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COBH4030Chp7.pptxChapter 7
Maternal, Infant, and Child Health
Chapter Objectives (1 of 2)
After studying this chapter, you will be able to:
Define maternal, infant, and child health.
Explain the importance of maternal, infant, and child health as indicators of a society’s health.
Define family planning and explain why it is important.
Identify consequences of teenage pregnancies.
Define legalized abortion and discuss Roe v. Wade and the pro-life and pro-choice movements.
Define maternal mortality rate.
Define preconception and prenatal care and the influence this has on pregnancy outcome.
List the major factors that contribute to infant health and mortality.
Chapter Objectives (2 of 2)
Explain the differences among infant mortality, neonatal mortality, and postneonatal mortality.
Identify the leading causes of childhood morbidity and mortality.
List the immunizations required for a 2-year-old child to be considered fully immunized.
Explain how health insurance and healthcare services affect childhood health.
Identify important governmental programs developed to improve maternal and child health.
Briefly explain what WIC programs are and who they serve.
Identify the major groups that are recognized as advocates for children.
Introduction
Using age-related profiles helps identify risks and target interventions
Infants <1 year
Children 1-9 years
Maternal, infant, and child health (MIC) encompasses health of women of childbearing age from pre-pregnancy through pregnancy, labor and delivery, and the postpartum period, and the health of the child prior to birth through adolescence
MIC Health (1 of 4)
MIC statistics are important indicators of effectiveness of disease prevention and health promotion services in a community
Decline in US MIC mortality in recent decades, but challenges remain
Significant racial disparities
Modified from: Mathews T.J., M.F. MacDorman, and M.E. Thoma. (2015). "Infant Mortality Statistics from the 2013 Period Linked Birth/Infant Death Data Set." National Vital Statistics Reports, 64(9). Hyattsville, MD: National Centers for Health Statistics. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_09.pdf. Accessed December 5, 2015.
MIC Health (2 of 4)
Infant mortality rates, by race and Hispanic origin of mother; United States, 2005and 2013.
Data from: Child Trends DataBank (2015). “Infant, Child, and Teen Mortality.”Available at http://www.childtrends.org/wp-content/uploads/2012/11/63_Child_Mortality.pdf Accessed December 6, 2015.
MIC Health (3 of 4)
Death rates for infants (deaths per 100,000): selected years, 1980–2013.
Data from: Child Trends DataBank (2015). “Infant, Child, and Teen -Mortality.”Available at http://www.childtrends.org/wp-content/uploads/2012/11/63_Child_Mortality.pdf
MIC Health (4 of 4)
Death rates among children ages 5 to 14 by race and Hispanic origin: 1980–2013.
Family and Reproductive Health
Families are the primary unit in which infants and children are nurtured and supported regarding healthy development
Various definitions of “family”
Concept has changed over time, depends on social and cultural norms and values, may be conceptualized differently on an individual basis
Research Indicators
Unmarried women are more likely than married women to experience negative birth outcomes
Married women are more likely than unmarried, non-cohabitating women to initiate prenatal care early in pregnancy
Married women are less likely than unmarried, non-cohabitating women to rely on government assistance to pay for prenatal care
Teenage Births (1 of 2)
Teenage pregnancies more likely to result in serious health consequences for mother and baby
Teen mothers less likely to receive early prenatal care
Teen mothers more likely to
Smoke during pregnancy
Have preterm birth
Have low-birth-weight babies
Have pregnancy complications
1/4 teenage girls get pregnant at least once before age 20
Teenage Births (2 of 2)
Teens who become pregnant and have a child are more likely to
Drop out of school
Not get married or have a marriage end in divorce
Rely on public assistance
Live in poverty
Substantial economic consequences for society
Family Planning
Determining the preferred number and spacing of children and choosing the appropriate means to accomplish it
Community involvement in family planning and care includes governmental and nongovernmental organizations
Unintended Pregnancies
~½ of pregnancies in U.S. are unintended
43% of those end in abortion
Unintended pregnancy
Mistimed or unwanted
Unintended pregnancy associated with negative health behaviors
Delayed prenatal care, inadequate weight gain, smoking, alcohol and other drug use
Title X – Family Planning Act
Federal program that provides funds for family planning services for low-income people
Aims to reduce unintended pregnancy by providing contraceptive and other reproductive healthcare services to low-income women
Supports 4,000+ family planning clinics in U.S.
