Women’s,Maternal, Women’s,Maternal, Child, and Infant HealthChild, and Infant Health

Video linksVideo links

Roe v. Wade in PBS’s “The Supreme Court” Roe v. Wade in PBS’s “The Supreme Court” http://www.youtube.com/watch?v=1q5AgCzPIuA

Unnatural CausesUnnatural Causeshttp://www.unnaturalcauses.org/video_clips.php?vid_filter=Episode%202%20-%20When%20the%20Bough%20Breaks

IntroductionIntroduction

Using age-related profiles helps identify risks Using age-related profiles helps identify risks and target interventionsand target interventions Infants <1 yearInfants <1 year Children 1-14 yearsChildren 1-14 years

Maternal, infant, and child health (MIC) Maternal, infant, and child health (MIC) encompasses health of women of childbearing age encompasses health of women of childbearing age from pre-pregnancy through pregnancy, labor and from pre-pregnancy through pregnancy, labor and delivery, and the postpartum period, & the health delivery, and the postpartum period, & the health of the child prior to birth through adolescenceof the child prior to birth through adolescence

MIC HealthMIC Health

MIC statistics important indicators of MIC statistics important indicators of effectiveness of disease prevention and health effectiveness of disease prevention and health promotion services in a communitypromotion services in a community

Decline in US MIC mortality in recent Decline in US MIC mortality in recent decades, but significant racial disparitiesdecades, but significant racial disparities

The Care Crisis The Care Crisis (Ruth Rosen)(Ruth Rosen)

Lack of support for working mothers: child Lack of support for working mothers: child care, sick time, time off for care-givingcare, sick time, time off for care-giving

Lack of state and federal policy to address Lack of state and federal policy to address care crisis.care crisis.

2/3 of mothers with young kids (<6) work 2/3 of mothers with young kids (<6) work in paid labor market.in paid labor market.

Most do second shift (housework, Most do second shift (housework, childcare), some do third shift (care for childcare), some do third shift (care for aging parents).aging parents).

Care CrisisCare Crisis

Families patch together child care and elder Families patch together child care and elder care.care.

Some companies/workplaces are flexible for Some companies/workplaces are flexible for women and family care.women and family care.

Market fundamentalism has dismantled Market fundamentalism has dismantled regulations and services to support family care.regulations and services to support family care.

U.S. among handful of countries without U.S. among handful of countries without guaranteed maternal leave, paid sick days, guaranteed maternal leave, paid sick days, maximum length work week.maximum length work week.

Care CrisisCare Crisis

Difficulty in finding new job after leaving Difficulty in finding new job after leaving work force.work force.

Welfare to work policy (Temporary Welfare to work policy (Temporary Assistance to Needy Families, 1996): Assistance to Needy Families, 1996): intent intent self-sufficiency for poor women; self-sufficiency for poor women; reality reality unskilled, low-wage jobs, join unskilled, low-wage jobs, join working poor.working poor.

Care CrisisCare Crisis

Women’s Strike for Equality, 1970Women’s Strike for Equality, 1970 Right to choose abortionRight to choose abortion Equal pay for equal workEqual pay for equal work Universal childcareUniversal childcare

What happened? What happened? Roe under fireRoe under fire Women still get only 77% of men’s payWomen still get only 77% of men’s pay No universal childcare policy in sight.No universal childcare policy in sight.

Care CrisisCare Crisis New Policies needed (numerous advocacy New Policies needed (numerous advocacy

groups):groups): Universal health careUniversal health care Paid parental leavePaid parental leave High-quality subsidized work-based and High-quality subsidized work-based and

community childcarecommunity childcare Living wageLiving wage Job training and educationJob training and education Flexible work hours, part-time work possibleFlexible work hours, part-time work possible Investment in affordable housing, mass transitInvestment in affordable housing, mass transit Bring back progressive tax structureBring back progressive tax structure

What are the factors in What are the factors in Maternal, Infant, Child illness Maternal, Infant, Child illness

and mortality?and mortality?

