18-44 were
less likely than women nationally to smoke, but there continue to be disparities, with women living
in poverty more likely than other women giving birth to be smokers. Unlike smoking, which is
decreasing, diabetes is on the rise. The rate of any type diabetes in mothers delivering a live birth
nearly doubled in 2008. Hypertension is also rising, as is obesity, which is associated with this
condition. Overweight and obesity can increase the chance of developing not only hypertension and
diabetes, but also other chronic health conditions such as coronary heart disease, stroke,
gallbladder disease, osteoarthritis, sleep apnea, high cholesterol/triglycerides, and some types of
cancers. Nearly half of all reproductive age women in Arizona are either overweight or obese and
Arizona is well above the Healthy People 2010 goal level. As with conditions mentioned previously,
there are disparities—in the case of overweight and obesity, the disparities are associated with race
and ethnicity, education, income, and residence.
A key protective factor for women of reproductive age is consuming multivitamins or supplements
with folic acid. In 2007, about half reported taking multi-vitamins or supplements and some who
reportedly knew the importance still did not engage in this behavior. Further, there were significant
disparities linked with race and ethnicity, education, and income.

The Strategic Planning Process
In May 2010, following the Preconception Health Care Summit held in Arizona in April, ADHS
established the Preconception Health Strategic Planning Task Force for the purpose of creating a
statewide plan for improving the preconception health of Arizonans. The intent was for the plan to
foster awareness and implementation of CDC’s “Recommendations to Improve Preconception
Health and Health Care” by serving as a
guide for stakeholders in both public and
private sectors who are interested in and
willing to play an active role. The plan
would build on past successes and work
already in progress, serve as a mechanism
for coordinating and integrating the work of
individual agencies and organizations, and

2/11/11

Page 6

provide a platform for identifying and taking advantage of funding opportunities.
In addition to representatives from several ADHS programs, members of the Task Force included
representatives from the Apache County Public Health Department Services District, Arizona
Association of Community Health Centers, Arizona Family Planning Council, Arizona Perinatal
Trust, Asian Pacific Community in Action, Chandler Regional Medical Center, First Things First,
Health Choice Arizona, March of Dimes, Maricopa County Department of Public Health, MIHS,
Native Health/Health Start, Rural Health Office/University of Arizona College of Public Health,
South Phoenix Healthy Start, Teen Outreach Pregnancy Services, and Yavapai County Community
Health Services.
The Task Force met monthly from May through August 2010. A detailed description of the planning
process is included as Appendix 1.

Next Steps
ADHS will convene a group of key community partners to guide and provide accountability in
implementation of Arizona’s Preconception Health Strategic Plan. We will develop and track
progress toward detailed implementation plans. We will stay abreast of the latest research and
policy changes that impact preconception health, as well as promising approaches to promoting
public awareness, healthy behaviors, healthy and secure environments, and access to and delivery
of physical, oral, and behavioral health services that contribute to preconception health. Lessons
learned will be utilized to refine the approaches envisioned in this plan.

2/11/11

Page 7

Arizona’s Plan
Vision for the Future
Healthy mothers, fathers, and babies
Women and their partners enter into pregnancy as healthy as possible because they engage in
healthy behaviors, ideally throughout their lifespan; have information, education, services, and
support required to achieve good health; and live in safe and secure environments.

Guiding Principles
Preconception health relates to both females and males—it is not solely a matter of women’s health.

Preconception health starts at the beginning of one’s life—it is not limited to the prenatal period.
Preconception health is inclusive of physical health, mental health, and oral health.
Preconception health requires an ecological approach—health occurs within the context of one’s
family, community, and culture.
Effective promotion of preconception health requires awareness, respect, and consideration of
diversity in its many forms.
Preconception health requires a focus on prevention—the emphasis should be on promoting
health, reducing risks, early detection and intervention to address health issues, improving social
factors that impact health, and promoting policies that support health.

