Healthy People 2020
Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans. For three decades, Healthy People has established benchmarks and monitored progress over time in order to:
The goals of Healthy People 2020 are:
Preconception and Pregnancy
In an effort to ensure and improve the well being of women and teens sexual and reproductive health the Healthy People 2020 has outlined goals for preconception health and pregnancy. In an effort to attain these goals, mutual collaboration has resulted in protocols and guidelines for preconception health and pregnancy (Healthy People 2020, 2011)
- Encourage collaborations across sectors
- Guide individuals toward making informed health decisions
- Measure the impact of prevention activities
The goals of Healthy People 2020 are:
- Attain high-quality, longer lives free of preventable disease, disability, injury and premature death
- Achieve health equity, eliminate disparities and improve the health of all groups
- Create social and physical environments that promote good health for all
- Promote quality of life, healthy development and healthy behaviors across all life stages
Preconception and Pregnancy
In an effort to ensure and improve the well being of women and teens sexual and reproductive health the Healthy People 2020 has outlined goals for preconception health and pregnancy. In an effort to attain these goals, mutual collaboration has resulted in protocols and guidelines for preconception health and pregnancy (Healthy People 2020, 2011)
Preconception Health
One of the most important ways of ensuring healthy pregnancies is to facilitate the well-being of the mother prior to conception. Unfortunately, few programs exist that address the comprehensive nature of preconception health. Moreover, lack of knowledge of these programs and lack of access by much of the population render these programs ineffectual.
Preconception health care is an approach to delivering health care that addresses medical, psychosocial, environmental and other factors that can have an impact on women’s health during reproductive years. Preconception is considered the three months prior to conception and is crucial to the health of the infant and mother.
According to Healthy People 2020 (2011) preconception health is multifactorial and consists of the following:
Preconception health care is an approach to delivering health care that addresses medical, psychosocial, environmental and other factors that can have an impact on women’s health during reproductive years. Preconception is considered the three months prior to conception and is crucial to the health of the infant and mother.
According to Healthy People 2020 (2011) preconception health is multifactorial and consists of the following:
- Family planning
- Nutrition
- Well woman checkups including examinations for transmission or presence of sexually transmitted diseases
- Exercise and weight considerations
Family planning
What is Family Planning?
Family planning is not about stopping couples from having children but about ensuring they are empowered in the decision-making process. Family planning is also not abortion as some of its critics have referred to it. Family planning is about the planned number, spacing and timing of children and reducing the incidence of unwanted pregnancies. It involves access to family planning services and information.
Why is Family Planning Important?
Lack of family planning can lead to an increase in infant and maternal mortality, transmission of HIV and other sexually transmitted diseases and unnecessary and, possibly, unsafe abortions. Lack of family planning also results in very young maternal age and pregnancies occurring very close together which also increase the risks to the infant and mother (Egan, 2008).
Nutrition
It is imperative that healthy nutritional habits be established prior to conception. A nutritional diet should consist of 5-7 servings of fruits or vegetables, lean protein, whole grains, nuts and seeds daily. 20-30 grams of daily fiber are recommended along with 8 glasses of water for colon health. Decreased amounts of sugar, sodium and preservatives are encouraged.
(National Institute of Diabetes and Digestive and Kidney Diseases, 2009)
Women in the reproductive age group should be advised about the benefits of folic acid and iron in addition to a multivitamin supplement during wellness visits especially if pregnancy is contemplated. Particularly important to the wellbeing of the fetus is an adequate intake of folic acid. Folic acid deficiency results in fetal neural tube defects and is highly preventable.
Good sources of folic acid are fortified grains, spinach, lentils, asparagus, broccoli, peas, corn and oranges. However, oftentimes, daily amounts of these fruits and vegetables are inadequate for proper levels to be maintained. It is recommended that a multivitamin with 5 mg folic acid be taken for the three months prior to conception and during pregnancy.
(National Institute of Diabetes and Digestive and Kidney Diseases, 2009)
Well Woman Examinations
Well woman examinations are essential in preparation for conception as well as identifying the presence of any sexually transmitted diseases. 50% of adult pregnancies and 82% of adolescent pregnancies are unplanned (Kass-Annese, Offer, Puffer, & Horsley, n.d.). Therefore, regular scheduled examinations can reduce the risk of unhealthy pregnancies.