Precursors to High Rates of MIC Precursors to High Rates of MIC Morbidity and MortalityMorbidity and Mortality

Unintended pregnanciesUnintended pregnancies Lack of prenatal careLack of prenatal care Poor maternal and child nutrition Poor maternal and child nutrition Maternal drug useMaternal drug use Low immunization ratesLow immunization rates Poverty Poverty Limited educationLimited education Insufficient child care Insufficient child care Lack of health care services in the communityLack of health care services in the community

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

Death from Pregnancy-Related Death from Pregnancy-Related ComplicationsComplications

Death Rates, Children 1-4 by RaceDeath Rates, Children 1-4 by Race

Death Rates, Children 5-14Death Rates, Children 5-14

National Infant MortalityNational Infant Mortality

FamilyFamily

Marriage, or having two parents, important Marriage, or having two parents, important family characteristic to a child’s well-beingfamily characteristic to a child’s well-being

Research indicatorsResearch indicators Increased health risks for infants and children who Increased health risks for infants and children who

are raised in single-parent familiesare raised in single-parent families• Adverse birth outcomesAdverse birth outcomes

• Low birth weightLow birth weight

• Higher infant mortalityHigher infant mortality

• More likely to live in povertyMore likely to live in poverty

Unmarried MothersUnmarried Mothers

Compared to married counterparts, generally Compared to married counterparts, generally have:have: Lower educationLower education Lower incomesLower incomes Greater dependence on welfare assistanceGreater dependence on welfare assistance

What leads to teen pregnancy?What leads to teen pregnancy?

Survey the views of people in your small Survey the views of people in your small group.group.

Divide your list of reasons into three Divide your list of reasons into three groups:groups: Personal beliefsPersonal beliefs Barriers to actionBarriers to action Social pressure, political/economic factorsSocial pressure, political/economic factors

Which category had the most responses? Which category had the most responses? Why?Why?

Teenage BirthsTeenage Births

Teens who become pregnant and have a child Teens who become pregnant and have a child are more likely toare more likely to Drop out of schoolDrop out of school Not get married or to have a marriage end in Not get married or to have a marriage end in

divorcedivorce Rely on public assistanceRely on public assistance Live in povertyLive in poverty

Substantial economic consequences for societySubstantial economic consequences for society

Teenage PregnanciesTeenage Pregnancies

Teen mothers less likely to receive early Teen mothers less likely to receive early prenatal careprenatal care

Teen mothers more likely to Teen mothers more likely to Smoke during pregnancySmoke during pregnancy Have preterm birthHave preterm birth Have low-birth-weight babiesHave low-birth-weight babies Have pregnancy complicationsHave pregnancy complications

1/3 teenage girls gets pregnant at least once 1/3 teenage girls gets pregnant at least once before age 20before age 20

Selected Characteristics of Teenage Selected Characteristics of Teenage MothersMothers

Teen births, 1940-2009Teen births, 1940-2009

Unintended PregnanciesUnintended Pregnancies

~½ of pregnancies in U.S. are unintended~½ of pregnancies in U.S. are unintended• 40% of those end in abortion40% of those end in abortion

Unintended pregnancyUnintended pregnancy• Mistimed or unwantedMistimed or unwanted

Unintended pregnancy associated with Unintended pregnancy associated with negative health behaviorsnegative health behaviors

• Delayed prenatal care, inadequate weight gain, Delayed prenatal care, inadequate weight gain, smoking, alcohol and other drug usesmoking, alcohol and other drug use

Family PlanningFamily Planning

Determining the preferred number and spacing Determining the preferred number and spacing of children and choosing the appropriate of children and choosing the appropriate means to accomplish itmeans to accomplish it

Community involvement in family planning Community involvement in family planning and care includes governmental and and care includes governmental and nongovernmental organizationsnongovernmental organizations

Margaret Sanger, 1879-1966, women’s reproductive rights activist, founder of Planned Parenthood.