2/11/11

Page 8

Healthy Behaviors within a Healthy and Secure Environment

HEALTHY BEHAVIORS
Develop a reproductive health plan
Space pregnancies
Enter pregnancy as healthy as possible
Breastfeed
Maintain a healthy weight
Engage in physical activity
Engage in good oral health practices
Utilize preventive healthcare services
Follow the recommended immunization schedule for all ages
Manage chronic conditions
Engage in a mentally healthy lifestyle/utilize services when needed
Avoid use of tobacco and drugs
Avoid use of alcohol if planning and during pregnancy
Engage only in safe and responsible sexual practices
Be an informed consumer of healthcare

Supported by and within a

HEALTHY AND SECURE ENVIRONMENT

2/11/11

Page 9

Target Populations

Women
who have had
adverse birth outcomes

Women at risk of adverse birth outcomes

Children and all adults of childbearing age

Goals
Goal 1: Public Awareness

Increase public and provider awareness of the importance of
preconception health, ways to improve preconception health, and
available resources and supports.

Goal #2: Healthy Behaviors

Promote behavior that contributes to preconception health among
both women and men throughout the lifespan.

Goal #3: Access/Delivery
of Quality Preconception
Health/ Healthcare

2/11/11

Increase access to and delivery of physical, oral, and behavioral
health services that contribute to preconception health.

Page 10

Five-Year Strategies

Goal 1: Public Awareness

Goal 2: Healthy Behaviors

Work with and through community partners to increase health literacy (knowledge, skills, and
confidence to take action that will lead to better health) among the public with whom they have
contact.
Identify and leverage opportunities to work with and through community partners to promote
environmental conditions that support healthy behaviors.
Identify and leverage opportunities to work with and through community partners to promote
business/organizational and public policies that support healthy behaviors.

Goal 3: Access/Delivery of Quality Preconception Healthcare

Provide information to healthcare providers and insurers on the benefits of preconception
healthcare and best practices.
Work with and through healthcare providers, insurers, and other community healthcare partners to
influence policy and practice.
Stay informed about healthcare reform and implications for preconception health care; share
information with community healthcare partners; take action as opportunities emerge.
Work to expand availability of preconception health data.
Identify and utilize available preconception health data to inform program and policy decision
making.

2/11/11

Page 11

Medical Providers:
Screen and educate their patients
about the importance of physical
activity to preconception health

Employers:
Make recreational facilities
available to workers

What Everyone
Can Do to Promote
Preconception
Health:
A Physical Activity
Example
Community:
Create and maintain safe
walking and biking paths

Churches:
Conduct family events that
promote physical activity

Individual:
Engage in regular physical
activity throughout the life
span

2/11/11

Page 12

Goal 1: Public Awareness
2011-2012 Priorities
Work with the following priority groups to
increase health literacy of the populations with
whom they have contact:
1) ADHS public health programs, their
contractors, and related community
partners;
2) Other State agency programs serving
adults of childbearing age, initially home
visitation and parent education
programs;
3) Healthcare providers, their professional
associations, and continuing education
providers; and
4) Arizona Department of
Education/Comprehensive School
Health and ADHS teen pregnancy
prevention programs.
(Indicators = groups engaged, new groups
reached, partners addressing preconception
health)

Goal 2: Healthy Behaviors
Action Plan
Convene a group of key community partners to
guide future action.
Identify funding opportunities to support the
preconception health plan.
Identify and engage program partners; identify
collaborative approaches with each partner.
Identify messages that are culturally
appropriate and supported by scientific data, on
the importance of preconception health, healthy
behaviors, and how to access healthcare,
resources, and support.
Select/develop materials, tools, templates, a
peer education and support model, and training
and education models to use with community
partners.
Provide/facilitate community partners’ access
to information, technical assistance, training,
and education.

Reach target populations directly through use of
social media and embed preconception health
messages into other social marketing efforts,
where possible. (Indicators = populations
reached, populations engaged)

2/11/11

Page 13

A Variety of Approaches2 to Promoting Preconception Health:
A Physical Activity Example

6
5
4
3
2
1

• Influencing Policy and Legislation: Support school district
policies that ensure physical education is provided to all
students

• Changing Organizational Practices: Create break-time walking
groups at the worksite

• Fostering Coalitions and Networks: Create a faith-based health
and fitness coalition

• Educating Providers: Provide a list of low-cost, safe, local
physical activity resources for healthcare providers to share
with their patients

• Promoting Community Education: Provide public service
announcements on the importance of lifetime physical activity
and how to build physical activity into the daily routine

• Strengthening Individual Knowledge and Skills: Provide ideas
for family-centered, lifetime physical activities for families
whose children are enrolled in childcare programs

The Spectrum of Prevention used as the framework for this chart was developed by the Prevention
Institute, www.preventioninstitute.com.
2

2/11/11

Page 14

Goal 3: Access/Delivery of Quality Preconception Healthcare
2011-2012 Priorities
Work with the following priority groups to
increase healthcare provider information about
preconception health, including CDC’s
“Recommendations to Improve Preconception
Health and Healthcare,” new Federal
requirements for preventive health services,
and best practices/policies:
1) Medical associations (Arizona Medical
Association, Arizona Academy of Family
Physicians, American Congress of
Obstetricians and Gynecologists,
American Academy of Pediatrics,
Arizona Chapter);
2) Community health nurses and schools of
nursing;
3) Behavioral health providers; and
4) Community health centers.

