U.S. newborn death rate high but early education could reduce infant mortality

CDC: Changes in knowledge and attitude are necessary

Health education aimed at healthy babies should begin long before conception, before even the thought of conception. According to a report issued by the Centers for Disease Control and Prevention, the majority of U.S. adults do not know how unhealthy lifestyle choices, such as smoking, obesity, or misuse of alcohol, influence reproductive health and childbearing. To improve preconception health, the report says, "Changes in the knowledge and attitudes and behaviors related to reproductive health among both men and women need to be made."

"Education needs to happen before a woman gets pregnant to prevent any kind of adverse outcome for the woman and for the infant," says Samuel F. Posner, PhD, assistant director for science at the CDC's division of reproductive health.

To achieve better outcomes for both mother and baby, the CDC issued recommendations in April on both preconception health and preconception health care. There are 10 categories of health action steps and many focus on education. (See a list of educational action steps below.)

Health action steps to smarter conception

In April, the Centers for Disease Control and Prevention recommended several preconception health action steps to improve the health of women and men in their reproductive years for healthier families.

• Develop, evaluate, and disseminate reproductive life planning tools for women and men in their childbearing years, respecting variations in age, literacy (including health literacy), and cultural/linguistic contexts.

• Conduct research leading to development, dissemination, and evaluation of individual health education materials for women and men regarding preconception risk factors, including materials related to biomedical, behavioral, and social risks known to affect pregnancy outcomes.

• Develop, evaluate, and disseminate age-appropriate educational curricula and modules for use in school health education programs.

• Integrate reproductive health messages into existing health promotion campaigns (e.g., campaigns to reduce obesity and smoking).

• Conduct consumer-focused research to identify terms that the public understands and to develop messages for promoting preconception health and reproductive awareness.

• Design and conduct social marketing campaigns necessary to develop messages for promoting preconception health knowledge and attitudes and behaviors among men and women of childbearing age.

• Educate women and couples regarding the value and availability of pre-pregnancy planning visits.

The complete list can be found at www.cdc.gov/reproductivehealth. Look for the report titled, "Recommendations to Improve Preconception Health and Health Care — United States."

"There are endless opportunities for health education in the context of preconception care and preconception health," says Posner.

One important message is that women should not wait until they are pregnant to make sure they are eating a healthy diet, taking vitamins, and getting enough sleep. Healthy behaviors should be developed before a woman becomes pregnant so that she doesn't have to adopt multiple behavioral changes afterwards, says Posner.

"This area is a great opportunity for patient education. What are some of the key areas they might want to think about? If there were some behavior changes they might want to initiate for improving their health, what would be the top priorities?" Posner says.

Education can start in schools with information on how decisions regarding health impact a person in the short and long term. While it is difficult to get young people to consider the consequences of poor health choices over a lifetime, it is important to begin to think about such things at a young age, Posner says.

Education should include learning how to prevent pregnancy, whether through abstinence from sex or use of effective contraceptive methods, so that pregnancy occurs at a time when couples are ready — psychologically, physically, and mentally. "All those things have an impact on a mother's health and well-being throughout the lifespan, as well as the infant's health," says Posner.

Creating a reproductive life plan

Women and men should consider developing a reproductive life plan that is part of a broader life plan. This plan considers what a person wants to achieve and what they want to do, whether traveling or obtaining a certain career, as well as becoming a parent, and how it all fits together.

Health care institutions can provide tools and education about reproductive life plans. Such tools can help people plan when they might want to become pregnant and what they need to do to prepare themselves spiritually, mentally, and socially, says Posner.

If preconception health screenings were part of routine care for women of reproductive age, such issues as poor nutrition and medical conditions and use of certain medications could be addressed to prepare for pregnancy whenever it might occur.

According to the CDC report, "a reproductive health plan might increase the number of planned pregnancies and encourage persons to address risk behaviors before conception, reducing the risk for adverse outcomes for both the mother and the infant."

"About 50% of the pregnancies in the U.S. are unintended. We need to recognize that is the case and work toward lowering that number and also realize that will not happen overnight," Posner says. "Anything we can do to improve how people plan how they will move through their lives, including their reproductive decisions, will benefit the women and the men, as well as any children they will have."

There are health care facilities that have developed tools for creating a reproductive health plan and other educational materials to support preconception health strategies. Posner says it would be beneficial for each institution to evaluate its tools for effectiveness and then share the materials along with the evaluation results.

"We are looking to people like patient educators who are doing these things to evaluate and disseminate their findings. If we can take advantage of what people have already done, it will help move this forward rather then having each clinic develop their own materials. What we need to do is share what we have already learned so everyone can benefit from it," says Posner.


For more information about the CDC report on preconception health, contact:

  • Samuel F. Posner, PhD, Assistant Director for Science, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, 4770 Buford Hwy., NE, MS K-20, Atlanta, GA 30341. Phone: 770-488-5200. Fax: 770-488-6450. E-mail: SPosner@cdc.gov.