Sexually Transmitted Diseases (STDs)
STDs pose a dangerous threat to all women, both prior to and during pregnancy. Less than half of women who are sexually active receive recommended STD screenings. An estimated 19 million STD infections occurred in the United States in 2009. Of those reported, 2,220,600 were pregnant women of which 80% reported not having been screened during the preconception period (Center for Disease Control, 2010)
The hazards posed to women are numerous. Untreated syphilis and gonorrhea can result in pelvic inflammatory disease, a condition that can cause infertility. STDs in pregnant women can cause stillbirth, early onset of labor, physical deformities and neurological complications. Untreated syphilis in pregnant women results in infant death in up to 40% of cases (Hardy, Nell, Spence, Graham, & Rosenbaum, 2003).
Exercise
Part of a healthy preconception plan is a healthy weight, and exercise is a healthy way of achieving that. Having a healthy weight at conception can lower the risks for a number of pregnancy complications including miscarriage, gestational diabetes and delivery complications. Achieving an exercise program during the preconception period is important in that the level of physical activity safe for a pregnant woman is the level achieved prior to pregnancy.
Preconception health is extremely important as the health of the fetus is contingent upon the health of the mother. Preconception health care as addressed by Healthy People 2020 also include discontinuing any tobacco and alcohol use, controlling hypertension, diabetes and inadequate nutrition.
Family planning is not about stopping couples from having children but about ensuring they are empowered in the decision-making process. Family planning is also not abortion as some of its critics have referred to it. Family planning is about the planned number, spacing and timing of children and reducing the incidence of unwanted pregnancies. It involves access to family planning services and information.
Why is Family Planning Important?
Lack of family planning can lead to an increase in infant and maternal mortality, transmission of HIV and other sexually transmitted diseases and unnecessary and, possibly, unsafe abortions. Lack of family planning also results in very young maternal age and pregnancies occurring very close together which also increase the risks to the infant and mother (Egan, 2008).
Nutrition
It is imperative that healthy nutritional habits be established prior to conception. A nutritional diet should consist of 5-7 servings of fruits or vegetables, lean protein, whole grains, nuts and seeds daily. 20-30 grams of daily fiber are recommended along with 8 glasses of water for colon health. Decreased amounts of sugar, sodium and preservatives are encouraged.
(National Institute of Diabetes and Digestive and Kidney Diseases, 2009)
Women in the reproductive age group should be advised about the benefits of folic acid and iron in addition to a multivitamin supplement during wellness visits especially if pregnancy is contemplated. Particularly important to the wellbeing of the fetus is an adequate intake of folic acid. Folic acid deficiency results in fetal neural tube defects and is highly preventable.
Good sources of folic acid are fortified grains, spinach, lentils, asparagus, broccoli, peas, corn and oranges. However, oftentimes, daily amounts of these fruits and vegetables are inadequate for proper levels to be maintained. It is recommended that a multivitamin with 5 mg folic acid be taken for the three months prior to conception and during pregnancy.
(National Institute of Diabetes and Digestive and Kidney Diseases, 2009)
Well Woman Examinations
Well woman examinations are essential in preparation for conception as well as identifying the presence of any sexually transmitted diseases. 50% of adult pregnancies and 82% of adolescent pregnancies are unplanned (Kass-Annese, Offer, Puffer, & Horsley, n.d.). Therefore, regular scheduled examinations can reduce the risk of unhealthy pregnancies.
Sexually Transmitted Diseases (STDs)
STDs pose a dangerous threat to all women, both prior to and during pregnancy. Less than half of women who are sexually active receive recommended STD screenings. An estimated 19 million STD infections occurred in the United States in 2009. Of those reported, 2,220,600 were pregnant women of which 80% reported not having been screened during the preconception period (Center for Disease Control, 2010)
The hazards posed to women are numerous. Untreated syphilis and gonorrhea can result in pelvic inflammatory disease, a condition that can cause infertility. STDs in pregnant women can cause stillbirth, early onset of labor, physical deformities and neurological complications. Untreated syphilis in pregnant women results in infant death in up to 40% of cases (Hardy, Nell, Spence, Graham, & Rosenbaum, 2003).
Exercise
Part of a healthy preconception plan is a healthy weight, and exercise is a healthy way of achieving that. Having a healthy weight at conception can lower the risks for a number of pregnancy complications including miscarriage, gestational diabetes and delivery complications. Achieving an exercise program during the preconception period is important in that the level of physical activity safe for a pregnant woman is the level achieved prior to pregnancy.
