Maternal, Infant, and Child Health Chapter 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

MIC Health (2 of 4) 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. Infant mortality rates, by race and Hispanic origin of mother; United States, 2005and 2013.

MIC Health (3 of 4) 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. Death rates for infants (deaths per 100,000): selected years, 1980–2013.

MIC Health (4 of 4) 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 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?