CommHealth: Maternal, Infant, and Child Health (Chapter 7)

African Proverb

- "It takes an entire village to educate and raise a child" - Therefore, the COMMUNITY must also make provisions for a child's care, nurture and socialization

The effect of pregnancy and childbirth on women is an important indicator of ...

- ...their health - Pregnancy and delivery can lead to serious health problems - Maternal mortality rates are the most severe measure of ill health for pregnant women

Every day in America

- 4,408 babies are born to UNMARRIED mothers - 2,723 are born into POVERTY - 1,837 are confirmed as ABUSED or NEGLECTED - 1,241 are born WITHOUT health insurance - 847 are born to TEENAGE mothers - 865 are born at a LOW BIRTH WEIGHT - 66 DIE BEFORE their first birthdays

Maternal deaths in developing countries

- 99% of maternal deaths occur in developing countries - Access to medical care is the primary reason for the differences in maternal mortality in developing countries.

Roe v. Wade

- A 1973 Supreme Court decision that made it unconstitutional for state laws to prohibit abortions in the first trimester for any reason and placed restrictions on the conditions under which states could regulate them in the second and third trimesters -As a result of the Roe v. Wade decision, the number of women dying from illegal abortions has diminished sharply during the last three decades, however, doubters remain, largely among those whose main strategy for reducing abortion is to outlaw it. However, the legal status of abortion appears to have relatively little connection to its overall pervasiveness

US Census Bureau Definition of Family

- A group of 2 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 - This definition DOES NOT include a variety of cultural styles and optional family structures that exist in our society today

Unintended Pregnancy

- A pregnancy that at the time of conception is either mistimes (the woman did not want to be pregnant until later) or unwanted (the woman did not want to be pregnant at ANY time) - Unintended pregnancy is associated with a range of behaviors that can be adversely affect the health of mothers and their babies - These risky behaviors include delayed entry into prenatal care and the use of harmful substances such as tobacco or alcohol, likely due to failure to recognize the pregnancy as early as if it had been planned - The rate of unintended births is HIGHEST among women ages 18-24, unmarried women (particularly those who are cohabiting), low income women, whose with lower educational attainment and minority women

Effectiveness of family planning

- Although many maternal, infant and child morbidity and mortality outcomes cannot be completely prevented by effective family planning, the frequency of occurrence can be reduced - Thus, preconception education and good gynecological and maternal health care are required for effective family planning - Given that nearly half of pregnancies are unintended, achieving and maintaining a good healths status during the reproductive years is critical

Childhood Morbidity

- Although the childhood for many children represents a time of relatively good overall health, it is a time when far too many suffer from acute illness, chronic disease, and disabilities. - Childhood morbidity includes unintentional injuries, child maltreatment, and infectious diseases

How many pregnancies in the US are unintended?

- Approximately one-half of pregnancies in the United States are unintended and 43% of those end in abortion - The United States has set a national goal of increasing the percentage of pregnancies that are intended to 56% by 2020

Factors of Birth Weight: Duration of Gestation

- Approximately ⅔ of LBW babies are born premature. - Therefore, reduction in premature births holds the most potential for overall reduction in LBW

Infectious Diseases and CDC involvment

- Because many vaccine-preventable diseases are more common and more deadly among infants and children, the CDC recommends vaccinating children against most vaccine-preventable diseases early in life - The CDC keeps track of how many children receive key sets of vaccines like the diphtheria, tetanus, and pertussis (DTP), polio, measles, mumps, and rubella (MMR), and Haemophilus influenzae type b (Hib) vaccines.

Drug Use: Risks

- Because women who use illicit drugs during pregnancy are also MORE LIKELY to engage in other risky behaviors, it's difficult to determine what specific effects various substances have on the developing fetus - Further, the impact of the drug(s) depends on when they were used during pregnancy and in what quantity - By understanding how the fetus develops throughout pregnancy, it is possible to determine how exposures at certain times may impact the fetus

Benefits of Breast Milk

- Breast milk is the ideal food for babies and has many advantages for both the baby and the mother - Breast milk contains substances that help babies resist infections and other disease - Breastfed babies have fewer ear infections and colds and experience less diarrhea and vomiting

Breastfeeding among races

- Breastfeeding rates for women of all races have increased in the last decade - Healthy people 2020 objective is to increase the percentage of women ever breastfeeding to 82% and those breastfeeding at 6 months to 60%

Causes of maternal death

- Causes of maternal death vary greatly by geographic region, likely due to differences in medical care throughout pregnancy and delivery - Hemorrhage and hypertensive disorders (ex: preeclampsia and eclampsia) account for the largest portion of maternal deaths in developing countries. - Deaths in the US from these disorders have been declining as deaths due to complications related to cardiovascular disease and infection risk have been increasing - An increased number of pregnant women with chronic disease such as hypertension and diabetes may be contributing to mortality in the US

Childhood Mortality

- Childhood mortality rates are the MOST SEVERE measure of health in children - The mortality rates of children have generally DECLINES over the past couple of decades

Patterns among abused children

- Children who are abused are MORE LIKELY to engage in high risk behaviors as they mature, which in turn increases their risk for long term health consequences such as sexually transmitted infections, cancer and obesity - The impact of abuse can continue over MULTIPLE generations because individuals who were abused as children are MORE LIKELY to victimize their own children - The rate of children maltreated annually has remained between 9 and 13 per 1,000 children over the past decade, with rates decreasing to a low of 9.8 per 1,000 children in 2013

Child Maltreatment: Community's Responsibility for child protection is based on...

