The Promise of
Preconception Care in
Prevention of Birth Defects
and Preterm Births
Dr Neena Raina
Regional Advisor
Child and Adolescent Health
WHO-SEARO
WHO - SEARO
1
Structure of presentation
1. What is Pre-conception Care
2. Do we have evidence based
interventions
3. Why is it important in SEAR
4. Opportunities for introducing
it in SEAR
5. “Healthy Transitions” for
Adolescents
6. Way forward
WHO-SEARO
2
1.What is Pre-conception Care
WHO-SEARO
3
Pre-pregnancy health status and health
behaviors have direct or indirect implications
for maternal and neonatal outcomes
• Intervening after a woman is pregnant has limited impact:
– First few weeks after conception are critical for fetal
development
• Week 5: brain, spinal cord, heart begin to form
• Week 6: Neural tube closes; the heart is pumping
• Week 7: Brain and face are rapidly developing
• Most women do not seek prenatal advice/care before 12 weeks
when it is too late to modify many risks
Intervening during pregnancy is too late for many
interventions
Many health risk behaviours are initiated during
adolescence
WHO-SEARO
4
Modifiable risk factors are common to
several “congenital conditions”
Malformations
Preterm
Birth
IUGR
Nutrition status
X
X
X
Insufficient folic acid/vitamin
X
X
X
Smoking
X
X
X
Alcohol use / abuse
X
X
X
X
Illicit drugs
X
X
X
X
Obesity
X
X
X
Diabetes - getsational
X
X
X
Infectious diseases
X
X
X
X
Selected medications
X
X
X
X
X
X
Risk factor
Psycho-social stressors
Environment and working
activity
Developm.
disability
X
X
X
X
ICBDSR presentation in Regional Meeting 2012
WHO-SEARO
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Modifiable risks for birth defects and prematurity
that need to be addressed before conception
• Undernutrition and
anaemia
• Folic Acid insufficiency
• Obesity
• Diabetes
• Hypertension
• Epilepsy
• Alcohol use
• Age at pregnancy
• Too close and too many
pregnancies
• Infections: TORCH
• Use of medications
during early pregnancy
• Exposure to toxins
• Exposure to tobacco
WHO-SEARO
Many risk factors are initiated during adolescence
6
Pre-Conception Care
• Preconception care is the provision of biomedical,
behavioral and social health interventions to women and
couples before conception occurs.
Aims:
• Improving health status and reducing behaviors and
individual and environmental factors to improve
maternal and child health outcomes.
Boundary: the period before pregnancy may be divided into
a proximal and a distal period:
Proximal period immediately preceding pregnancy
Distal adolescence (10-19 years)
WHO-SEARO
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Life course – when to intervene?
2.Do we have evidence based
interventions
WHO-SEARO
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Gathering evidence: Global
consultation
Global consultation in WHO Headquarters, Geneva - February 2012
Meeting to develop a global consensus on preconception care to reduce maternal
and childhood mortality and morbidity
Three questions were answered:
1. What are the health problems, risk behaviours and risk factors
contributing to maternal and childhood mortality and
morbidity?
2. What are the effective interventions to address them?
3. What are the
effective means
of delivering these
interventions?