Approximately 4 million women receive care at clinics funded by Title X
“Gag rule” – enacted in 1984, rescinded as of 2015
Evaluating the Success of Community Health Family Planning Programs
Clinics have improved MIC health indicators
Have shown large reductions in unintended pregnancies, abortions, and births
Each year, publicly subsidized family planning clinics help prevent 1.9 million unplanned pregnancies that would result in
860,000 unintended births, 810,000 abortions, and 270,000 miscarriages
Each public health dollar spent saves $3.74 in Medicaid costs
Abortion
Legal in early stages of pregnancy since 1973 (Roe v. Wade)
Majority of abortions
Unmarried women (85.3%)
Women aged 20-29 (58.2%)
Rates highest among Non-Hispanic black women
Pro-life vs. pro-choice
Maternal Health
Effect of pregnancy and childbirth on women important indicator of health
Pregnancy and delivery can lead to serious health problems
Maternal death
Maternal mortality and morbidity rates
Causes include poverty and limited education
Preconception and Prenatal Health Care (1 of 2)
Preconception care – medical care provided to women of reproductive age to promote health prior to conception
Prenatal health care – medical care from time of conception until birth process
Early and continuous preconception and prenatal care leads to better pregnancy outcomes
Less likely to give birth to a low-birth-weight infant
Preconception and Prenatal Health Care (2 of 2)
Modified From: U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (2015). "Child Health USA 2014." Rockville, Maryland: U.S. Department of Health and Human Services. Available at http://mchb.hrsa.gov/chusa14/dl/chusa14.pdf. Accessed January 24, 2016.
Timing of prenatal care initiation, by maternal education, 2012.
Infant Health
Depends on many factors
Mother’s health and her health behavior prior to and during pregnancy
Genetic characteristics
Mother’s level of prenatal care
Quality of delivery
Infant’s environment after birth (home and family, medical services)
Nutrition
Immunizations
Infant Mortality
Measure of a nation’s health
Decline in infant mortality due to
Improved disease surveillance
Advanced clinical care
Improved access to health care
Better nutrition
Increased education
Leading causes of infant death: congenital abnormalities, preterm/low birth weight, SIDS
Improving Infant Health
Premature births
Low birth weight
Cigarette smoking
Alcohol and other drugs
Breastfeeding
Sudden Infant Death Syndrome (SIDS)
Child Health
Good health during childhood years essential to child’s optimal development
Medical home recommended
Childhood Mortality (1 of 2)
Most severe measure of health in children
Rates have generally declined in past few decades
Unintentional injuries are leading cause of death in children
Specifically, motor vehicle deaths, especially those not wearing seat belts/restraints
Childhood Mortality (2 of 2)
Unintentional injuries
Significant economic, emotional, and disabling impact
Child maltreatment
Strong community response needed
Infectious diseases
Importance of immunization schedule
Community Programs for Women, Infants, and Children
Federal government has over 35 programs in 16 different agencies to serve needs of nation’s children
Many are categorical programs
Only available to people who fit into a specific group
Many fall through the cracks
Maternal and Child Health Bureau
Title V
Only federal legislation dedicated to promoting and improving health of mothers and children
Maternal and Child Health Bureau (MCHB)
Established in 1990 to administer Title V funding
Accomplishes goals through four core public health services
Infrastructure building, population-based, enabling, and direct healthcare services
Women, Infants, and Children (WIC) Program
Clinic-based program designed to provide nutritional and health-related goods and services to pregnant, postpartum, and breastfeeding women, infants up to 1 year of age, and children under age 5
Sponsored by the USDA; established in 1974
Eligibility requirements
Residency in application state, income requirements, at “nutritional risk”
2014: over 9 million participants
WIC Enrollees
Modified from: Thorn, B., C. Tadler, N. Huret, E. Ayo, and C. Trippe. (2015). “WIC Participant and Program Characteristics Final Report.” U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support. Available at http://www.fns.usda.gov/sites/default/files/ops/WICPC2014.pdf
Breastfeeding initiation rates by state for WIC infant participants, ages 6 to 13 months; April 2014.
Providing Health Insurance for Women, Infants, and Children
Children without insurance more likely to have necessary care delayed or receive no care for health problems
Medicaid – low-income individuals and families; children are slightly more than half of all Medicaid beneficiaries
CHIP – targets uninsured children whose families don’t qualify for Medicaid
Providing Child Care
FMLA – Family and Medical Leave Act
Grants 12 weeks unpaid job-protected leave to men or women after birth of child, adoption, or illness in immediate family
Only affects businesses with 50+ employees
Cost of child care
Child Care and Development Block Grant
Other Advocates for Children
Numerous groups advocate for children’s health and welfare
Children’s Defense Fund (CDF)
United Nations Children’s Fund (UNICEF)
American Academy of Pediatrics (AAP)
Discussion Questions
What are ways community programs can increase participation in early prenatal care services?
What kind of impact do programs such as WIC have on community health outcomes?