- Communities should develop and implement programs to strengthen families and prevent the likelihood of child abuse and neglect - Child maltreatment is a community problem; no single agency or individual has the necessary knowledge, skills, resources, or societal mandate to provide the assistance to abused and neglected children and their families - Intervention must be sensitive to culture, values, religion and other differences - Professionals must recognize that most parents do not intend to harm their children. Rather, abuse and neglect may be the result of a combination of psychological, social, situational and societal factors - Service providers should recognize that many maltreating adults have the capacity to change their abusive/neglectful behavior, when given sufficient help and resources to do so - To help families protect their children and meet their basic needs, the community's response should be nonpunitive, noncrital and conducted in the least intrusive manner possible - Growing up in their own family is optimal for children, as long as the children's safety can be assured - When parents cannot or will not meet their child's needs, removal from the home may be necessary. All efforts to develop a permanent plan for a child should be made as quickly as possible

Leading causes of infant death

- Congenital malformation - Preterm birth/low birth weight - Sudden infant death syndrome (SIDS) - Problems related to complications of pregnancy, and accidents

Infant Mortality

- Death to a child younger than 1 year - The infant mortality rate is expressed as the number of deaths of children younger than 1 year per 1000 live births

Fears of Immunizations

- Despite improvements in vaccination rates, fears about vaccine safety among parents continue to negatively impact vaccination - Fears about the safety of vaccines are largely a response to the now-debunked work of British doctor Andrew Wakefield, who's now-redacted study claims that vaccines were linked to the development of autism spectrum disorders. - In the year since his work was published, several large and rigorous studies by the IOM and the CDC have determined there is not link between autism and receipt of vaccines

Disparities in infant mortality

- Disparities in infant mortality by racial and ethnicity are both great and persistent - Both sudden unexplained infant death and increased rates of prematurity are thought to be the greatest contributor to these disparities in infant mortality in the US

Teenagers who become pregnant and have a child are more likely than their peers who are not mothers to

- Drop out of school - Not get married or have a marriage end in divorce - Rely on public assistance - Live in poverty

Two factors that govern infant birth weight

- Duration of gestation (premature births) - Intrauterine growth rate

The infant mortality rate has decreased substantially from the early 1900s, which are attributed to...

- Economic growth - Improved sanitation - Advanced clinical care - Improved access to healthcare - Better nutrition

Do laws against abortion decrease abortion rates?

- Evidence shows that laws against abortion do not correspond with lower rates of abortion. In, fact the highest rates of abortion occur in countries where the practice is illegal, and the lowest rates are in countries where it is legal and access to contraceptives is high. This suggests that access to contraception and corresponding declines in unintentional pregnancy are most effective means of reducing abortions . - In countries where abortion is illegal, women may resort to dangerous methods to terminate the pregnancy, which is a significant contributor to maternal death

Gag Rule Arguments

- Family planning providers challenged this legislation on the grounds that it denied women their right to information that was needed to make an informed decision. - Many healthcare providers believed that the gag rule restricted their right to counsel a client even when childbirth could be detrimental to her health. - Supporters of the gag rule felt that Title X was created to help prevent unwanted pregnancy by providing education and contraception services and was not intended to provide services related to pregnancy options

What more is to be done in the health of American children?

- First we must recognize there are "new morbidities" that include the children's family and social environments, behaviors, economic security, and education. - Second, we must be concerned with differences in mortality rates between races

Preconception care

- Focuses on the health of both men and women, even before they are considering having children - For women, this includes making health choices and working with a health care provider for education and early identification of any health issues. (ex: working with health care provider to stop smoking,start taking folic acid, achieving healthy weight) - GOAL: Make woman as healthy as possible before pregnancy - Preconception health for men includes them maintaining a healthy lifestyle and supporting healthy choices for their partner

What should all pregnant women do to prevent IUGR

- Get early and regular prenatal care - Eat a balanced diet including adequate amounts of folic acid - Gain the appropriate amount of weight based on Institute of Medicine (IOM) guidelines - Avoid smoking and drinking alcohol

How and why is there an effort to reduce births

- Given the negative consequences associated with preterm and early term deliveries, and increase in elective inductions and elective cesarean section deliveries before 39 weeks gestation has resulted in a nationwide effort to reduce births before 39 weeks through provider and patient education and implementation of quality measures. - Prenatal care and lifestyle changes can help women reduce their risk of having premature delivery. Consequently there is a lot that community health programs can do to assist a woman in reducing her risk of having a premature baby specifically, educating parents about premature labor and what can be done to prevent it and expanding access to health care coverage so that more women can get prenatal care

Child Health

- Good health during the childhood years (ages 1-9) is essential to each child's optimal development and this country's future. - Children are less likely to become productive members of society if they grow up in poverty, live in a violent environment, have poor or mediocre child care, or have no health insurance. - Failure to provide timely and remedial care leads to unnecessary illness, disability, and death-- events that are associated with much greater costs than the timely care itself - Vivid examples are the costs associated with late or no prenatal care given earlier in this chapter

Planned Parenthood Federation of America, Inc

- Has grown to be the largest voluntary reproductive health care organization in the world and is still dedicated to the principle that every woman has the fundamental right to choose when or whether to have children. - Is a not-for-profit organization that serves nearly 5 million women and men yearly - Currently operates approximately 700 health centers; it is estimated that their service aver more than 500,000 unintentional pregnancies each year.