Title X – Family Planning ActTitle X – Family Planning Act

Federal program that provides funds for family Federal program that provides funds for family planning services for low-income peopleplanning services for low-income people Nation’s major program to reduce unintended Nation’s major program to reduce unintended

pregnancy by providing contraceptive and other pregnancy by providing contraceptive and other reproductive health care services to low-income reproductive health care services to low-income womenwomen

• Supports 61% of the 4,000+ family planning clinics in Supports 61% of the 4,000+ family planning clinics in U.S.U.S.

• Over 5 million women receive care at clinics funded by Over 5 million women receive care at clinics funded by Title XTitle X

Family Planning Clinic ServicesFamily Planning Clinic Services

Success of Community Health Success of Community Health Family Planning ProgramsFamily Planning Programs

Clinics have improved MIC health indicatorsClinics have improved MIC health indicators• Have shown large reductions in unintended Have shown large reductions in unintended

pregnancies, abortions, and birthspregnancies, abortions, and births

• Each year, publicly subsidized family planning clinics Each year, publicly subsidized family planning clinics help prevent 1.9 million unplanned pregnancies that help prevent 1.9 million unplanned pregnancies that would result in:would result in:

860,000 unintended births, 810,000 abortions, and 270,000 860,000 unintended births, 810,000 abortions, and 270,000 miscarriagesmiscarriages

Each public health $ spent saves $4 in Each public health $ spent saves $4 in Medicaid costsMedicaid costs

AbortionAbortion Roe v. WadeRoe v. Wade

A 1973 Supreme Court decision that made it A 1973 Supreme Court decision that made it unconstitutional for state laws to prohibit abortions unconstitutional for state laws to prohibit abortions

As a result of Roe v. Wade, the number of women dying As a result of Roe v. Wade, the number of women dying

from illegal abortions has diminished sharply during the from illegal abortions has diminished sharply during the last 3 decades in the U.S. last 3 decades in the U.S.

Majority of abortionsMajority of abortions Unmarried women (83.5%)Unmarried women (83.5%) 55% white55% white 52% under age 2552% under age 25

Pro-life vs Pro-choicePro-life vs Pro-choice

Pro-life Pro-life A medical/ethical position that holds that A medical/ethical position that holds that

performing an abortion is an act of murder performing an abortion is an act of murder

Pro-choicePro-choice A medical /ethical position that holds that A medical /ethical position that holds that

women have a right to reproductive freedom women have a right to reproductive freedom

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

Abortion by Age GroupAbortion by Age Group

Maternal HealthMaternal Health

National Survey on Family Growth: National Survey on Family Growth: women 15-44, many topicswomen 15-44, many topics

Family Planning: Title X, major program to Family Planning: Title X, major program to reduce unintended pregnancy.reduce unintended pregnancy.

Maternal mortality rates: declined last 30 Maternal mortality rates: declined last 30 years.years.

Maternal mortality: 4x for black Americans Maternal mortality: 4x for black Americans than white Americans.than white Americans.

Maternal HealthMaternal Health

Factors associated with maternal health:Factors associated with maternal health: 1 million teenagers become pregnant ea. year1 million teenagers become pregnant ea. year 1.6 million legal abortions ea. year in U.S.1.6 million legal abortions ea. year in U.S. Legalized abortion is controversial.Legalized abortion is controversial. Pro-life groups believe abortion is murder.Pro-life groups believe abortion is murder. Pro-choice groups believe women have right Pro-choice groups believe women have right

to reproductive freedom.to reproductive freedom. Prenatal health care: should be early, Prenatal health care: should be early,

continuing care, education, through birth continuing care, education, through birth process.process.

