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    Ch07 outline Ch07 outline Presentation 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 LegalAbortions 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?