Friendly Hospital Initiative 10 steps that have been shown to increase breastfeeding initiation, exclusivity, and continuation

- Have a written breastfeeding policy - Train health care staff to implement the policy - Tell pregnant women about the benefits of breastfeeding - Help new mothers start breastfeeding within 1 hour of delivery - Show women how to breastfeed, even if they are not able to see their infants - Do not give infants any food or drink besides breast milk unless they need it for medical reasons - Allow the mothers and infant to stay in the same room during their entire time at the hospital - Encourage breastfeeding when the baby gives cues that he/she would like to - Do not give pacifiers or artificial nipples to infants who are breastfeeding - Help to establish breastfeeding support groups and tell mothers about these groups before they leave the hospital

The infant's environment includes...

- Home and the family environment - Availability of essential medical services such as postnatal physical examination, regular visits to a physician, and the appropriate immunizations

Infectious Disease: Immunizations

- Immunization rates are considered an important indicator of the adequacy of health care for children and of the level of protection a community values related to preventable infectious diseases. - All children should be immunized beginning at birth and according to schedules available from the CDC for birth through age 6, 7 to 18 years of age, and adults 19 years of age and older. - By immunizing, the community safeguards its children against the potentially devastating effects of vaccine-preventable diseases

Infant Mortality Timeline

- Improvements made in the 1990s were attributed particularly to the availability of better treatment for respiratory distress syndrome and the recommendation that infants be placed on their backs when sleeping - Between 2000 and 2005, there was a lack of improvement, which is attributed to an increase in preterm births, and obstetric interventions, such as induction of labor and cesarean delivery - The rate has declined in more recent years likely due to the decrease in early deliveries that were performed in non-medical reasons.

Gag Rule Introduction

- In 1981, family planning clinics that received federal funds were required to provide counseling on ALL options open to a pregnant woman, including abortion, as outline in Title X, but these facilities were NOT allowed to perform abortions - In 1984, the "gag rule" regulations were enacted - Gag Rule: Regulations that barred physicians and nurses in clinics receiving federal funds from counseling clients about abortion

1989 Measles epidemic

- In 1989 a measles epidemic occurred in the U.S. leading to approximately 55,000 reported cases of measles and hundreds of deaths - Even though many of the infected children had seen a health care provider, investigation of the outbreak revealed that more than half of them had not been immunized - In response to the epidemic, the Vaccines for Children (VFC) Program was created

Gag Rule Tug of War

- In 1992, congressional action loosened the gag rule and allowed for abortion options to be discussed between a client and her physician at Title X facilities - Although this may appear to be a reasonable compromise, in reality, most women who visit family planning clinics are served by a nurse or nurse practitioner and never see a physician; therefore this change in the gag rule still did not permit the free exchange of information between clients and ALL professionals in the clinic - Presidents William CLinton, George W. Bush, and Barack Obama each reversed the regulations of the gag rule. This tug of war is expected to continue

Low Birth Weight

- In 2005, the average birth weight for infants born at 40 to 41 weeks gestation was 7.5Ib - Low birth weight (LBW) infants weigh less than 5.5 Ib.

Unintentional Injuries: Economic Consequences

- In addition to the physical and emotional effects on children and their families, these injuries have enormous financial costs. - Medical care and societal costs total approximately $87 billion per year for injuries to those 19 years of age and under. - With reduced quality of life factored in, this total is over $200 billion each year - In 2005, injuries to those 19 and younger from the five leading causes of death (as listed before) were associated with $11.9 billion in lifetime costs related to work loss and $77.6 million in medical expenses. - Injuries from the five leading causes of nonfatal injuries (falls, struck by/against something, overexertion, motor vehicle accidents, cuts/piercings) were associated with an estimated $18.5 billion in lifetime work loss costs and $9.2 billion in medical expenses

Medical home

- In an effort to improve child care, the AAP promotes the concept of a medical home, which is the provision of continuous, comprehensive, coordinated, family oriented care. - The physician not only addresses routine health issues and makes sure the child has his or her recommended immunization, he or she also discusses growth and development, parenting, nutrition, safety, and psychological issues that may affect the child. They will also coordinate with other providers to ensure the well-being of each child - When possible, having the same provider means continuity of care and a centralized location for a comprehensive record of the child's well-being - Provider should also work to ensure that care is culturally appropriate - The medical home can be located in different types of locations, such as a physician's office or a health department, but this approach to care helps to provide effective and efficient care for children