Maternal HealthMaternal Health

Effect of pregnancy and childbirth on women Effect of pregnancy and childbirth on women important indicator of healthimportant indicator of health

Pregnancy and delivery can lead to serious Pregnancy and delivery can lead to serious health problemshealth problems

Maternal deathMaternal death Maternal mortality and morbidity ratesMaternal mortality and morbidity rates

Causes include poverty and limited educationCauses include poverty and limited education

Prenatal Health CarePrenatal Health Care

Medical care from time of conception until Medical care from time of conception until birth processbirth process

Three major componentsThree major components Risk assessmentRisk assessment Treatment of medical conditions, or risk reductionTreatment of medical conditions, or risk reduction EducationEducation

Early and continuous prenatal care leads to Early and continuous prenatal care leads to better pregnancy outcomesbetter pregnancy outcomes

Sara Josephine Baker, 1873-1945children’s health champion.

Infant HealthInfant Health

Infant mortality ratesInfant mortality rates Death of child under 1.Death of child under 1. Single most important measure of community Single most important measure of community

health.health. Declined significantly 1950-1995.Declined significantly 1950-1995. U.S. ranks 22U.S. ranks 22ndnd among developed countries. among developed countries. Large disparity between subpopulations in USLarge disparity between subpopulations in US

Leading causes of infant mortalityLeading causes of infant mortality

Infant HealthInfant Health

Factors associated with infant healthFactors associated with infant health Low birth weightLow birth weight Maternal smokingMaternal smoking Maternal use of alcohol, other drugsMaternal use of alcohol, other drugs Poverty, socioeconomic statusPoverty, socioeconomic status BreastfeedingBreastfeeding

Sudden Infant Death Syndrome (SIDS)Sudden Infant Death Syndrome (SIDS)

Infant HealthInfant Health

Depends on many factorsDepends on many factors Mother’s health and her health behavior prior to Mother’s health and her health behavior prior to

and during pregnancyand during pregnancy Mother’s level of prenatal careMother’s level of prenatal care Quality of deliveryQuality of delivery Infant’s environment after birth (home and family, Infant’s environment after birth (home and family,

medical services)medical services) NutritionNutrition ImmunizationsImmunizations

Infant MortalityInfant Mortality

Measure of a nation’s healthMeasure of a nation’s health Decline in infant mortality due to Decline in infant mortality due to

• Improved disease surveillanceImproved disease surveillance

• Advanced clinical careAdvanced clinical care

• Improved access to health careImproved access to health care

• Better nutritionBetter nutrition

• Increased educationIncreased education

Leading causes of infant death: congenital Leading causes of infant death: congenital abnormalities, preterm/low birth weight, SIDSabnormalities, preterm/low birth weight, SIDS

Improving Infant HealthImproving Infant Health

Premature birthsPremature births Low birth weightLow birth weight Cigarette smokingCigarette smoking Alcohol and other drugsAlcohol and other drugs BreastfeedingBreastfeeding SIDSSIDS

Leading Causes of Death in ChildrenLeading Causes of Death in Children

Childhood MortalityChildhood Mortality

Most severe measure of health in childrenMost severe measure of health in children Rates have generally declined in past few Rates have generally declined in past few

decadesdecades Unintentional injuries leading cause of death Unintentional injuries leading cause of death

in childrenin children• Specifically, motor vehicle related deaths, especially Specifically, motor vehicle related deaths, especially

those not wearing seat belts/restraintsthose not wearing seat belts/restraints

Childhood MorbidityChildhood Morbidity

Unintentional injuriesUnintentional injuries

MaltreatmentMaltreatment

CancerCancer

Infectious diseasesInfectious diseases

Child HealthChild Health

Childhood mortality rates.Childhood mortality rates. Annual death rate declined since 1950.Annual death rate declined since 1950. Homicide and suicide rates up sinceHomicide and suicide rates up since

Childhood morbidityChildhood morbidity Unintentional injury: leading cause.Unintentional injury: leading cause. Child abuse and neglect: important causes.Child abuse and neglect: important causes. Infectious diseases impact the non-immunized.Infectious diseases impact the non-immunized. Sexually transmitted diseases: big impact.Sexually transmitted diseases: big impact.