Action Plan
Identify and engage healthcare partners.
Provide information to healthcare partners on
preconception health and emerging promising
or best practices.
Monitor healthcare reform and provide
information to healthcare partners.
Work with healthcare partners on a cost
savings/financial model; share with decisionmakers.
Convene a data group to identify a dataset.
Identify content and prepare a women’s health
status report.

(Indicators = providers reached, information/
presentations provided)
Document healthcare cost savings and develop a
related financial model. (Indicators = model
created and disseminated)
Promote coverage for preconception healthcare.
(Indicators = actions taken, partners engaged)
Stay current on healthcare reform and
implications for preconception health.
(Indicators = fact sheets created and
disseminated)
Assemble an Arizona preconception dataset
based on currently available data. (Indicators =
dataset created and shared with partners)
Produce a biennial report on the status of
women’s health in Arizona with a focus on
preconception health. (Indicators = report
prepared and disseminated)

2/11/11

Page 15

The Array of Preconception Health Services

Preventive
Medical Care

Pre-pregnancy
Check-ups

Preventive
Dental Care

Healthcare
Coverage for
these and other
needed services

Behavioral
Health Services

Interconception
Care especially
for those who
have had a high
risk birth

2/11/11

Interventions for
those with
identified risks/
conditions

Page 16

Potential Partners
State Agencies
Arizona Department of Health Services
Arizona Department of Economic
Security
Arizona Department of Education
First Things First

Other Community Programs
Adult Education Programs
Breastfeeding Support Programs
Correctional Facilities
Early Care and Education Programs
Family Planning Programs
Foster Parent Training Programs
Health Education Centers
HIV/AIDS Programs
Home Visitation Programs
Immunization Programs
Job Readiness Programs
Life Skills Education Programs
March of Dimes
Nutrition Programs
Parent Education Programs
Prenatal Programs
Programs for Pregnant Women
Refugee Programs
Substance Abuse Prevention/Treatment
Programs
Teen Pregnancy Prevention Programs
Tobacco Prevention/Cessation Programs

2/11/11

Health Partners
Arizona Public Health Association
Behavioral Health Providers
Community Health Centers
County Health Departments
Health Insurance Providers
Health Plans
Health-related Organizations,
Associations, and Coalitions
Healthcare Provider Education
Programs
Healthcare Providers
Hospitals
Indian Health Service
Medical, Dental, Nursing, and Other
Professional Associations
Oral Health Providers
Professional Student Associations
Tribal Health Directors
Other Community Partners
Advocacy Organizations
Businesses
Elected Officials
Ethnic Organizations
Faith-based Organizations
Media
Military
Parks and Recreation
Schools (Pre-K through Higher
Education)
Sororities and Fraternities
Tribes/American Indian Communities
Women’s and Men’s Health and Other
Groups
Youth-serving Organizations

Page 17

Resources
American Academy of Family Physicians:
http://familydoctor.org/online/famdocen/home/women/mental/443.html
American Heart Association:
http://www.americanheart.org
Arizona Department of Health Services, Bureau of Women’s and Children’s Health:
http://www.azdhs.gov/phs/owch/index.htm
Arizona Department of Health Services, Bureau of Women’s and Children’s Health, Every
Woman, Arizona (preconception health educational materials):
http://www.azdhs.gov/phs/owch/publicat.htm
Arizona Department of Health Services, Tobacco Education and Prevention Program:
http://www.tobaccofreearizona.com/
Association of Maternal and Child Health Programs:
http://www.amchp.org/Pages/Welcome.aspx
BMI Calculator:
http://www.cdc.gov/nccdphp/dnpa/bmi/index.htm
Bright Futures for Women’s Health:
http://www.hrsa.gov/womenshealth
Bright Futures Health Promotion:
http://www.brightfutures.org
Centers for Disease Control and Prevention (preconception health):
http://www.cdc.gov/ncbddd/preconception/default.htm
Centers for Disease Control and Prevention (reproductive health/tobacco use):
http://www.cdc.gov/reproductivehealth/TobaccoUsePregnancy/index.htm
CityMaTCH Lifecourse Toolbox:
http://www.citymatch.org/lifecoursetoolbox
Health Resources and Services Administration (HRSA) Information Center:
1-888-ASK-HRSA
It’s Your Health:
http://www.hc-sc.gc.ca/iyh-vsv/life-vie/shs-fs_e.html
March of Dimes:
http://www.marchofdimes.com

