Integrating preconception health into public health practice: a tale of three cities

In 2006, the national Select Panel on Preconception Care published a set of 10 recommendations on how to improve preconception health and healthcare in the United States. Since then, CDC has been engaged in efforts to ensure that those recommendations are implemented. To help translate the national recommendations into action at the local level, CDC funded CityMatCH, a national maternal and child health organization representing urban health departments, to coordinate a practice collaborative. Beginning in October 2006, multidisciplinary teams from Hartford, Connecticut, Nashville, Tennessee, and Los Angeles County, California, have engaged in the CityMatCH Urban Practice Collaborative on Preconception Health. The CityMatCH practice collaborative process includes team building and leadership development, community assessment, identification of strategies, and action planning around those strategies. The Hartford team's strategies are broad--conducting a scan of preconception health-related activity in Hartford and promoting public policy-and intended for building awareness of preconception health and healthcare among multiple audiences while strengthening the systems necessary to provide women's services. The Nashville team has focused on sickle cell trait as a point of entry into preconception care for women of reproductive age and has developed strategies involving extensive collaboration, a public awareness campaign, and data gathering. The Los Angeles County, California, team is strengthening and more explicitly connecting work related to preconception health that was already being performed in the public sector and the community. This paper describes the collaborative process designed by CityMatCH and highlights the three participating teams' experiences in implementing the national recommendations at the local urban level.