Gathering evidence: Existing reviews
Using existing evidence and reviews from:
• The Centers for Disease Control and Prevention
• Erasmus University
• Aga Khan University
• Health Council of the Netherlands
Evidence for Pre-Conception Care
Recommendations to
Improve Preconception
Health – United States by the
Centers for Disease Control
and Prevention (2006)
Systematic Review of
Preconception Evidence by the
Aga Khan University in Karachi,
Pakistan
(2011)
WHO-SEARO
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Gathering evidence: WHO departments
Consultation with various relevant WHO departments:
• Maternal, Newborn, Child and
Adolescent Health
• Reproductive Health and
Research
• Nutrition for Health and
Development
• HIV
• Mental Health and Substance
Abuse
• Immunization, Vaccine and
Biologicals
• Public Health and Environment
• Tobacco-Free Initiative
• Violence and Injury Prevention
• Partnership for Maternal,
Newborn and Child Health
Strength of evidence
•
•
•
There is growing experience in
implementing preconception care
initiatives:
In high-income countries, such as Italy, the
Netherlands and the United States
In low- and middle-income countries, such
as Bangladesh, the Philippines and Sri Lanka
Preconception care has a positive effect
on a range of health outcomes
child mortality
maternal mortality
birth defects
Reduced too early
pregnancy
Reduced abortion
preterm birth
congenital and
neonatal infections
cretinism
Improved mental
health
Improved mother
nutritional status
macrosomia
childhood cancers
vertical transmission
of HIV/STIs
diarrhoea
Low birth weight
Underweight and
stunting
hypothyroidism
Tobacco use and youth health: a
potential for Healthy Transitions
5 million
deaths in
2005
10 million
deaths in
2020
20 y.o.
90% of adult smokers are estimated to
have started smoking before age 20 years
Exposure to environmental toxins in early
life and its long term effect
cigarette
smoking
during
pregnancy
reduced birth
weight or
increased risk
of lower birth
weight
offspring
obesity
eliminating smoking before
or during pregnancy could avoid 5–7% of preterm related
deaths and 23–24% of cases of sudden infant death
syndrome
Areas addressed by preconception care package
WHO-SEARO
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Evidence-based interventions: Selected examples
Area addressed by the
preconception care
package
Nutritional
conditions
Evidence-based
interventions
•
•
•
•
•
•
•
•
•
•
•
Screening for anemia
Supplementing iron and folic acid
Information, education and counselling
Monitoring nutritional status
Supplementing energy- and nutrient-dense food
Screening for diabetes mellitus
Management of diabetes mellitus
Counselling people with diabetes mellitus
Monitoring blood glucose (also in pregnancy)
Promoting exercise
Salt iodization
WHO-SEARO
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Evidence-based interventions: Selected examples
Areas addressed by the
preconception care
package
Genetic conditions
Evidence-based
interventions
•
•
•
•
•
•
•
•
•
Screening for anemia
Taking a thorough family history
Family planning
Genetic counselling
Carrier screening and testing
Appropriate treatment
Providing community-based education
Community-wide or national screening
among populations at high risk
Population-wide screening
WHO-SEARO
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Evidence-based interventions: Selected examples
Areas addressed by the
preconception care
package
Too-early, unwanted
and rapid successive
pregnancy
Evidence-based
interventions
•
•
•
•
•
•
•
•
•
•
Keeping girls in school
Influencing cultural norms that support early marriage and
coerced sex
Creating visible, high-level support for pregnancy
prevention programmes
Educating girls and boys about sexuality, reproductive
health and contraceptive use
Building community support for preventing early pregnancy
and for contraceptive provision to adolescents
Enabling adolescents to obtain contraceptive services
Empowering girls to resist coerced sex
Engaging men and boys to critically assess norms and
practices regarding gender-based violence and coerced sex
Educating women and couples about the dangers to the
baby and mother of short birth intervals
Providing contraceptives
WHO-SEARO
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3.Why Preconception care is
important in SEAR
WHO-SEARO
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MDG 5 Indicators-SEAR Countries
Unmet
Births
Post
ANC (%)
Need
by
natal
SBA
CPR
for
caesare within 2
Countries
At
(%)
(%) family
an
days of
planning least 1 Atleast section child
1990 2000 2010
visit 4 visits (%) birth (%)
(%)
BAN
800
400
240
31
61
12
50
26