2/11/11

Page 18

Maternal Child Health Life Course Research Network
http://healthychild.ucla.edu/LCRN.asp

Maternal Stress:
http://mchb.hrsa.gov/pregnancyandbeyond/depression/help.htm
National Domestic Violence:
http://www.ndvh.org
National Institutes of Health:
http://www.nicdh.nih.gov/health/topics/preconception_care.cfm
National Institute of Mental Health:
http://www.nimh.nih.gov/health/publications/depression-what-every-woman-shouldknow/summary.shtml
Netwellness Consumer Health Information:
http://www.netwellness.org/healthtopics/pregnancy
http://www.cdc.gov/nccdphp/dnpa/physical/importance/index.htm
Office on Women’s Health:
http://www.womenshealth.gov and http://www.girlshealth.gov
PRAMS Data:
http://www.cdc.gov/PRAMS/UP.htm
Preconception Health and Health Care Updates (newsletter):
http://www.beforeandbeyond.org/index.php?page=breaking-news
Spectrum of Prevention, Prevention Institute:
http://www.preventioninstitute.org
Spectrum of Prevention, Contra Costa Health Services:
http://cchealth.org/topics/prevention/spectrum.php
United States Department of Agriculture:
http://www.mypyramid.gov
U.S. Department of Health and Human Services, The Health Consequences of Involuntary
Exposure to Tobacco Smoke: A Report of the Surgeon General. Available at:
http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2006/index.htm
U.S. Department of Health and Human Services Substance Abuse and Mental Health Services
Administration’s National Drug and Alcohol Treatment:
http://www.samhsa.gov/index.aspx

2/11/11

Page 19

Appendix 1
Strategic Planning Process Description
In May 2010, following the Preconception Health Care Summit held in Arizona in April, ADHS
established the Preconception Health Strategic Planning Task Force for the purpose of creating a
statewide plan for improving the preconception health of Arizonans. The intent was for the plan to
foster awareness and implementation of CDC’s “Recommendations to Improve Preconception
Health and Health Care” by serving as a guide for stakeholders in both public and private sectors
who are interested in and willing to play an active role. The plan would build on past successes and
work already in progress, serve as a mechanism for coordinating and integrating the work of
individual agencies and organizations, and provide a platform for identifying and taking advantage
of funding opportunities.
In addition to representatives from several ADHS programs, members of the Task Force included
representatives from the Apache County Public Health Department Services District, Arizona
Association for Community Health Centers, Arizona Family Planning Council, Arizona Perinatal
Trust, Asian Pacific Community in Action, Chandler Regional Medical Center, First Things First,
Health Choice Arizona, March of Dimes, Maricopa County Department of Public Health, MIHS,
Native Health/Health Start, Rural Health Office/University of Arizona College of Public Health,
South Phoenix Healthy Start, Teen Outreach Pregnancy Services, and Yavapai County Community
Health Services.
The Task Force met monthly from May through August 2010. The desired results for the first
meeting (May 21, 2010) were that participants would have an understanding of the CDC
recommendations for preconception health and an awareness of Arizona initiatives designed to
improve preconception health and would have identified how Arizona is doing currently with
respect to the CDC recommendations. During this meeting, the CDC goals and recommendations
were reviewed and ideas that emerged from the Arizona Preconception Health Care Summit were
shared. Categories for action identified by the Summit participants included: 1) fostering individual
responsibility, 2) increasing consumer awareness, 3) increasing preventive healthcare visits, 4)
improving interconception care, 5) increasing health insurance coverage for women with low
incomes, 6) using public health programs and strategies, and 7) research.
Strategic planning task force members began work on a vision statement by answering the
questions: What would success look like? How will we know it when we see it? From this
discussion, a draft vision statement was created. The participants also identified current assets that
can serve as a foundation for future action, including funding, programs, and potential partners.
Finally, participants reviewed each of the ten CDC recommendations and made an assessment of
Arizona’s current status with respect to each and where they would like for Arizona to be in five
years.

