Women’s,Maternal, Child, and Infant Health

Video links Roe v. Wade in PBS’s “The Supreme Court” Unnatural Causes pisode%202%20-%20When%20the%20Bough%20Breaks pisode%202%20-%20When%20the%20Bough%20Breaks

Introduction  Using age-related profiles helps identify risks and target interventions Infants <1 year Infants <1 year Children 1-14 years Children 1-14 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, & the health of the child prior to birth through adolescence

MIC Health  MIC statistics important indicators of effectiveness of disease prevention and health promotion services in a community  Decline in US MIC mortality in recent decades, but significant racial disparities

The Care Crisis (Ruth Rosen)  Lack of support for working mothers: child care, sick time, time off for care-giving  Lack of state and federal policy to address care crisis.  2/3 of mothers with young kids (<6) work in paid labor market.  Most do second shift (housework, childcare), some do third shift (care for aging parents).

Care Crisis  Families patch together child care and elder care.  Some companies/workplaces are flexible for women and family care.  Market fundamentalism has dismantled regulations and services to support family care.  U.S. among handful of countries without guaranteed maternal leave, paid sick days, maximum length work week.

Care Crisis  Difficulty in finding new job after leaving work force.  Welfare to work policy (Temporary Assistance to Needy Families, 1996): intent  self-sufficiency for poor women; reality  unskilled, low-wage jobs, join working poor.

Care Crisis  Women’s Strike for Equality, 1970 Right to choose abortion Right to choose abortion Equal pay for equal work Equal pay for equal work Universal childcare Universal childcare  What happened? Roe under fire Roe under fire Women still get only 77% of men’s pay Women still get only 77% of men’s pay No universal childcare policy in sight. No universal childcare policy in sight.

Care Crisis  New Policies needed (numerous advocacy groups): Universal health care Universal health care Paid parental leave Paid parental leave High-quality subsidized work-based and community childcare High-quality subsidized work-based and community childcare Living wage Living wage Job training and education Job training and education Flexible work hours, part-time work possible Flexible work hours, part-time work possible Investment in affordable housing, mass transit Investment in affordable housing, mass transit Bring back progressive tax structure Bring back progressive tax structure

What are the factors in Maternal, Infant, Child illness and mortality?

Precursors to High Rates of MIC Morbidity and Mortality Unintended pregnancies Unintended pregnancies Lack of prenatal care Lack of prenatal care Poor maternal and child nutrition Poor maternal and child nutrition Maternal drug use Maternal drug use Low immunization rates Low immunization rates Poverty Poverty Limited education Limited education Insufficient child care Insufficient child care Lack of health care services in the community Lack of health care services in the community

U.S. Infant Mortality Rate by Race/Ethnicity

Death from Pregnancy-Related Complications

Death Rates, Children 1-4 by Race

Death Rates, Children 5-14

National Infant Mortality

Family  Marriage, or having two parents, important family characteristic to a child’s well-being  Research indicators Increased health risks for infants and children who are raised in single-parent families Increased health risks for infants and children who are raised in single-parent families Adverse birth outcomesAdverse birth outcomes Low birth weightLow birth weight Higher infant mortalityHigher infant mortality More likely to live in povertyMore likely to live in poverty

Unmarried Mothers  Compared to married counterparts, generally have: Lower education Lower education Lower incomes Lower incomes Greater dependence on welfare assistance Greater dependence on welfare assistance

What leads to teen pregnancy?  Survey the views of people in your small group.  Divide your list of reasons into three groups: Personal beliefs Personal beliefs Barriers to action Barriers to action Social pressure, political/economic factors Social pressure, political/economic factors  Which category had the most responses? Why?