17
27
BHU
1000
430
180
58
66
12
74
77
12
MMR (per 100 000
live births)
KRD
IND
INO
MAV
MMR
NEP
SRL
THA
TLS
97
600
600
830
520
770
85
54
120
390
340
190
300
360
58
66
81
200
220
60
200
170
35
48
100
58
80
95
71
36
99
99
94
50
82
85
43
50
93
80
13
8
7
32
48
70
67
27
7
3
100
75
93
99
83
58
99
99
55
61
35
46
50
68
80
21
13
29
5
24
45
71
1000
610
300
30
22
32
84
55
2
25
Source: World Health Statistics 2013
The Region is not likely to reach MDG4
Child Mortality in SEA Region in 2012 (UN-IGME Report 2013)
Decline in NMR has been slower
140
120
118
100
80
81
77
60
50
39
44
40
27
MDG Target
36
20
0
1990
1995
2000
U5MR
IMR
2005
NMR
WHO-SEARO
2012
2015
MDG Target
25
Newborn mortality remains high in
SEAR
• Responsible for 54% of under-five deaths
• Three congenital conditions: Prematurity,
Birth Asphyxia and Birth Defects
account for 35-55% of under-5 mortality
• These causes of mortality share many risk
factors
WHO-SEARO
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90.0
60%
80.0
50%
70.0
60.0
40%
50.0
30%
40.0
30.0
20%
20.0
10%
10.0
0.0
Distribution of causes of deaths (%)
Under-5 mortality rate (per 1,000 births)
Prematurity, Birth Asphyxia and Birth Defects account for
35% (Myanmar) to 55% (Thailand) of under-5 mortality
0%
Birth defects
Prematurity
Birth asphyxia
Under-5 mortality rate
Source:
World Health Statistics 2011 http://www.who.int/whosis/whostat/2011/en/index.html
WHO-SEARO
27
Estimates of Birth Defects in SEAR
Birth Defects prevalence / 1000 live births
66
64.3
64
62.2
62
60
60.8
59.9
59.3
58.6
60.3
59.9
58.5
58.4
58
56
54.1
54
52
50
Le
st
e
nd
Ti
m
or
Th
ai
la
an
ka
Sr
iL
ep
al
N
ya
nm
ar
M
al
di
ve
s
M
In
do
ne
si
a
PR
In
di
a
Ko
re
a
n
hu
ta
B
D
B
an
gl
ad
es
h
48
March of Dimes Global Report on Birth Defects (2006)
WHO-SEARO
28
28
Birth Defects
Situation
Analysis:
WHO-SEARO
and US-CDC
WHO-SEARO
Estimates of Pre Term Births
Born Too Soon Report: 2012
WHO-SEARO
30
Eleven countries with PT birth >15% by Rank
Born Too Soon Report: 2012
WHO-SEARO
31
4.Preconception Care in SEAR
Twin track:
• Pre- and Inter-pregnancy care: Maternal
Health
• Healthy Transitions for adolescents:
Adolescent Health
WHO-SEARO
32
Is there a gap in Continuum of Care?
• Healthcare provided across
the lifecycle through
strong public health
programs can ensure that
all women and babies are
healthy
• There is a gap in the
continuum of care for
adolescent girls (and boys)
and women before
pregnancy.
33
Family/community
Outreach/outpatient
Clinical
Strengthening pre-conception care in the RMNCAH Continuum
•Screening and
management of chronic
diseases especially
diabetes
•Genetic counselling
• Multivitamin and folic
acid supplementation
• Family planning
• Youth development
programs
EMERGENCY NEWBORN AND CHILD CARE
CHILDBIRTH CARE
-Post-abortion care
- STI case management
– Emergency obstetric care
– Skilled obstetric care and
immediate newborn care
(hygiene, warmth,
breastfeeding) and
resuscitation
– PMTCT
ANTENATAL CARE
- Hospital care of newborn and childhood
illness including HIV care
- Extra care of preterm babies including
kangaroo mother care
- Emergency care of sick newborns
POSTNATAL CARE
- Promotion of healthy behaviors
- 4-visit focused ANC package
- Early detection of and referral for illness
- IPTp and bednets for malaria
- Extra care of LBW babies
- PMTCT
- PMTCT
• Prevention of obesity
• Optimising Adolescent
and pre-pregnancy
nutrition
• Health education and
counseling on risk
factors prevention
INTERSECTORAL
Pre-pregnancy
- Counselling and
preparation for
newborn care,
breastfeeding, birth
and emergency
preparedness
Healthy home care including:
- Newborn care (hygiene, warmth)
- Nutrition including exclusive breastfeeding and
appropriate complementary feeding
- Seeking appropriate preventive care
- Danger sign recognition and careseeking for illness
- Oral rehydration salts for prevention of diarrhoea
- Where referral is not available, consider case
management for pneumonia, malaria, neonatal sepsis
- Where skilled care is not
available, consider clean
delivery and immediate
newborn care including
hygiene, warmth and early
initiation of breastfeeding
Improved living and working conditions – Housing, water and sanitation, and nutrition
education and female empowerment
Pregnancy
WHO-SEARO
Birth
34
Pre-pregnancy care for prevention birth defects
Life course Continuum
10-19
Ado Health
Infancy U5
CH
Immunization
Birth
Newborn
Care
Neonatal period
SBA
ANC
PCC
Pre-Pregnancy Pregnancy
Interventions to address MH
risk factors for BD and PT births
WHO-SEARO
35
Sri Lanka
Package for newly married
couples
Goal: To have improved
reproductive health outcomes
by improving the health of the
newly married couples.
