Encouraging Women By Means of Referrals, Access, Coordination and Education: An Interconception Intervention to Improve Birth Outcomes

Local and national research, including local Perinatal Periods of Risk (PPOR) results, suggest that to improve birth outcomes, interventions should be focused on improving the health of women before and between pregnancies. In response, the Fort Worth Public Health Department created the Women's Health Initiative whose mission is to “share with women the knowledge, skills, support and resources needed to improve and/or maintain health; to foster a physical environment which ensures that those opportunities exist.” One of the first activities of this initiative was to create a population-based intervention entitled “Encouraging Women By Means of Referrals, Access, Coordination and Education (EMBRACE). The intervention focuses on recruiting women who have either experienced a previous adverse birth outcome, or women at risk for an adverse birth outcome, but not currently pregnant, into a voluntary brief home-visitation intervention. Findings from a community-based Women's Health Assessment of over 400 women living in the areas most impacted by infant mortality and known preconception/interconception health risks informed the development of objectives for the intervention. The primary objectives include: assess preconception/interconception health risks, establish a medical home, screen and refer women for depression, facilitate the creation of a reproductive health plan and to identify and refer and/or resolve other health risks tailored to the needs and desires of the participants. A discussion of the development and implementation of the intervention, current outcomes and lessons learned will be of interest to health care professionals charged with addressing infant morality and improving birth outcomes.