2014 Measles outbreak

- In december 2014, an outbreak of measles originated at a theme park in orange county, California and 111 confirmed cases of measles occurs in the U.S., Mexico, and Canada as a result - Many of the cases were in unvaccinated persons who cited religious and philosophical reasons for not vaccinating - A high proportion of cases also occurred in persons who were unable to receive the MMR vaccine, often because they were too young - This outbreak highlights the widespread effects of having large numbers of children remain unvaccinated, reducing herd immunity and putting the health of infants and those who cannot be vaccinated at risk

Using Age to Analyze Community Data

- In describing the personal characteristics of a population, age is the first and most important population characteristic when describing the occurrence of disease, injury, and/or death in the population - When communities analyze data by age (which they most often do to compare amount of disease within a population), they use groups that are narrow enough to detect any age-related pattern, which may be present as a result of either the natural life cycle or behavioral patterns. - Using age-group profiles in this way enables for the identification of risk factors for specific age groups in a population and development of interventions to reduce risk factors

Improving Infant Health

- In part because of medical research and public health and social services supported by both public and private organizations, infant mortality has declined considerably during the past couple of decades. - However, there are many opportunities for decreasing infant deaths and improving infant health even further through reducing risk factors associated with these conditions.

Infectious Disease History

- In the past, infectious diseases were the leading health concern for children in the U.S., but increased public health action has resulted in a substantial reduction in both morbidity and mortality rates. - Infectious disease control resulted from improvements in sanitation and hygiene and the implementation of universal vaccination programs - In the past, infectious diseases were the leading health concern for children in the U.S., but increased public health action has resulted in a substantial reduction in both morbidity and mortality rates. Infectious disease control resulted from improvements in sanitation and hygiene and the implementation of universal vaccination programs

Post neonatal mortality

- Includes deaths that occur between 28 days and 365 days after birth. - The most common causes of postneonatal deaths are SIDS, congenital malformations, and accidents.

Neonatal mortality

- Includes deaths that occur during the first 28 days after birth. - Approximately two-thirds of all infant deaths take place during this period - The most common causes of neonatal death are disorders related to short gestation (premature births) and low birth weight, congenital malformations, and complications of pregnancy

Child Maltreatment

- Includes physical abuse, neglect (physical, educational, emotional or medical), sexual abuse, emotional abuse (psychological/verbal abuse and or mental injury) and other types of maltreatment such as abandonment, exploitation and/or threats to harm the child - The causes of child maltreatment are not well understood

Risks and probabilities of children born from teenage mothers

- Increased risk of being abused or neglected and of experiencing lower educational attainment - Sons of teen mothers are more likely to be imprisoned at some point - Daughters are more likely to become teenage mothers themselves when compared with children born to older mothers

Age Ranges

- Infants (Younger than 1) - Children (Ages 1-9 years) - Adolescents and Young Adult (Ages 10-24 Years) - Adults (Ages 25-64) - Older Adults and Seniors (Ages 65 and older)

Intrauterine growth restriction (IUGR)

- Intrauterine growth restriction (IUGR), or small for gestational age, is when a baby's weight is below the 10th percentile for his or her gestational age. - Causes of IUGR: low maternal weight; poor nutrition during pregnancy; birth defects; use of drugs, cigarettes or alcohol; maternal health problems; placental or umbilical cord abnormalities; and having multiples (twins, triplets, etc.)

Title X of the Public Health Service Act (aka Family Planning Act)

- Is the only federal program dedicated solely to funding family planning and related reproductive health care services through the National Family Planning Program. - Was signed into law by President Nixon in 1970 to provide family planning services to all who wanted, but could not afford them - For over 4 decades, Title X has been the nation's major program to reduce unintended pregnancy by providing contraceptive and of reproductive health care services (such as screenings for STIs) to low-income women. - Provided funding support to 4,100 family planning centers nationwide and each year, approximately 4 million women receive health care services at family planning clinics funded by Title X - Those served are predominantly female, poor, uninsured, and have never had a child

Unmarried and Cohabiting Women

- It is important to keep in mind that within the marital status categories, women are still very heterogeneous. - "Unmarried" includes both women who are single and those who are cohabitating with the father of their child. - Cohabitating women generally fall in between those who are married and those who are single but not cohabitating.

What does a family represent and do?

- It represents a primary social group that influences and is influenced by other people and establishments - Are the primary unit in which infants and children are nurtured and supported regarding their healthy development

Barriers reported by women who receiving late or no prenatal care included...

- Lack of insurance coverage for visits - An inability to receive an appointment when desired - The mother being too busy - Not having transportation - Not knowing she is pregnant - Not wanting others to know she was pregnant

Unintentional Injuries

- Leading cause of death among children - Leading causes of injuries among children: drowning, falls, fires or burns, poisoning, suffocation, and injuries related to transportation (motor vehicle accidents). - While unintentional injuries are an important concern for all children, the type of accidents varies based on the child's age - Toddlers are at especially high risk of drowning, whereas older children are most at risk of transportation-related injuries - It is evident that there are many opportunities for prevention

Why is MIC important to the community?

