By Julie M. McFarlane, MPH
Women's Health Operations & Policy Analyst, Center for Prevention and Health Promotion, Oregon Public Health Division
Senior Policy Analyst, AMCHP
As part of an ALC supported by AMCHP, Oregon created a team that consisted of members from Oregon Public Health Division offices (Women's Health and Adolescent Health); Oregon Health & Science University, Office of Women's Health; Women with Disabilities Health Equity Coalition (WowDHEC); National Youth Leadership Network; GimpGirl Community; and youth with disabilities, with the goal of developing and implementing action plans, sharing strategies and problem solving across communities around preconception health. The Oregon team set the goal of creating a set of Preconception Health Recommendations for Young Adults with Disabilities to build on its Preconception Health Action Plan, which was created in 2008. The action plan focuses on four main recommendations: 1) 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. 2) As a 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. 3) Integrate components of preconception health into existing local public health and related programs, including emphasis on interconception interventions for women with previous adverse outcomes. 4) Maximize public health surveillance and related research mechanisms to monitor preconception health.
The team working on the Preconception Health Recommendations for Young Adults with Disabilities performed a literature review, data analysis, and online survey of youth with disabilities to inform the recommendations. The recommendations were developed as a starting point for a national discussion to further expand on the work by continuing the dialogue and test their viability.
- Using the Socio-Ecological Model of Health (SeMH) as a framework, the ALC made recommendations organized by individual-level, relationship-level, community-level, and societal-level. Within each level, a variety of recommendations were made. Recommendations included: individual-level: preconception health care for young adults with disabilities (YAWD) should be supported by encouraging access, information, health equality and physical safety.
- Relationship-level: Family members, caseworkers, and teachers should work to support and encourage environments that allow for access of reproductive and preconception health information and services.
- Community-level: Community-based programs, social service providers, and health systems play an important role in creating a community that is supportive, ensuring that YAWD are included in program and services design and implementation and recognized for their strengths and contributions to the community.
- Societal-level: Preconception health policies, marketing and health messages, data collection, and research should reflect the inclusion and support of young adults with disabilities.
Suggestions for further work regarding preconception health and disability include developing recommendations and suggestions for alcohol, tobacco and other drug use, obesity and physical activity, folic acid, diabetes, and special challenges that YAWD may face, such as physical barriers in receiving clinical care (as in a mammogram or PAP smear). The ALC team recommends that YAWD, stakeholders, public health entities, and the medical community continue this work, and contribute to the dialogue to improve on these recommendations and test their viability. Oregon is continuing its preconception health care work in focusing on well-women visits and health equity issues.