Background:
Despite numerous state programs targeted to improve the pregnant women and infants' health, Michigan remains above the national average when it comes to maternal and child health outcomes. About 40% (40.6%) of women, Michigan's residents who delivered in 2002 had an unintended pregnancy with the majority from the socio-economically vulnerable groups: young, uninsured, low income, and racial/ethnic minorities (PRAMS data). Over 50% of them indicated using a contraceptive method at the time they became pregnant and this suggests that they are not either well informed or misunderstand information regarding the proper use of effective methods to prevent pregnancy (PRAMS findings). The high infant mortality rate in Michigan and the associated disparities prompted the use of different approaches such as Perinatal Periods of Risk (PPOR). The state wide and county specific PPOR findings highlighted again the need for comprehensive preconception/interconception health, education and care services.
As a result, in the fall of 2004, an 1115 Medicaid waiver application was submitted. With the support of the Michigan Legislature, an appropriation of State funds was allocated to support family planning services. Another initiative is the Governor's Blueprint for Preventing Unintended Pregnancies Provider Task Force that resulted in the development of clinical guidelines targeted to the reduction of unintended pregnancy. “MQIC 2007 Prevention of Unintended Pregnancy in Adults 18 Years and Older” guidelines were approved by the MQIC Medical Directors' Committee and endorsed for distribution/publication effective June 20, 2007.
Two other important initiatives emerged in 2004: 1/ Medicaid in collaboration with the Department of Community Health started to work on reengineering the Maternal and Infant Health Program (MHIP). Targeted services to pregnant women to thus further improve their health prior to the next conception (pre/interconception) are being developed and implemented. 2/ Infant Mortality Initiative targeted to eleven communities with high mortality rates and racial disparities, is another important state initiative that besides enhancing the collaboration with local health departments, led to new successful community strategies/actions.
Further steps:
The state public health efforts to address the preconception/interconception care would be further blended within the evaluation and re-design of the Michigan's perinatal system of care.

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