- MIC statistics are regarded as important indicators of the effectiveness of the disease prevention and health promotion services in a community - We now know that many of the risk factors specified can be reduced or prevented with the early intervention of educational programs and preventive medical services for women, infants, and children.

Preconception health care

- Medical care provided to women of reproductive age to promote health prior to conception - Often medical and behavioral risk factors that can lead to negative pregnancy outcome can be identified an modified before conception

Ensuring Children are Immunized

- More stringent measures by the medical community are needed to ensure that all children are immunized - Opportunities to vaccinate are frequently missed by health care practitioner in primary care settings that do not routinely inquire about the immunization status of the child. - Parents and health practitioner need to work together to ensure that youth are protected from communicable disease; some states have started immunization registries to facilitate timely vaccination by notifying providers when a vaccination is due

Despite the progression of the US in reducing infant and maternal mortality, what is a concern that remains?

- Most important concern is that infant and maternal mortality data for the US are characterized by a continual and substantial disparity between mortality rates for white and black infants and mothers - These disparities may not be directly attributable to race or ethnicity. Often race and ethnicity are proxy measures for other factors such as socioeconomic status that may actually be at the root of observed disparities (ex: low income and limited education correlate with poor health status) - Mortality Rate in black infants is two times the mortality rate of white infants. The pregnancy-related mortality ratio among black women is 3 times the rate among white women

Are there any safe levels of alcohol when pregnant?

- No level of alcohol during pregnancy is known to be safe - Adverse effects are STRONGLY associated with heavy consumption during the first few months of pregnancy, but alcohol at ANY time during pregnancy can be harmful - Abstaining from alcohol altogether alcohol pregnancy is highly recommend; however, data from 2011-2013 Behavioral Risk Factor Surveillance System indicated that 10.2% of pregnant women used alcohol during the past 30 days

Nutrition Counceling

- Nutrition counseling is especially critical early in pregnancy (and ideally would occur during PRECONCEPTION counseling) as many nutritional deficits can increase the risk for birth defects that develop in the first trimester. - Use of a multivitamin containing folic acid has been shown to reduce the risk of neural tube defects like spina bifida by two-thirds

For clinics to receive funding under the Title X program, they must...

- Offer a broad range of acceptable family planning methods (ex: oral contraceptives, condoms, sterilization, and abstinence) - Encourage family participation - Give property to low income families - Not use abortion as a method of family planning.

Alcohol: Fetal Alcohol Spectrum Disorders

- Prenatal exposure to alcohol can cause a range of disorders, known as fetal alcohol spectrum disorders (FASDs) - FASD refers to conditions such as Fetal Alcohol Syndrome (FAS), Fetal Alcohol Effects (FAE), alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD)

Vaccines for Children (VFC) Program

- Provides vaccines to children whose families are not able to afford them to ensure that all children have a better chance of getting their recommended vaccinations on schedule. - Eligible children are those who are medicaid-eligible, uninsured, underinsured, or American Indian or Alaska Native. - Estimated that among children born during 1994-2013, the era of the VFC, prevention of 322 million illnesses, 21 million hospitalizations, and 732k deaths can be attributed to vaccination over the course of a lifetime.

Preconception care is individualized care for both men and women that is designed to:

- Reduce maternal and fetal illness and mortality - Increase the success of conception when pregnancy is desired - Provide contraceptive education to prevent undesired pregnancy

Breastfeeding has been shown to improve maternal health by...

- Reducing postpartum bleeding - Allowing for an earlier return to pre-pregnancy weight - Reducing the risk of osteoporosis

Cigarette Smoking

- Research has shown that maternal cigarette smoking during pregnancy is one of the most common causes of infant morbidity and mortality in the US, making it an ideal target for intervention - Researchers estimate that smoking DURING pregnancy is linked to 5-8% of preterm deliveries and 5-7% of preterm-related deaths - Smoking during pregnancy is also linked to 23-24% of infant deaths related to sudden infant death syndrome (SIDS) - Although percentage of women who smoked during pregnancy DECREASED significantly over time, from 13.2% in 2010 to 11.8% in 2006, the US is still far from reaching its goal of 98.6% of females abstaining cigarettes during pregnancy, or only 1.4% reporting smoking during pregnancy, by 2010

Sudden Infant Death Syndrome

- Sudden unanticipated death of an infant in whom, after examination there is no recognized cause of death - SIDS was listed as a cause of death for 1,679 infants in the US in 2012 - There were probably even more deaths caused by SIDS, but issues with correctly classifying infant causes of death result in underreporting - Because most cases of SIDS occur when a baby is sleeping in a crib, SIDS has been referred to as crib death - SIDS is the 3RD leading cause of infant death - Moreover, after the first month of life, it is a leading cause of postneonatal mortality - SIDS is just one type of sudden unexpected infant death (SUID), which also includes death due to unknown cause and accidental suffocation or strangulation in bed

Pattern of teen pregnancy

- Teen pregnancy and birth rates have declined steadily in recent years, in large part as a result of effective community and public health campaigns aimed at reducing teenage pregnancies - Despite the recently declining rates, roughly one in four teenage girls get pregnant at least once before they reach age 20, resulting in approximately 273,105 teen pregnancies per year - In fact, the United States still leads the industrialized world in teen pregnancy and birth rates by a LARGE MARGIN