2/11/11

Page 20

Preconception Health Strategic Planning Worksheet
CDC Goals:
1. Improve the knowledge and attitudes and behaviors of men and women related to preconception health.
2. Assure that all women of childbearing age in the US receive preconception care services that will enable them
to enter pregnancy in optimal health.
3. Reduce risks indicated by a previous adverse pregnancy outcome through interventions during the
interconception period, which can prevent or minimize health problems for a mother and her future children.
4. Reduce disparities in adverse pregnancy outcomes.
CDC Recommendations

1.

Individual responsibility across the lifespan. Each woman, man,
and couple should be encouraged to have a reproductive life
plan.

2.

Consumer awareness. Increase public awareness of the
importance of preconception health behaviors and
preconception care services by using information and tools
appropriate across various ages; literacy, including health
literacy; and cultural/linguistic contexts.

3.

Preventive visits. As part of primary care visits, provide risk
assessment and educational and health promotion counseling to
all women of childbearing age to reduce reproductive risks and
improve pregnancy outcomes.

4.

Etc.

Where do
we want to
be?

Where are
we now?

What do
we need to
do?

The desired results for the second meeting (June 11, 2010) were that the vision statement would be
developed and that the task force would have identified the major areas of focus for the plan and
begun to identify strategies to be undertaken in each of these areas. The Prevention Institute’s
Spectrum of Prevention was used to help stimulate thinking about possible strategies in the
following categories: 1) strengthening individual knowledge and skills, 2) promoting community
education, 3) educating providers, 4) fostering coalitions and networks, 5) changing organizational
practices, and 6) influencing policy and legislation. Additionally, the task force identified and
applied criteria to help guide their decision making about strategies. These were as follows: 1) the
strategy is feasible to implement with few or no new resources; 2) the strategy is feasible to
implement in the current environment; 3) the strategy will help us achieve the desired result for
each of the target populations identified; and 4) the strategy will promote partnerships. The
resulting matrix was used to begin development of the plan. The draft was then posted and written
comments solicited for incorporation into the draft to be reviewed at the third task force meeting.

2/11/11

Page 21

Preconception Health Strategic Planning Worksheet 2
Type of Action (based on the Prevention Institute’s Spectrum of Prevention)

Area of Focus

Strengthening
individual
knowledge
and skills

Promoting
community
education
(groups)

Educating
providers

Fostering
coalitions
and
networks

Changing
organizational
practices

Influencing
policy and
legislation

1.

Consumer awareness (why
important, what to do, where to
get support and other
resources)
Through existing programs
Through schools
Through media, social
networking, and other
direct means
Will need to identify priorities and
messages
2.

Healthy behaviors (e.g.,
developing reproductive health
plans, delaying pregnancy,
healthy weight, physical activity,
mental health, avoiding use of
tobacco and drugs, seeking
health care, being informed
consumers of healthcare)
Will need to identify priorities
3.

Integration with public health
and other programs
Will need to identify priorities
4.

Health care (availability, access,
quality)
Preventive visits
Interventions for identified
risk
Interconception care
Prepregnancy check-up
Health insurance coverage

5.

Research/surveillance/data/eval
uation

6.

Other?

The desired results for the third task force meeting (July 30, 2010) were to have finalized major
areas of focus and strategies. In this meeting, the task force also agreed on target audiences, the
overarching message of the plan, a list of healthy behaviors, a list of health care services that
contribute to preconception health, and a list of potential partners (program, community, and
healthcare).

2/11/11

Page 22

The desired results for the fourth and final meeting of the task force (August 27, 2010) were to
reach agreement on realistic priorities for the first year of the plan. Additionally, the task force
learned about national recommendations related to preconception health indicators and discussed
the creation of a preconception health dataset for Arizona. Their recommendations were included
in the draft plan. The task force also discussed the format for the plan and the desirability of
convening an ongoing group focused on preconception health.

