Reproductive Life Plans RLPs

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Reproductive Life PlansRLPs

• Lillian Maddox-Whitehead, MS
• Metro Nashville Public Health Department

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What Is A Goal?
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• According to the Merriam-Webster dictionary, it
  is a the end toward which effort is directed, an
  aim.

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Back Ground Significance

• ? Four in ten girls in the U.S. will get pregnant
  at least once before age 20

Source National Campaign to Prevent Teen
Pregnancy analysis of Henshaw, S.K., U.S..
Teenage Pregnancy Statistics, New York Alan
Guttmacher Institute, May, 1996 and Forrest,
J.D., Proportion of U.S. Women Ever Pregnant
Before Age 20, New York Alan Guttmacher
Institute, 1986, unpublished.
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Background cont.

• STD/HIV/AIDS
• ? 1 in 4 teenage girls in the U.S. (ages 14-19)
  has a sexually transmitted disease.
• ? Among females ages 13-24, the main route of
  HIV/AIDS transmission is through heterosexual
  contact (85) of the cases.

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Pregnancy Rates per 1,000 Females Aged 10-17
Davidson County and Tennessee, 1990-2006
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Davidson County Teen Data by Age, 2006
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Facts About Teen Births for Davidson County-2006
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Why Care About Subsequent Births?
Nearly 1/4 of teen mothers nationwide have a
second birth before age 20.

• In Tennessee in 2006, there were 330 subsequent
  births to mothers 17 and under, representing 9.3
  of all teen births in the state.

In Davidson County, there were 37 such births in
2006, representing 11.1 of births to this age
group.
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• Medical Teen mothers initiate pre-natal care
  later with subsequent pregnancies.
• Education Additional births make the teen mother
  less likely to attend school or to complete
  school.
• Work Additional births make it less likely that
  a teen mother will be working and more likely
  that they will be on welfare.

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What Is a Reproductive Life Plan(RLP)

• ? Developed following the CDCs Preconception
  Health Recommendations as a guide, the
  Reproductive Life Plans (RLP) purpose is to
  provide women of reproductive age with a written
  tool to help translate preconception health
  concepts into easy, lay health objectives to
  ensure health birth outcomes prior to pregnancy.

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RLPs Among Birthing Project Participants

• Adolescents and young women most vulnerable to
  experience multiple, unplanned pregnancies
  represent a population subset that may benefit
  the most from having a Reproductive Life Plan and
  an accountability partner/mentor to help them
  follow their plan.

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Objectives for Implementation Among Birthing
Project Participants

• a) To ensure daily multi-vitamin intake for
  pregnant teens for a healthy birth outcome
• b) To increase post-partum, daily folic acid
  efficacy among parenting teens
• c) To develop a written plan to prevent
  subsequent pregnancy and adequate birth spacing
  as appropriate
• d) To maintain post-partum contraceptive usage

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Birthing Project USA

• We are a community based volunteer
• organization that began in Sacramento, CA in
  1988
• Over the last 20 years, over 11,000
• babies have been born into the project
• 11,000 women in 80 cities across the US, Canada,
  and the Honduras have been helped and nurtured
  through their pregnancy and through their infants
  first year of life.
•  

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Nashville Chapter

• Participants are 14-20 years of age
• Commitment of 18 months
• 68 babies born into chapter
• The average weight of our babies is 6 lbs 8 oz
  (3072 gms)
• 66/68 or 96 of the infants have been full term
  with the average gestational age of 38.5 weeks.

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Implementation of RLPs With Birthing Project
Participants

• The RLP tool was distributed to a 3-year cohort
  of participants in the Birthing Project Nashville
  Chapter (BP-N) - the local mentoring program for
  pregnant and parenting teens. The BP-N consists
  of 175 women of reproductive age 100 trained
  sister friend mentors and 75 little sisters
  (pregnant/parenting teens).

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Implementation cont.

• Sister friend mentors and their little sisters
  were tracked over the course of 12 to 18 months
  (or until the babys first birthday) to assess
  utilization of the reproductive life plan as well
  as self-efficacy for daily folic acid intake,
  contraceptive usage, annual GYN exam,
  vaccinations (as appropriate) and intention of
  subsequent pregnancy.

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Implementation Cont.

• The sister friend mentors communicated with the
  little sisters on a weekly basis and had
  community meetings with the full little
  sister/sister friend mentor on a monthly basis to
  discuss success/barriers to following the RLP
  plan.