Burdens teenage childbearing inclicts

- Teenage childbearing represents a significant social and financial burden on BOTH the family and the community - Teenage pregnancies are more likely to result in serious health consequences for these women and their babies compared to those who delay childbearing until their 20s

Risks teenage mothers may inflict on baby

- Teenage mothers are much LESS LIKELY than women age 20 and older to receive early prenatal care and MORE LIKELY to smoke during pregnancy, have a preterm birth, and have a baby who was a low birth weight - As a consequence of these and other factors, babies born to teenagers are MORE LIKELY to DIE during the first year of life than a baby born to a mother aged 20 years or older - A teenage mother is at a GREATER RISK for many pregnancy complications including premature delivery and low birth weight - Studies have also found that teen mothers are at an increases risk of intimate partner violence during pregnancy compared with older women

Economic consequences of teenage pregnancy

- Teenage pregnancy and childbearing also have a substantial economic consequences for society - In 2010, teenage childbearing cost taxpayers AT LEAST $9.4 BILLION in costs associated with health care, foster care, incarceration, and lost tax revenue

During prenatal visits...

- Test are performed on both the mother and fetus assess any potential risks, to treat any maternal or fetal complications, and to monitor the growth and development of the fetes. - Counseling and guidance are provided regarding the various aspects of pregnancy, including weight gain, exercise, nutrition, and overall health. - The woman and provider discuss what to expect and options for the delivery

Affordable Care Act contribution to Family Planning

- The Affordable Care Act expanded regulations required new private health plans written on or after August 1, 2012 to cover contraceptive counseling, services, and prescriptions at no out-of-pocket cost to patients (For many plans- took effect in Jan 2013) - This has led to an estimated 48 million women having guaranteed access to free preventive women's health services, despite some inconsistencies in the implementation of the law - Despite the increase in health insurance coverage through ACA, its was found that 36% of visits to Title X-funded clinics were by patients without insurance coverage, and many insured persons still depended upon these clinics to provide access to care.

Timeline and Restrictions of Abortion

- The Hyde Amendment of 1976 made it ILLEGAL to use federal funds to perform an abortion except in cases where the woman's life was in danger. - The Roe v. Wade Supreme Court ruling made it unconstitutional for state laws to prohibit abortions. - In effect, this decision concluded that an unborn child is NOT a person and therefore has no rights under the law. - The decision of whether to have an abortion was left up to the woman until she was 12 weeks pregnant. - After the twelfth week, an abortion was permissible only when the health of the mother was in question. - In 1989, the Supreme Court ruled that the individual states could place restriction on a woman's right to obtain an abortion. Some states now have a 24 hour waiting period after counseling before permitting an abortion

How does the US compare to other industrialized nations when dealing with infant mortality rate?

- The US has a higher infant mortality rate than other industrialized nation (ranked 26th in 2010) - These differences among industrialized nations show differences in the health status of women before and during pregnancy; availability of preventive care; and ease of access, quantity, and quality of medical care for pregnant women and their infants

Premature Births

- The average length of gestation is 40 weeks, and premature (or preterm) babies are those born prior to 37 weeks of gestation. - Disorders related to short gestation and low birth weight are the leading causes of neonatal death in the US - Premature babies often require neonatal intensive care, which utilized specialized medical personnel and equipment. This costs the healthcare system a great amount of money. - Other factors that contribute to the economic burden are maternal care services, early intervention services, special education for preterm infants with learning difficulties, and lost labor productivity. - Approximately HALF of all premature births have no known cause

Evaluating the Success of Community Health Family Planning Programs

- The establishment of local family planning clinics has resulted in an improvement in maternal and child health indicators for the communities serves - Many in need of family planning services are uninsured and rely on family planning clinics that may provide contraception at minimal or no cost - By providing access to contraceptive materials, instructions on how to use contraception effectively, and counseling about reproductive health matters, community family planning clinics are able to show large reduction in unintended pregnancies, abortions, and births. - Publicly funded family planning services are vital to enabling low-income women to avoid unintended pregnancy.

How does the government help with family planning?

- The federal and state governments provide funding assistance through a myriad of family planning services (including Title X of the Public Health Service Act, MEdicaid, state funds, the Maternal and Child Health Bureau, and Social Service block grants)

Risks and Patterns of Low Birth Weight

- The fetal period is a critical time for development, and LBW infants have an increased risk of multiple medical problems and may require special care in a neonatal intensive care unit after delivery. - Include health issues related to the development of the baby's respiratory, cardiovascular, and digestive systems. - LBW has been linked to problems later in life such as high blood pressure, diabetes, and heart disease - Overall percentage of LBW babies in the U.S. has remained relatively stable (between 6.97% and 8.26%) in the last two decades - Non-Hispanic Black mothers have almost twice the rate of LBW babies

Impact of Child Abuse

- The impact of abuse depends on the age of the child and their stage of development, the intensity and duration of the abuse, the type of abuse, and the relationship between the child and his/her abuser - Child abuse or neglect is associated with physical, psychological, behavioral and societal consequences, which overlap and are intertwined - The consequences of adverse experiences during childhood can impact individuals throughout their entire lifetime

An infant's health depends on many factors, which include...