Preconception health is extremely important as the health of the fetus is contingent upon the health of the mother. Preconception health care as addressed by Healthy People 2020 also include discontinuing any tobacco and alcohol use, controlling hypertension, diabetes and inadequate nutrition.
Pregnancy
In an effort to improve quality of life for all, Healthy People 2020 examined issues in maternal care and have identified several pertaining to health promotion and disease prevention for these women. These social and physical determinants of maternal health include access to preconception care as well as healthcare during pregnancy, socioeconomic factors and injury and violence prevention.
Healthcare during pregnancy
Healthcare during pregnancy should be guided by a licensed obstetrician. Regular visits aid in identifying not only any existing problems but, also, any potential problems for the mother and fetus. Regular visits include blood pressure monitoring and diabetes testing. If the mother is sexually active these visits also provide a means to check for any sexually transmitted diseases.
Socioeconomic Factors
Racial disparities, particularly involving African American women, are evident. Although teen pregnancy rates have declined, young black females are still two to three times more likely than white females to conceive during their adolescent years. Black women are also more than twice as likely as white women to get late or no prenatal care (Healthy People 2010, n.d.).
African American women are nearly four times more likely to die of pregnancy-related complications than white women. Many black women also had prenatal complications from diabetes and hypertension. Many of the these same women reported wanting earlier prenatal care but many providers refused government healthcare plans and traditional medical plans were too costly (Chen, 2010).
Injury and violence prevention
Studies have shown pregnant women to be much more likely to be the victims of assault by their current partner than non pregnant women. Women screened at prenatal visits reported a 17% (1/6) prevalence of physical or sexual abuse. Abuse was recurrent, with 60% of abused women reporting two or more episodes of assault (MacFarlane, 2007).
Healthcare during pregnancy
Healthcare during pregnancy should be guided by a licensed obstetrician. Regular visits aid in identifying not only any existing problems but, also, any potential problems for the mother and fetus. Regular visits include blood pressure monitoring and diabetes testing. If the mother is sexually active these visits also provide a means to check for any sexually transmitted diseases.
Socioeconomic Factors
Racial disparities, particularly involving African American women, are evident. Although teen pregnancy rates have declined, young black females are still two to three times more likely than white females to conceive during their adolescent years. Black women are also more than twice as likely as white women to get late or no prenatal care (Healthy People 2010, n.d.).
African American women are nearly four times more likely to die of pregnancy-related complications than white women. Many black women also had prenatal complications from diabetes and hypertension. Many of the these same women reported wanting earlier prenatal care but many providers refused government healthcare plans and traditional medical plans were too costly (Chen, 2010).
Injury and violence prevention
Studies have shown pregnant women to be much more likely to be the victims of assault by their current partner than non pregnant women. Women screened at prenatal visits reported a 17% (1/6) prevalence of physical or sexual abuse. Abuse was recurrent, with 60% of abused women reporting two or more episodes of assault (MacFarlane, 2007).
Implications for Advanced Practice Nurses
There are several implications for Advanced Practice Nurses (APNs) in preconception health and pregnancy. First, education must be at the forefront and is the most powerful tool APNs possess. APNs are in a unique position to disseminate information on all types of family planning, nutrition and exercise. Their educational background allows for educational seminars and the design of educational materials geared to meet the needs of all populations.
Second, APNs are able to assess the needs of women in their reproductive years as well as pregnant women. Evaluation and recognition of signs and symptoms of illness in this population is crucial in women obtaining medical treatment. Assessment and reporting of abuse, as well as providing information on available resources is invaluable as well.
Third, APNs with specialized training in gynecology and obstetrics are able to provide the physical services to meet the specific needs of both pregnant and non pregnant populations. APNs are coming more into the forefront of healthcare and it is imperative that they present a united front in the legislation of equitable and accessible healthcare for all.
Second, APNs are able to assess the needs of women in their reproductive years as well as pregnant women. Evaluation and recognition of signs and symptoms of illness in this population is crucial in women obtaining medical treatment. Assessment and reporting of abuse, as well as providing information on available resources is invaluable as well.
Third, APNs with specialized training in gynecology and obstetrics are able to provide the physical services to meet the specific needs of both pregnant and non pregnant populations. APNs are coming more into the forefront of healthcare and it is imperative that they present a united front in the legislation of equitable and accessible healthcare for all.