WHO-SEARO
36
Package for newly married couples
• RISK SCREENING
• CLINICAL ASSESSMENT
• IMMUNIZATION
• AWARENESS AND COUNSELLING
• PROVISION OF OTHER SERVICES
WHO-SEARO
37
TOOLS IN THE PACKAGE
• INVITATION CARD
• SCREENING TOOL
• GUIDE FOR HEALTH
WORKERS
• BOOK FOR THE NEW
COUPLE
• BMI CALCULATOR
WHO-SEARO
38
SCREENING TOOL
• Screen for risk factors by
using the screening tool by
PHM/MOH
• Basic investigations
• Physical assessment by
PHM
• Height, weight and BMI
• Clinical examination by MOH
• Refer for further diagnosis
/treatment/ for specialized
care
• Follow up
WHO-SEARO
39
Book for the New Couple
♣ SEXUALITY AND SEXUAL RELATIONSHIP
♣ SEXUALLY TRANSMITTED DISEASES AND
RESPONSIBLE SEXUAL BEHAVIOUR
♣
A PLANNED FAMILY
♣
GOOD NUTRITION
♣ GOOD HEALTH HABITS/ HEALTHY
BEHAVIOUR/ HEALTHY LIFE STYLE
♣ GOOD MARITAL RELATIONSHIP AND WELL
BEING OF THE FAMILY
♣ BENEFITS OF NON VIOLENCE
♣ BEFORE CONCEPTION
♣ MALE PARTICIPATION AND PARENTHOOD
♣ TOBACCO AND ALCOHOL
WHO-SEARO
40
5.Many health risk behaviours are initiated
during adolescence: Need to catch them
young
“Healthy Transitions”
WHO-SEARO
41
Large number of adolescents in SEAR with
many health problems
Adolescents in SEAR
Proportion of adolescents (10-19)
• Sexual and reproductive
health problems
• Nutritional problems
• Substance use: Tobacco,
alcohol
1.2 billion adolescents (10-19)
globally About 350 Millions in
SEAR of which 230 million in India
• Injuries, accidents and
violence
• Mental health problems
Source: World population prospects: The 2006 Revision PopulationWHO-SEARO
Database.