- The mother's health and health behavior prior to and during pregnancy - Genetic characteristics - Level of prenatal care - The quality of her deliver - The infant's environment after birth - Proper nutrition and other nurturing care in the home environment

Teenage pregnancies: What must be reemphasized and why?

- The need to PLAN a pregnancy and thereby place children first in families and in communities must be REEMPHASIZED - Unwanted and unplanned childbearing has long been linked with adverse consequences for mothers, couples and families as well as for the children themselves

Patterns of the number, rate, and ratio of abortions

- The number, rate, and ratio, of abortions declined gradually by 17%, 18%, and 14% respectively between 2003 and 2012. - Women ages 20-29 make up the largest percentage of abortions and have the highest abortion rate compared with other age groups - A much higher percentage of abortions are to unmarried women compared to married women. - Although the percentage of abortion to white and black women is similar, black women have the highest abortion rate and ratio.

Child Maltreatment: Children's Bureau

- The oldest federal agency for children, the Children's Bureau (CB), located in the Administration for Children and Families, has worked to lead the public in taking a more informed and active part in child abuse prevention - The CB has been instrumental in defining the scope of the problem of child maltreatment and in promoting community responsibility for child protection - The CB believes that parents have a RIGHT to raise their child as long as they are willing to protect them

Patterns in premature birth

- The preterm birth rate in the US increased more than 20% between 1990 and 2006 but declined by 8% to 9.57% between 2007 and 2014 - Because premature babies usually have less developed organs than full-term babies, they are more likely to face serious multiple health problems following delivery -Have a higher risk of negative outcomes, for instance, the development of key organs such as the brain, lungs, and liver, actually occurs up until 39 weeks - Infants born 39 weeks or later are less likely to have problems with vision and hearing, are more likely to gain adequate weight before delivery, and are more likely to be able to suck and swallow appropriately.

Family Planning

- The process of determining the preferred number and spacing of children in one's family and choosing the appropriate means to achieve this preference - Family planning is critical for REDUCING unwanted pregnancies and their adverse consequences - Planning a pregnancy is the first step to ensuring the best health for the mother and fetus during the pregnancy

Patterns in Immunizations

- There has been a lack of progress in the proportion of young children immunized in the past decade or so, and with approximately 20% of children missing key vaccinations, there is plenty of opportunity for improvement. - The National Immunization Survey data showed considerable variation between states and urban areas and by poverty level, indicating that all children are not equally vaccinated. - The large number of unvaccinated children has been attributed to cost, lack of access to medical care, uneducated parent, concerns related to vaccine safety, and confusion around when to vaccinate children

How to help reduce SIDS

- There is currently no way of predicting which infants will dies because of SIDS - However, research has shown that sleeping on the BACK all the time rather than the stomach or side greatly DECREASES the risk of SIDS - In response to this research, the federal government initiated a national "Safe to Sleep" campaign, which began in 1994 as the "Back to Sleep" campaign, to EDUCATE parents and health professionals that placing babies on their backs to sleep can REDUCE the risk of SIDS - Since the dissemination of the recommendation, more infants have been put to bed on their backs, and the rate of SIDS has fallen by more than 50%

Programs that promote and help breastfeeding

- Two voluntary community groups, the L Leche League and the Nursing Mother's Council, are good sources for breastfeeding information, advice, and support - In an effort to promote breastfeeding, the United Nations Children's Emergency Fund (UNICEF) and the World Health Organization (WHO) implemented the Baby Friendly Hospital Initiative.

Childhood Mortality: Unintentional Injuries

- Unintentional injuries are the LEADING CAUSE of mortality in children In fact, unintentional injuries kill more children than all diseases combined - The overwhelming majority of unintentional injury deaths among children are the result of motor vehicle crashes - Many of these deaths could be prevented with the appropriate use of child restraints such as seat belts or car seats - Although all 50 states have primary child restraint laws that allow law enforcement officers to stop a driver if a child is not restrained, the provisions of these laws vary from state to state

Differences between unmarried women and married women

- Unmarried women are more likely than married women to experience negative birth outcomes including low birth weight, preterm birth, small for gestational age, and fetal and infant death. - These associations are most likely due to differences in social and financial support - Unmarried women are more likely to smoke and to experience and unintended pregnancy compared with married women - Married women were also more likely than unmarried and non-cohabiting women to initiate prenatal care during the first 4 months of pregnancy and were less likely to depend on government assistance to pay for prenatal care.

