Using age-related profiles helps identify risks and target interventions

Maternal, infant, and child health (MIC) encompasses health of Women of childbearing age from pre-pregnancy

through pregnancy, labor and delivery, and postpartum period

Child prior to birth through adolescence▪ Infants <1 year▪ Children 1-14 years

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2223rank.html

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.

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

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

Higher Infant mortality rate 1/3 teenage girls gets pregnant at least once before age 20

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

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

What is women’s Birth Right?

~½ of pregnancies in U.S. 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

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

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

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

Majority of abortions Unmarried women (85%) Women aged 20-29 (57.1%) Rates highest among Non-Hispanic black women

Pro-life vs. pro-choice

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

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

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

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

Premature births Low birth weight Cigarette smoking Alcohol and other drugs Breastfeeding SIDS

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

Unintentional injuries Significant economic, emotional, and disabling

impact Child maltreatment

Strong community response needed Infectious diseases

Importance of immunization schedule

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

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

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

Children without insurance more likely to have necessary care delayed or receive no care

Medicaid – low-income individuals and families Children are slightly more than half of all

beneficiaries CHIP – targets uninsured children whose

families don’t qualify for Medicaid

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

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)