Maternal, Infant, and Child Health

Chapter 7

Introduction

• Using age-related profiles helps identify risks and target interventions• Infants <1 year

• 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

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 and Reproductive Health

• Families are the primary unit in which infants and children are nurtured and supported regarding healthy development

• Various definitions of “family”• U.S. Census Bureau definition of family• A group of two people or more (one of whom is

the householder) related by birth, marriage, or adoption and residing together; all such people (including related subfamily members) are considered as members of one family.

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• Adverse birth outcomes

• Low birth weight

• Higher infant mortality

• More likely to live in poverty

Unmarried Mothers

• Compared to married counterparts, generally have:• Lower education

• Lower incomes

• Greater dependence on welfare assistance

Teenage Births

• 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

Teenage Pregnancies

• 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

Selected Characteristics of Teenage Mothers

Unintended Pregnancies

• ~½ of pregnancies in U.S. are unintended• 40% 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

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

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• Supports 61% of the 4,000+ family planning

clinics in U.S.

• Over 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 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 $ spent saves $4 in Medicaid costs

Abortion

• Legal in early stages of pregnancy since 1973 (Roe V. Wade)

• Majority of abortions• Unmarried women (83.5%)

• 55% white

• 52% under age 25

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

Abortion by Age Group

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

Prenatal Health Care

• Medical care from time of conception until birth process

• Three major components• Risk assessment

• Treatment of medical conditions, or risk reduction

• Education

• Early and continuous prenatal care leads to better pregnancy outcomes

Reducing Maternal and Infant Mortality

Racial Disparities in Prenatal Care

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

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

Early-Life Mortality Time Periods

Improving Infant Health

• Premature births

• Low birth weight

• Cigarette smoking

• Alcohol and other drugs

• Breastfeeding

• SIDS

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/restraints

Leading Causes of Death in Children

Childhood Morbidity

• Unintentional injuries• Significant economic, emotional, and disabling

impact

• Child maltreatment• Strong community response needed

• Infectious diseases• Importance of immunization schedule

Community Programs

• 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 4 core public health services• Infrastructure building, population-based,

enabling, and direct health care services

MCH Pyramid of Health Services

WIC

• A special supplemental food program for women, infants, and children 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

WIC Enrollees

Health Insurance

• 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

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 certain businesses

• 13 million children younger than 6 in child care every day• Family Support Act

• Child Care and Development Block Grant

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?