1. Chapter 7 Maternal, Infant, and Child Health

2. 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, & the health of the child prior to birth through adolescence

3. 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 challenges remain
Significant racial disparities

4. U.S. Infant Mortality Rate by Race/Ethnicity

5. Death Rates, Children 1-4

6. Death Rates, Children 5-14

7. 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

8. 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

9. Teenage Births
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
1/3 teenage girls gets pregnant at least once before age 20

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

11. 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

12. 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

13. 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 health care services to low-income women
Supports 4,000+ family planning clinics in U.S.
Over 5 million women receive care at clinics funded by Title X
“Gag rule” – enacted in 1984, rescinded in 2009

14. 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

15. Abortion Legal in early stages of pregnancy since 1973 (Roe V. Wade)
Majority of abortions
Unmarried women (85%)
Women aged (57.1%)
Rates highest among Non-Hispanic black women
Pro-life vs. pro-choice

16. 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

17. Prenatal Health Care
Medical care from time of conception until birth process
Early and continuous prenatal care leads to better pregnancy outcomes
Less likely to give birth to a low birth weight infant

18. Racial Disparities in Prenatal Care

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

20. 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

21. Improving Infant Health
Premature births
Low birth weight
Cigarette smoking
Alcohol and other drugs
Breastfeeding
Sudden Infant Death Syndrome (SIDS)

22. Child Health
Good health during childhood years essential to child’s optimal development
Medical home recommended

23. 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 deaths, especially those not wearing seat belts/restraints

24. Childhood Morbidity Unintentional injuries Child maltreatment
Significant economic, emotional, and disabling impact
Child maltreatment
Strong community response needed
Infectious diseases
Importance of immunization schedule

25. 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

26. 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 4 core public health services
Infrastructure building, population-based, enabling, and direct health care services

27. 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”
2008: 9.5 million participants; nearly half of all infants born in U.S., ¼ of children ages 1-5

28. WIC Enrollees

29. 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

30. 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 childcare
Child Care and Development Block Grant

31. 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)

32. 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?