Teenage Births  Teens who become pregnant and have a child are more likely to Drop out of school Drop out of school Not get married or to have a marriage end in divorce Not get married or to have a marriage end in divorce Rely on public assistance Rely on public assistance Live in poverty Live in poverty  Substantial economic consequences for society

Teenage Pregnancies  Teen mothers less likely to receive early prenatal care  Teen mothers more likely to Smoke during pregnancy Smoke during pregnancy Have preterm birth Have preterm birth Have low-birth-weight babies Have low-birth-weight babies Have pregnancy complications Have pregnancy complications  1/3 teenage girls gets pregnant at least once before age 20

Selected Characteristics of Teenage Mothers

Teen births,

Unintended Pregnancies  ~½ of pregnancies in U.S. are unintended 40% of those end in abortion40% of those end in abortion  Unintended pregnancy Mistimed or unwantedMistimed or unwanted  Unintended pregnancy associated with negative health behaviors Delayed prenatal care, inadequate weight gain, smoking, alcohol and other drug useDelayed prenatal care, inadequate weight gain, smoking, alcohol and other drug use

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

Margaret Sanger, , women’s reproductive rights activist, founder of Planned Parenthood.

Title X – Family Planning Act  Federal program that provides funds for family planning services for low-income people Nation’s major program to reduce unintended pregnancy by providing contraceptive and other reproductive health care services to low-income women Nation’s major program to reduce unintended pregnancy by providing contraceptive and other reproductive health care services to low-income women Supports 61% of the 4,000+ family planning clinics in U.S.Supports 61% of the 4,000+ family planning clinics in U.S. Over 5 million women receive care at clinics funded by Title XOver 5 million women receive care at clinics funded by Title X

Family Planning Clinic Services

Success of Community Health Family Planning Programs  Clinics have improved MIC health indicators Have shown large reductions in unintended pregnancies, abortions, and birthsHave 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: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 860,000 unintended births, 810,000 abortions, and 270,000 miscarriages  Each public health $ spent saves $4 in Medicaid costs

Abortion  Roe v. Wade A 1973 Supreme Court decision that made it unconstitutional for state laws to prohibit abortions A 1973 Supreme Court decision that made it unconstitutional for state laws to prohibit abortions  As a result of Roe v. Wade, the number of women dying from illegal abortions has diminished sharply during the last 3 decades in the U.S.  Majority of abortions Unmarried women (83.5%) Unmarried women (83.5%) 55% white 55% white 52% under age 25 52% under age 25

Pro-life vs Pro-choice  Pro-life A medical/ethical position that holds that performing an abortion is an act of murder A medical/ethical position that holds that performing an abortion is an act of murder  Pro-choice A medical /ethical position that holds that women have a right to reproductive freedom A medical /ethical position that holds that women have a right to reproductive freedom

Number, Ratio, and Rate of Legal Abortions Performed by Year, U.S.

Abortion by Age Group

Maternal Health  National Survey on Family Growth: women 15-44, many topics  Family Planning: Title X, major program to reduce unintended pregnancy.  Maternal mortality rates: declined last 30 years.  Maternal mortality: 4x for black Americans than white Americans.

Maternal Health  Factors associated with maternal health: 1 million teenagers become pregnant ea. year 1 million teenagers become pregnant ea. year 1.6 million legal abortions ea. year in U.S. 1.6 million legal abortions ea. year in U.S. Legalized abortion is controversial. Legalized abortion is controversial. Pro-life groups believe abortion is murder. Pro-life groups believe abortion is murder. Pro-choice groups believe women have right to reproductive freedom. Pro-choice groups believe women have right to reproductive freedom. Prenatal health care: should be early, continuing care, education, through birth process. Prenatal health care: should be early, continuing care, education, through birth process.

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 Causes include poverty and limited education

Prenatal Health Care  Medical care from time of conception until birth process  Three major components Risk assessment Risk assessment Treatment of medical conditions, or risk reduction Treatment of medical conditions, or risk reduction Education Education  Early and continuous prenatal care leads to better pregnancy outcomes

Sara Josephine Baker, children’s health champion.

Infant Health  Infant mortality rates Death of child under 1. Death of child under 1. Single most important measure of community health. Single most important measure of community health. Declined significantly Declined significantly U.S. ranks 22 nd among developed countries. U.S. ranks 22 nd among developed countries. Large disparity between subpopulations in US Large disparity between subpopulations in US  Leading causes of infant mortality

Infant Health  Factors associated with infant health Low birth weight Low birth weight Maternal smoking Maternal smoking Maternal use of alcohol, other drugs Maternal use of alcohol, other drugs Poverty, socioeconomic status Poverty, socioeconomic status Breastfeeding Breastfeeding  Sudden Infant Death Syndrome (SIDS)