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Tool

• Reproductive Life Plan
• Name ___________________________________
• Date ____________________________________
• What is a Reproductive Life Plan?
• A Reproductive Life Plan is a set of personal
  goals about having (or not having) children. It
  also states how to achieve those goals. Everyone
  needs to make a Reproductive Plan based on
  personal values and resources.
• There are many kinds of Reproductive Life Plans.
  Whats important is that you think about when and
  under what conditions you want to become
  pregnant. Then make sure your actions support
  these goals. Healthcare providers and counselors
  can help you understand the clinical and
  lifestyle options that are best for you.
• Short term goals 3-6 months
• Take folic acid __________
• Refill of multi-vitamins (every three months)
  __________
• Get STD/STI screening (date of screening)
  __________
• Get contraceptives if you have not already
  __________(practice double barrier method every
  time)
• Get GYN annual physical and check-up
• Get HPV/Gardasil vaccine (date of vaccines)
  _________________
• Get HIV/AIDS test (date of test) __________
• Not to get pregnant _____
• Long term goals 6-12 months
• Get HIV retest __________
• To not get pregnant ______
• Last dose of Gardasil vaccine (date of
  vaccine)___________

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10 Tips On Preconception Health

• Talk to your health care provider about pregnancy
  prior to becoming pregnant. It is important to
  see your doctor before you become pregnant.
  There are medical conditions that you may not be
  aware of.
• Plan your pregnancy to ensure a healthier baby.
• Take 400 mg of folic acid daily.
• Dont drink alcohol or use any type of drugs.
• Dont smoke. And, if you do, stop.
• Exercise-its important for your general health.
  
• Get adequate sleep-at least eight hours a night.
  
• Keep stress at a minimum.
• Eat well. Eat the recommended allowance of
  fruits and vegetables 5 a day!
• Read! Increase your knowledge on how to have the
  healthiest pregnancy possible.

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Outcome

• Among the 3-year cohort, 66 healthy term babies
  have been delivered. 100 of BP-N participants
  who completed a reproductive life plan and
  graduated from the project (designated as
  participation through the babys first birthday)
  have delivered healthy term babies and have not
  experienced subsequent parity.

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Outcome Cont.

• Additionally, many of the little sisters and
  sister friend mentors continue to use their RLP
  after they graduate from the BP-N.

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Barriers

• One of the greatest barriers for the
  implementation of the RLP is the need to
  consistently review the goals and objectives that
  each little sister determines for herself. Many
  young mothers may feel too overwhelmed by the
  parenting experience to continually focus on self
  development and growth.

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Barriers Cont.

• One means to overcome this barrier is with
  consistent follow up by the sister friend
  mentors. Sister friend mentors have been most
  successful by making reference to their own
  reproductive life plan as a means of open
  communication and trust with the little sister.

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Public Health Implications

• Women of reproductive age, particularly
  adolescents who are most vulnerable for
  subsequent pregnancy and inadequate birth
  spacing, may benefit from having a written
  reproductive life plan and a professional woman
  mentor to follow-up with her on the plan on a
  monthly basis.

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Taking It To the Streets

• After conducting RLPs with the participants of
  the Birthing Project, more opportunities became
  available to conduct RLPs with other women in the
  Nashville community. The concept was conducted
  at community health fairs throughout the city as
  well as the National Office of Minority Healths
  Healthy Baby Begins With You event.

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What About The Men?

• After conducting RLPs at numerous community
  health fairs, men who attended with their mates,
  were interested in completing an RLP too. Some
  of the comments shared by men were
• So a woman does this all alone?
• Why does the medical professionals always find
  womens health more important than men?
• How can I complete an RLP?

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Reproductive Health Among Men

• Traditionally as a couple prepared for pregnancy,
  there was only focus on the health of the woman.
• However, there are several habits men need to be
  forming during these critical months of
  preparation, too. Issues of fertility do not rest
  solely on the female

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Habits for a Highly Reproductive Man

• Make an appointment with your doctor
• Clean out the medicine cabinet
• Eat and Sleep
• Avoid alcohol and other substances
• Keep your testicles cool
• Stay away from cycling for a while

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Creating A Reproductive Life Plan for Men

• Although there are no current reproductive life
  plans for men, we as MCH leaders can encourage
  our male clients to start practicing healthier
  life styles to have more healthier outcomes.

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Special Thanks

• City MatCH
• Dr. Kimberlee Wyche-Etheridge
• Ms. DYuanna Allen
• Birthing Project Mentors and Participants

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References

• American Pregnancy Association, Preconception
  Health for Men. http//www.americanpregnancy.org/g
  ettingpregnant/menpreconception
• CDC HIV/AIDS surveillance in adolescents and
  young adults (through 2008)
• CDC, Recommendations to Improve Preconception
  Health and Health Care --- United States, April
  21, 2006. http//www.cdc.gov/mmwr/preview/mmwrhtml
  
• Source National Campaign to Prevent Teen
  Pregnancy analysis of Henshaw, S.K., U.S..
  Teenage Pregnancy Statistics, New York Alan
  Guttmacher Institute, May, 1996 and Forrest,
  J.D., Proportion of U.S. Women Ever Pregnant
  Before Age 20, New York Alan Guttmacher
  Institute, 1986, unpublished.
• TN Department of Health,
• http//health.state.tn.us/statistics/pregnancy.ht
  m

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Thank You!

• Contact Information
• lillian.maddox-whitehead_at_nashville.gov
• Questions??