Maternal Child Health Services Contract Work Plan
FFY 2015-2017
Contract Period October 1, 2014-September 30, 2017
LPHA Contractor: Audrain County Health Department
Selected Priority Health Issue: Prevent and reduce adverse birth outcomes
Statement of the Problem: According to the Infant Health Profile from MODHSS, 2005-2009, Audrain County has
a high rate of neural tube defects, 25.6/10,000 births, with the State of Missouri’s rate being 6.28/10,000 births. That puts
Audrain County significantly higher than the state rate.
The CDC’s Data and Statistics states national estimates in 2004 – 2006: anencephaly as 1 in 4859 births, spina bifida
without anencephaly as 1 in 2858 births, and encephalocele as 1 in 12235 births. Compared with infants of non-Hispanic
white mothers, infants of Hispanic mothers had a higher birth prevalence of anencephaly, spina bifida, and encephalocele.
Folic acid is a B vitamin that, if taken before and during early pregnancy, can help prevent neural tube defects, which are
major birth defects of the baby’s brain and spine. Neural tube closure is completed 28 days (four weeks) from conception,
and the preventive effect of folic acid is not effective after that period. Moreover, highest serum folate levels require at
least three weeks of treatment with folic acid. That is why folate supplementation should start at least one month before
conception and continue until at least two months after conception. (According to the Journal of Prenatal Medicine, 2008,
Oct-Dec)
In 1991, the CDC recommended that women with a history of a prior neural tube defect (NTD) affected pregnancy should
consume 4000 mcg of folic acid daily starting at the time they begin planning a pregnancy. Subsequently, in 1992, the
U.S. Public Health Service recommended that all women of childbearing age consume 400 mcg of folic acid daily through
fortification, supplementation, and diet to prevent NTD’s. In 1996, the United States Food and Drug Administration (FDA)
mandated that by January 1, 1998 all grain products labeled as ‘enriched’, such as bread, cereals, and rice have folic acid
added to them to help reduce the risk of neural tube defects. This is known as folic acid fortification. After folic acid
fortification was started, there was a 36% decrease in the prevalence of spina bifida and a 17% decrease in the
prevalence of anencephaly. In 1998, the Institute of Medicine recommended that women capable of becoming pregnant
should consume 400 mcg of folic acid daily from fortified foods or supplements, or both, in addition to that obtained
through a normal diet. In 2009, the U.S. Preventive Services Task Force published updated guidelines that reinforced
these recommendations.
Maternal Child Health Services Contract Work Plan
FFY 2015-2017
According to a 2007 Survey done by the CDC among all women of childbearing age: 40% reported taking folic acid daily,
81% reported awareness of folic acid and 12% reported knowing that folic acid should be taken before pregnancy.
Women of childbearing age who were aware of folic acid reported hearing about it from: health care providers (33%),
magazine or newspaper (31%), radio or television (23%). Women aged 18-24 years were more likely to hear about folic
acid from a magazine or newspaper (25%) or school or college (22%) than from their health care provider (17%).
Whereas 37% of women aged 25-34 years and 36% of women 35-45 years reported hearing about folic acid from their
health care provider. Among women who reported not taking a vitamin or mineral supplement on a daily basis, the most
common reasons were: forgetting (33%), no need (18%), no reason (14%), already get balanced nutrition (12%).
Goal(s): Improve the knowledge and attitudes and behaviors of men and women related to preconception health.
Strategies: Implement health promotion and education efforts to improve birth outcomes by supporting folic acid
campaigns to target preconception and interconception women about the importance of folic acid to reduce the
occurrence of neural tube defects.
Instructions: Develop a three-year work plan for actions in each level of the Spectrum of Prevention for each contract period
year that progress toward the planned System Outcomes, giving consideration to the Life Course Framework and issues in Risk
and Protective Factors (see MCH Services Contract Proposal Guidance).
Spectrum of
Prevention
Influence Policy
and Legislation
Develop strategies to
change laws and policies
to influence outcomes in
health, education, and
justice
Change
Organizational
Practices
Adopt regulations and
Activities
System Outcomes by
Sept. 30, 2017
FFY 2015: Research and develop policies for Audrain County Health
Department programs.
FFY 2016: Implement policies at Audrain County Health Department
into applicable programs.
FFY 2017: Brief BOH and local policy makers on outcomes.
The Audrain county Health
Department has a policy that
for integrating preconception
health education into existing
programs as evidenced by
other ACHD standing
programs.
Number of ACHD clients
receiving preconception/
interconception health
education on folic acid has
FFY 2015: Research and develop policies for Audrain County Health
Department programs.
FFY 2016: Implement policies at Audrain County Health Department
into applicable programs.
Maternal Child Health Services Contract Work Plan
norms to improve health
and safety and creating
new models
FFY 2017: Brief BOH and local policy makers on outcomes.
FFY 2015: Share data on adverse birth outcomes with coalition
members.
Foster Coalitions
and Networks
Bring together groups and
individuals for broader
goals and greater impact
FFY 2016:
Identify possible media campaigns.
FFY 2017: Implement media campaign plans.
FFY 2015: Research and develop information specific for providers.
Educate Providers
Inform influential
organizations and leaders
to transmit skills and
knowledge to others
Promote
Community
Education
Reach groups of people
with information and
resources to promote
health and safety
FFY 2016: Provide information and literature to nurses in the
physician offices, FQHC, and SSM Audrain
FFY 2017: Provide information and literature to nurses in the schools
and school counselors.
FFY 2015: Research and assess what information is available in
Audrain County and to Audrain County residents.
FFY 2016: Get information out to the community through newspaper
articles and ads, social media like Facebook, mass e-mails, and
presentations at clubs and organizations in Audrain County, etc.
FFY 2017: Continue education and expand coverage with updated
information, through social media.
FFY 2015-2017
increased as evidenced by
health department
documentation.
The coalition (HSC) has
engaged in a Folic acid media
campaign as evidenced by
health department
documentation.
The number of providers that
receive information and tools
related to
preconception/interconception
health education has
increased evidenced by
health department
documentation.
The coalition (HSC) has
engaged in a Folic acid media
campaign as evidenced by
health department
documentation.
Maternal Child Health Services Contract Work Plan
Strengthen
Individual
Knowledge and
Skills
Enhance an individual’s
capability for health and
safety
FFY 2015: Develop a survey and present to ACHD clients, especially
clients who come for WIC, STD testing, Love & Logic Parenting
Classes, and pregnancy testing.
FFY 2016: Educate through Love & Logic, WIC Breastfeeding Peer
Counselors, WIC, STD testing, and pregnancy tests by providing
handouts and one on one education.
FFY 2017: Continue education and perform a follow-up survey of
ACHD clients, especially clients of WIC, Love & Logic Parenting
Classes.
Revision Date:
(to be completed only for an amendment)
FFY 2015-2017
The number of ACHD clients
who receive folic acid
education has increased as
evidenced by ACHD
documentation.