Post on 09-May-2015
transcript
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?