42
Health problems start during Adolescent
period
• Age parameter: 10-19 years
• Confounding factors:
– Biological: Early or late onset of
puberty
– Social-cultural factors
• Experiencing rapid growth and
development:
–
–
–
–
–
Physical: Body image and form
Sexual: Reproductive capacity
Mental: Mind
Emotional-psychological
Social
• Formative Phase:
– Attitudes
– Behaviours
Heterogeneous groups and
circumstances with variable
needs:
– Boys and girls
– Urban and rural
– In school and out of
school
– Unmarried and married:
Pregnant and mothers
– At home and homeless
(on streets)
– In employment (formal
and informal
43
70
64.9
Early Marriage and childbearing
60
47.4
50
40.7
40
25.8
30
22
20
19.6
18.9
THA
TLS
Per cent married by Age 18 among
adolescents (15-19 yrs)
11.8
10
3.9
0
BAN
BHU
IND
INO
MAV
NEP
SRL
45
41.5
40
35
30
25
20
25.3
19.7
18.2
14.4
15
11.8
9.6
10
7.6 7.1
5.9
5.1
17.6
5
0
Bangladesh
India
Indonesia
Highest Quintile
Proportion of adolescents who
have begun childbearing
Nepal
Sri Lanka
Timor Leste
Lowest Quintile
Poor women aged 15-19 are more
likely to begin child bearing early
Source: Bangladesh DHS 2007; India NFHS-3 2005-06; Indonesia DHS 2007; Nepal DHS 2006; Sri Lanka DHS 2005WHO-SEARO
44
06; Timor-Leste DHS 2003
Adolescent Pregnancy: Higher Child Mortality
NMR
60
54
80
51
50
45
60
40
30
34
30
26
76
1.5
x
57
35
50
32
26
25
1.6
x
34
2x
14
13
64
58
56
1.8
x
23
19
20
20
10
69
64
32 29
30
16
74
50
40
22
2x
20
82
70
43
34
IMR
90
10
0
0
BAN
IND
INO
MAV MMR NEP
<20
20-29
SRL
TLS
BAN
IND
INO MAV MMR NEP
<20
SRL
TLS
20-29
Source: Bangladesh DHS 2011; India NFHS3 2005-06; Indonesia DHS 2007; Maldives DHS 2009; Myanmar FRHS 2007; Nepal
DHS 2011; Sri Lanka DHS 2006-07; Timor-Leste DHS 2009-10WHO-SEARO
47
Large number are under-nourished and
anaemic
BMI
Anaemia
80
80
71
70
65
64
60
53
51
50
60
52
47
50
49
25
24
24
26
30
22
20
15
11
8
3
2
IND
<18.5
MAV
NEP
18.5-24.5
SRL
20
10
0
BAN
39
40
33
10
56
40
40
30
70
TLS
0
BAN
IND
NEP
TLS
≥25
WHO-SEARO
48
Source: Bangladesh DHS 2011; India NFHS3 2005-06; Nepal DHS
2011; Sri Lanka DHS 2006; Maldives DHS 2009; Timor-Leste DHS 2009-10
Dietary behaviors, Overweight &
Obesity (13-15 years)
20
Percentage
15
10.8
9.9
10
9
5.8
5
3.5
6.5
5.1
2.1
1.8
4.5
4.2
2.6
2.5
0.7
0.5
0
IND
INO
MMR
SRL
THA
Who went hungry most of the time during the past 30 days because there was not enough food in their
home
Who are overweight
Who are obese
Source: Latest Global school-based student health survey (GSHS)
WHO-SEARO
49
Early Tobacco use among adolescents
(13-15 years)
70
57
Total
Male
60
53
Female
50
Percentage
41
28
30
10
23
19
7
5
BAN (2007) BHU (2009)
15
15
8
IND (2009)
6
16
15
11
7
24
20
19
12
9
25
23
8
INO (2009) MAV (2011) MMR (2011) NEP (2011)
16
16
11
5
SRL (2011)
8
THA (2011)
TLS (2009)
-10
Source: Latest Global Youth Tobacco Survey (GYTS)
WHO-SEARO
50
Early Alcohol Consumption(13-15 years)
25
19.8
20
Percentage
15.6
15
9.9
10
5
4.9
2.6 2.7 1.9
4.4
4
0.8 1.4
0
INO
MAV
MMR
THA
Who had at least one drink containing alcohol during the past 30 days
who drank so much alcohol that they were really drunk one or more times during their life
who had a hang-over, felt sick, got into trouble with family or friends, missed school, or got into fights one or more times
with family or friends, missed school, or got into fights one or more times as a result of drinking alcohol during their life
Source: Latest Global school-based student health survey (GSHS)
WHO-SEARO
51
High Unintentional Injuries and
Violence(13-15 Years)
60
50
Percentage
50
40
48 47.1
45.9
40
39.8
33.7
37.9
37.2
36.9
30.4
32.9 34.1
27.2
27
30
20.8
20
46.8
19.4
14.6
10
0
INO
MAV
MMR
SRL
THA