Child Health (ages 1-14)Child Health (ages 1-14)

Is essential to each child’s optimal developmentIs essential to each child’s optimal development

Failure to provide timely and remedial care leads Failure to provide timely and remedial care leads to unnecessary illness, disability, and death – to unnecessary illness, disability, and death – events that are associated with much greater events that are associated with much greater costs than the timely care itselfcosts than the timely care itself

Community Programs for Women, Community Programs for Women, Infants, ChildrenInfants, Children

Maternal and Child Health BureauMaternal and Child Health Bureau Dept. of AgricultureDept. of Agriculture Other advocates:Other advocates:

Children’s Defense FundChildren’s Defense Fund United Nations Children’s FundUnited Nations Children’s Fund American Academy of PediatricsAmerican Academy of Pediatrics

Community Programs for Women, Community Programs for Women, Infants, ChildrenInfants, Children

Providing health insurance for women, infant Providing health insurance for women, infant and children.and children. Routine pediatric care unavailable for millionsRoutine pediatric care unavailable for millions Two-thirds living in underserved areas are Two-thirds living in underserved areas are

children, women of child-bearing age.children, women of child-bearing age.

Women, Infants, and Children (WIC) Women, Infants, and Children (WIC) ProgramProgram

A clinic-based program designed to provide a A clinic-based program designed to provide a variety of nutritional and health-related goods variety of nutritional and health-related goods and services to pregnant, postpartum, and and services to pregnant, postpartum, and breastfeeding women, infants, and children breastfeeding women, infants, and children under age 5 under age 5

Program criteriaProgram criteria Reside in the state in which applyingReside in the state in which applying Meet the income guidelines Meet the income guidelines Are determined to be at “nutritional risk” by a Are determined to be at “nutritional risk” by a

health care professionalhealth care professional

Women, Infants, and Children ProgramWomen, Infants, and Children ProgramTrends in WIC Program Participation, 1977-2004

© USDA. Used with permission.

Government Health Insurance for Government Health Insurance for Women, Infants, and ChildrenWomen, Infants, and Children

MedicaidMedicaid Health care program for low-income childrenHealth care program for low-income children Early and periodic screening, diagnostic, and Early and periodic screening, diagnostic, and

treatment program treatment program

State Children’s Health Insurance ProgramState Children’s Health Insurance Program Targets low-incomes families that do not qualify for Targets low-incomes families that do not qualify for

Medicaid Medicaid

Government Health Insurance for Government Health Insurance for Women, Infants, and ChildrenWomen, Infants, and Children

Percentage of Children Covered by Health Insurance

© Child Trends Data Bank

Providing Child CareProviding Child Care

Family and Medical Leave Act (FMLA)Family and Medical Leave Act (FMLA) Grants 12 weeks of unpaid leave to men or women Grants 12 weeks of unpaid leave to men or women

after the birth of a child, an adoption, or in the event after the birth of a child, an adoption, or in the event of illness in the immediate familyof illness in the immediate family

Family Support ActFamily Support Act Provides funding for child care assistance to welfare Provides funding for child care assistance to welfare

parents who are employed or participating in an parents who are employed or participating in an approved training program approved training program

Summary pointsSummary points Decline in infant mortality, but large racial Decline in infant mortality, but large racial

disparities.disparities. Decline in teen pregnancies since 1990.Decline in teen pregnancies since 1990. Family Planning Clinics with federal funding have Family Planning Clinics with federal funding have

improved maternal and child health, but are highly improved maternal and child health, but are highly controversial.controversial.

High quality pre-natal care is critical. Large class High quality pre-natal care is critical. Large class disparities in access to care.disparities in access to care.

Environmental contamination is huge concern, Environmental contamination is huge concern, particularly in urban, low-income areas. Women particularly in urban, low-income areas. Women and children affected. Rising childhood cancers.and children affected. Rising childhood cancers.

Lack of effective supports for working mothers and Lack of effective supports for working mothers and care-giving women.care-giving women.