Background:
In California and nationally, a high proportion of women receive first-trimester prenatal care, and their health behaviors improve after they know they are pregnant. Yet, the low birth-weight rate has not decreased, the infant mortality rate remains excessively high, and marked racial/ethnic disparities persist. Since these poor reproductive outcomes are often determined before women know they are pregnant, and about half of pregnancies are unintended, preconception health has become a priority.

Objectives:
To provide data to guide targeting as well as provide a baseline for evaluation of California's preconception health efforts.

Methods:
2005 California Women's Health Survey (CWHS) data were analyzed to obtain the prevalence among non-pregnant California women of childbearing age (18-44) (N=2037) of MCH program-related risk factors for adverse reproductive outcomes. The CWHS is a population-based, random-digit-dialed telephone survey in English and Spanish only.

Results:
Frequencies of risk conditions were high, and disparities pronounced. The frequency for one or more groups was at least twice that of another group for: daily smoking - 13% of blacks, 12% of whites, 4% of Hispanics; drinking alcohol in past month - 69% of college graduates, 58% of women with (only) some college, 26% of non-high school (HS) graduates; daily folic acid use - 16% of non-HS graduates, 35% of women with some college, 45% of college graduates, and 20% of Hispanics, 39% of blacks, and 45% of whites; diabetes - 6% of Hispanics, 3% of whites; intimate partner physical violence - 14% of blacks, 5% of whites; frequent mental distress - 18% of non-HS graduates, 8% of college graduates. A study limitation is that responses are self-report, with differentially biased answers possible among subgroups.

Conclusion and implications for practice:
The preconception health of non-pregnant California women of childbearing age is poor, and major disparities exist. California must improve pre-conception care and education and reduce demographic disparities to improve the health and well-being of its population and reduce long-term spending on the health care for preventable adverse birth outcomes.