Who were physically attacked ≥1x during the past 12 months
Who were in a physically fight ≥1x during the past 12 months
Who were seriously injured ≥1x during the past 12 months
Who were bullied on ≥1 days during the past 30 days
Source: Latest Global school-based student health survey (GSHS)
WHO-SEARO
52
Mental Health Problems ( 13-15 Years)
25
20
Percentage
17.2
15
10
10.1
8.4
9.9
9.6
8.7
8.1 8.5
7.6
5.6
5
4
3.8
1.4
3.6
3.5
0.7
0
IND
INO
MAV
MMR
SRL
THA
who felt lonely most of the time or always during the past 12 months
who ever seriously considered attempting suicide during the past 12 months
who have no close friends
WHO-SEARO
Source: Latest Global school-based student health survey (GSHS)
53
Public Health Issues with Adolescents
• Nutrition Issues:
– Undernutrition, Anemia, Overnutrition
• Sexual And reproductive health:
–
–
–
–
Early sex: unsafe
Coerced sex
Early marriage and child bearing
STI, HIV
• Mental Health: Anxiety, stress, depression, suicide
• Tobacco and alcohol use
• Injury and accidents
• Violence: Victims and perpetrators
Health Sector needs to collaborate with
other sectors
WHO-SEARO
54
“Home” for adolescents in health services ?
Maternal and
reproductive
health services
Disease
Treatment for
all
Newborn and
child
health services
Health Sector Response to improve
Adolescent Health - - The “4 S framework”
Collect
Strategic
Information
Strengthen
Health services
For
Adolescents
Supportive
Evidencebased
Policies
Support to & synergy with other sectors to ensure
community support and improve demand
for health services use by adolescents
56
Progress so far
• Regional Strategy and National
strategies (9 countries)
• Country Fact sheets on AHD and
Adolescent pregnancy
• National Standards and
implementation guidelines on
AFHS (9 countries)
• Training packages adapted, HWs
trained (8 countries)
• Quality and coverage assessments
(6 countries)
• Regional Program management
capacity building course
• Collaboration with other sectors education
57
Package of AH services:
Range in SEAR Countries
•
•
•
•
•
•
•
•
•
Physical & mental health
promotion
Nutrition and micronutrients
STI/RTI: Screen and manage
HIV/AIDS prevention, testing
Contraception, condom
promotion
Pregnancy and childbirth
care
Substance use prevention
Healthy Lifestyles promotion
Immunization
58
Coverage assessment: Utilization
Received IFA Tabs in Last Six Month
August 2013
WHO-SEARO
Haryana, India
59
Adolescent Health Programme in SEAR
Adolescent Health
Programme being scaled
up in SEAR Countries
Focus has been on
Sexual and
Reproductive
Health
Opportunity to add
elements of PreConception Care
Package –
Healthy Transitions
Package
August 2013
WHO-SEARO
60
We know that specific interventions are
effective and can be delivered to Adolescents
Evidence-based preventive and
curative health interventions for
adolescents
Existing delivery mechanisms
that could be used to deliver
interventions at scale
 Provide age-appropriate sexual
health education
 Delay pregnancy
 Provide contraceptive services
including condoms
 Prevent, screen and manage STIs,
HIV
 Provide Iron folic acid
 Immunization
 Prevention of Substance use
 Prevent NCD risk behaviours
•
•
•


School health program
Nutrition program
Youth programs
AFHS
HIV testing and counselling
clinics
 NCD programmes
 Mental Health programmes
“Healthy Transitions for Adolescents” package
WHO-SEARO
61
‘Healthy Transitions for adolescents’
Ensuring health across life-course
• Healthy adolescence
• Healthy reproductive health
outcomes
– Reduction in prevalence of
prematurity, LBW, Birth Defects
– Reduction in maternal, foetal,
neonatal and child mortality
• Healthy adulthood (long term)