Infant Health  Depends on many factors Mother’s health and her health behavior prior to and during pregnancy Mother’s health and her health behavior prior to and during pregnancy Mother’s level of prenatal care Mother’s level of prenatal care Quality of delivery Quality of delivery Infant’s environment after birth (home and family, medical services) Infant’s environment after birth (home and family, medical services) Nutrition Nutrition Immunizations Immunizations

Infant Mortality  Measure of a nation’s health  Decline in infant mortality due to Improved disease surveillanceImproved disease surveillance Advanced clinical careAdvanced clinical care Improved access to health careImproved access to health care Better nutritionBetter nutrition Increased educationIncreased 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  SIDS

Leading Causes of Death in Children

Childhood Mortality  Most severe measure of health in children  Rates have generally declined in past few decades  Unintentional injuries leading cause of death in children Specifically, motor vehicle related deaths, especially those not wearing seat belts/restraintsSpecifically, motor vehicle related deaths, especially those not wearing seat belts/restraints

Childhood Morbidity  Unintentional injuries  Maltreatment  Cancer  Infectious diseases

Child Health  Childhood mortality rates. Annual death rate declined since Annual death rate declined since Homicide and suicide rates up since Homicide and suicide rates up since  Childhood morbidity Unintentional injury: leading cause. Unintentional injury: leading cause. Child abuse and neglect: important causes. Child abuse and neglect: important causes. Infectious diseases impact the non-immunized. Infectious diseases impact the non-immunized. Sexually transmitted diseases: big impact. Sexually transmitted diseases: big impact.

Child Health (ages 1-14)  Is essential to each child’s optimal development  Failure to provide timely and remedial care leads to unnecessary illness, disability, and death – events that are associated with much greater costs than the timely care itself

Community Programs for Women, Infants, Children  Maternal and Child Health Bureau  Dept. of Agriculture  Other advocates: Children’s Defense Fund Children’s Defense Fund United Nations Children’s Fund United Nations Children’s Fund American Academy of Pediatrics American Academy of Pediatrics

Community Programs for Women, Infants, Children  Providing health insurance for women, infant and children. Routine pediatric care unavailable for millions Routine pediatric care unavailable for millions Two-thirds living in underserved areas are children, women of child-bearing age. Two-thirds living in underserved areas are children, women of child-bearing age.

Women, Infants, and Children (WIC) Program  A clinic-based program designed to provide a variety of nutritional and health-related goods and services to pregnant, postpartum, and breastfeeding women, infants, and children under age 5  Program criteria Reside in the state in which applying Reside in the state in which applying Meet the income guidelines Meet the income guidelines Are determined to be at “nutritional risk” by a health care professional Are determined to be at “nutritional risk” by a health care professional

Women, Infants, and Children Program Trends in WIC Program Participation, © USDA. Used with permission.

Government Health Insurance for Women, Infants, and Children  Medicaid Health care program for low-income children Health care program for low-income children Early and periodic screening, diagnostic, and treatment program Early and periodic screening, diagnostic, and treatment program  State Children’s Health Insurance Program Targets low-incomes families that do not qualify for Medicaid Targets low-incomes families that do not qualify for Medicaid

Government Health Insurance for Women, Infants, and Children Percentage of Children Covered by Health Insurance © Child Trends Data Bank

Providing Child Care  Family and Medical Leave Act (FMLA) Grants 12 weeks of unpaid leave to men or women after the birth of a child, an adoption, or in the event of illness in the immediate family Grants 12 weeks of unpaid leave to men or women after the birth of a child, an adoption, or in the event of illness in the immediate family  Family Support Act Provides funding for child care assistance to welfare parents who are employed or participating in an approved training program Provides funding for child care assistance to welfare parents who are employed or participating in an approved training program

Summary points  Decline in infant mortality, but large racial disparities.  Decline in teen pregnancies since  Family Planning Clinics with federal funding have improved maternal and child health, but are highly controversial.  High quality pre-natal care is critical. Large class disparities in access to care.  Environmental contamination is huge concern, particularly in urban, low-income areas. Women and children affected. Rising childhood cancers.  Lack of effective supports for working mothers and care-giving women.