2/11/11

Page 23

Appendix 2
Arizona Preconception Health Strategic Plan 2011-2015 Plan Diagram
VISION FOR THE FUTURE: Healthy mothers, fathers, and babies
Women and their partners enter into pregnancy as healthy as possible because they engage in healthy behaviors, ideally throughout their lifespan; have information, education, services, and support required to achieve good health; and live in safe and secure
environments
PRECONCEPTION HEALTH GUIDING PRINCIPLES
Relates to both females and males Starts at the beginning of one’s life Includes physical health, mental health, and oral health Occurs within the context of one’s family, community, and culture Promotion of preconception health requires awareness,
respect, and consideration of diversity in its many forms The emphasis should be on promoting health, reducing risks, early detection and intervention to address health issues, improving social factors that impact health, and promoting policies that support
health
GOALS
Goal 1: Public
Awareness
Increase public and
provider awareness
of the importance of
preconception
health, ways to
improve
preconception
health, and available
resources and
supports
Goal #2: Healthy
Behaviors
Promote behavior
that contributes to
preconception health
among both women
and men throughout
the lifespan
Goal #3:
Access/Delivery of
Quality
Preconception
Healthcare
Increase access to
and delivery of
physical, oral, and
behavioral health
services that
contribute to
preconception health

FIVE-YEAR STRATEGIES
Work with and through community partners to increase health literacy
(knowledge, skills, and confidence to take action that will lead to better
health) among the public with whom they have contact
Identify and leverage opportunities to work with and through community
partners to promote environmental conditions that support healthy
behaviors
Identify and leverage opportunities to work with and through community
partners to promote business/organizational and public policies that
support healthy behaviors

Provide information to healthcare providers and insurers on the benefits
of preconception healthcare and best practices
Work with and through healthcare providers, insurers, and other
community healthcare partners to influence policy and practice
Stay informed about healthcare reform and implications for
preconception health care; share information with community healthcare
partners; take action as opportunities emerge
Work to expand availability of preconception health data
Identify and utilize available preconception health data to inform
program and policy decision making

ONE-YEAR PRIORITIES
Work with the following priority groups to increase health literacy of the populations with whom they
have contact: 1) ADHS public health programs, their contractors, and related community partners; 2)
other State agency programs serving adults of childbearing age, initially home visitation and parent
education programs; 3) healthcare providers, their professional associations, and continuing
education providers; and 4) Arizona Department of Education/Comprehensive School Health and
ADHS teen pregnancy prevention programs. (Indicators = groups engaged, new groups reached,
partners addressing preconception health)
Reach target populations directly through use of social media and embed preconception health
messages into other social marketing efforts, where possible (indicators = populations reached,
populations engaged)

MAJOR ACTIONS FOR 2011-2012
Convene a group of key community
partners to guide future action
Identify funding opportunities to support
the preconception health plan
Identify and engage program partners;
identify collaborative approaches with each
partner
Identify messages that are culturally
appropriate and supported by scientific
data, on the importance of preconception
health, healthy behaviors, and how to
access healthcare, resources, and support

Work with the following priority groups to increase healthcare provider information about
preconception health, including the Centers for Disease Control and Prevention’s Recommendations
to Improve Preconception Health and Healthcare, new Federal requirements for preventive health
services, and best practices/policies: 1) medical associations (Arizona Medical Association, Arizona
Academy of Family Physicians, American Congress of Obstetricians and Gynecologists, American
Academy of Pediatrics, Arizona Chapter); 2) community health nurses and schools of nursing; 3)
behavioral health providers; and 4) community health centers (indicators = providers reached,
information/presentations provided)

Select/develop materials, tools, templates,
a peer education and support model, and
training and education models to use with
community partners

Document healthcare cost savings and develop a related financial model (indicators = model created
and disseminated)

Identify and engage healthcare partners

Promote coverage for preconception healthcare (indicators = actions taken, partners engaged)
Stay current on healthcare reform and implications for preconception health (indicators = fact sheets
created and disseminated)
Assemble an Arizona preconception dataset based on currently available data (indicators = dataset
created and shared with partners)

Provide/facilitate community partners’
access to information, technical assistance,
training, and education

Provide information on preconception
health and emerging promising or best
practices
Monitor healthcare reform and provide
information to healthcare partners
Work with healthcare partners on a cost
savings/financial model; share with
decision-makers
Convene a data group to identify a dataset

Produce a biennial report on the status of women’s health in Arizona with a focus on preconception
health (indicators = report prepared and disseminated)

Identify content and prepare a women’s
health status report