– NCD prevention
– Reduction in Tobacco and harmful
use of alcohol related problems and
cost
– STIs and HIV prevention WHO-SEARO
62
Existing Opportunities in Public Health Programmes
Where
Intervention / package
Service type
Health
Facilities
•RH Services
•AFHS
•Immunization programmes
•Add preconception-related
interventions
•Integrate essential components of
Pre-marital counseling and genetic
screening
•Expanded post-natal care (facility
visits)
• Healthy Lifestyles: NCD prevention
Schools
•School Health Programme
•Health Promoting Schools
•Integrate essential components of
Pre-marital counseling
•Nutrition and micronutrient
supplementation
•Healthy Lifestyles: NCD prevention
Out Reach
•Community support groups &
delivery platforms
•Mass media campaigns/ Social
marketing
•Information technology,
(mHealth)
•Expanded post-natal care (home
visits)
•Pre-marital counseling
•Healthy Lifestyles: NCD prevention
•Optimizing Adolescent and prepregnancy nutrition
WHO-SEARO
63
Existing Opportunities in Public Health Programmes
Where
Intervention / package
Service type
Health
Facilities
•RH Services
•AFHS
•Immunization programmes
•Add preconception-related
interventions
•Integrate essential components of
Pre-marital counseling and genetic
screening
•Expanded post-natal care (facility
visits)
• Healthy Lifestyles: NCD prevention
Schools
•School Health Programme
•Health Promoting Schools
•Integrate essential components of
Pre-marital counseling
•Nutrition and micronutrient
supplementation
•Healthy Lifestyles: NCD prevention
Out Reach
•Community support groups &
delivery platforms
•Mass media campaigns/ Social
marketing
•Information technology,
(mHealth)
•Expanded post-natal care (home
visits)
•Pre-marital counseling
•Healthy Lifestyles: NCD prevention
•Optimizing Adolescent and prepregnancy nutrition
WHO-SEARO
64
Preconception care in SEAR: 2 Tracks
Maternal
Health
WHO-SEARO
10-19
AFHS
Infancy U5
CH
Immunization
Birth
Newborn Care
Neonatal period
SBA
ANC
PCC
Pre-Pregnancy Pregnancy
Healthy
Transitions for
adolescents
65
6. Way forward and challenges
WHO-SEARO
66
Regional expert Group
Consultation on PreConception Care: Aug 2013
WHO-SEARO and CDC-US
• PCC package would address maternal mortality, neonatal
morality, pregnancy wastage, birth defects, pre term births
and intrauterine growth retardation.
• The selected interventions would need to be implemented
through integration and convergence within the health
system as well as in other sectors.
• Optimize on established programmes such as Maternal,
Reproductive ,Newborn and Child Health and adolescent
health programmes as well as the programmes like Birth
Defects prevention and Non Communicable Diseases.
• Expanding interventions to adolescent boys and girls would
ensure better RH outcomes as well as healthy adulthood in
the long term.
WHO-SEARO
67
Opportunities
• Global commitments and partnerships for MDG 4 and 5 – Health
agenda beyond 2015
• Enhanced commitment of national governments for AH programme
and earmarking of domestic resources
• Better understanding of adolescent brain
• Newborn and child health plans, RH plans at Global, regional and
national level.
• New technology: Information and communication technology
(internet,Mobile phones,Social media) to connect with young people and
gatekeepers
• New initiatives: Newborn health, Preterm births, RH ,Birth
defects prevention, Pre-conception, HPV, NCD prevention
• Need for demonstration projects
August 2013
WHO-SEARO
68
Every Journey begins with a single step, But you will
never finish if you don’t start!
miles to go…
13 Dec 2011
Regional Meeting on Birth Defects, New
Delhi
71