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?