Margaret Sanger

- Was a maternity nurse in the early 1900s that delivered babies the homes of poor, mostly immigrant women. In her work, she witnessed and was told stories of women who were somewhat relieved of receiving a dead baby or having an older child die and many abortions done by mothers that killed them. She wanted solutions - Sanger began to write articles about sex education and women's health to address the lack of information she saw in her work. She faced challenges from the "Comstock Laws" which made it a federal offense to provide information, devices, or medications related to contraception and unlawful abortion through the mail. She faced many obstacles including numerous stays in prison

Child Maltreatment: Community's Role

- When parents cannot meet their children's needs and keep them from harm, the community has a responsibility to act on behalf of the child - If one suspects a child is being abused or neglected, it's important to CALL the proper authorities - Any actions into the family life should be guided by federal and state laws

Inductions

- While labor occurs naturally for many women, some decide with their doctors to have labor induced. This is where the doctor starts labor using medications or other methods, such as "breaking the woman's water" - Inductions increase the risk of many problems including stronger,more painful contractions, infection, changes in the baby's heart rate, uterine rupture and needing a cesarean section. - While inductions are sometimes done for medical reasons, there has been an increase in the number of inductions that are elective.

Pattern of Unmarried Women

- With delays in childbearing, increases in cohabitation, and changed in societal norms related to having children outside of marriage, the percentage of births to unmarried women has risen over the past several decades. - Historically, having children out of wedlock was associated with teen childbearing given that half of all women who had a baby out of wedlock were under 20 years of age. - However, the distribution of unmarried childbearing women has shifted with more births to older unmarried women. - Births to unmarried teenagers have dropped and births to unmarried women in their twenties and thirties have increased. - Unmarried births also vary among other population subgroups. For example, 35.8% of births to white women were out of wedlock, where as 71% of births to black women were out of wedlock

Margaret Sanger: Contribution

- With the health of supporters worldwide, Sanger founded the National Birth Control League in 1921. This establishment began the birth control movement in the US - PURPOSE: To win greater public support for birth control by demonstrating the association between a woman's ability to control her fertility and the improvement of both her health and the health of children. - Sanger also challenged the morality of the times by declaring that women had the right to experience sexual pleasure and that freeing them from the fear of pregnancy would assist women in achieving this - 1942: The National Birth Control league joined with hundreds of family planning clinics nationwide and formed the Planned Parenthood Federation of America

Major Risk Factors for Preterm birth/labor

- Woman's past history of preterm delivery - Multiple fetuses - Late or no prenatal care - Cigarette smoking - Drinking alcohol - Using illegal drugs - Exposure to domestic violence - Lack of social support - Low income - Diabetes - Anemia - High blood pressure - Obesity - Being younger than 17 or older than 35 years of age.

Patterns with Prenatal Care

- Women who receive early and continuous prenatal health care have better pregnancy outcomes than women who do not. - A pregnant woman who receives no prenatal care is three times more likely to give birth to a low birth weight infant as one who receives the appropriate care, and she is five times more likely to have her baby die in infancy - Prenatal care attainment is less likely to be taken up through different races - Educational attainment is also associated with prenatal care - women with less than a high school education are the least likely to receive first trimester prenatal care.

Underlying causes of high maternal morbidity and mortality rates

- poverty - sociocultural factors - limited education

Alcohol: Fetal Alcohol Syndrome (FAS)

A group of abnormalities that may include growth retardation, abnormal appearance of face and head, and deficits of central nervous system function, including mental retardation, in babies born to mothers who have consumed heavy amounts of alcohol during their pregnancies

How long have abortions been legal?

Abortions have been LEGAL throughout the US since 1973 when the Supreme Court ruled in the Roe v. Wade case that women, in the sonsulation with their physician, have a constitutionally protected right to have an abortion in the first trimester of pregnancy, free from government interference.

Use of Birth Certificates

Birth certificates can be used to determine the number of total live births, whereas the total number of pregnant women is unknown; therefore, the number of live births is used as the denominator even through maternal mortality includes women who dies without having a live birth.

Breastfeeding Patterns

Breastfeeding rates are highest among children whose mothers are college educated (91.2% ever breastfed), among women 30 years and older (84.1%) breastfed, and women who are married (87% ever breastfed)

How is the community involved in family planning?

Community involvement in family planning programs has historically included governmental and non governmental health organizations

Elective Inductions

Elective means there is no medical reason for the induction, but is done as a matter of convenience (ex: scheduling the birth for a particular day and time) or preference (ex: the woman is uncomfortable with being pregnant or wants a certain doctor to perform the delivery)

Maternal health

Encompasses the health of women in the childbearing years, including those in the pre-pregnancy period, those who are pregnant, and those who are caring for young children.

Maternal, infant, and child health

Encompasses the health of women of childbearing age from pre-pregnancy through pregnancy, labor, delivery, and the postpartum period, and the health of the child prior to birth up to adolescence

What does parenthood require?

Enormous amounts amounts of time, energy, and financial commitment, but most notably it requires the willingness to take full responsibility for the child's growth and development

What do clinics provide?

Family planning methods and a comprehensive group of other health services critical to their clients' sexual and reproductive health

US's position in child health

For those who believe that access to basic care is a standard of justness and fairness in any civilized society, the U.S. lingers sadly behind many other nations in child health

Evaluating the Success of Community Health Family Planning Programs: Economic Perspective

From an economic perspective, each public health dollar spent to help women avoid unwanted pregnancies saves taxpayers $7.09 for every public dollar spent

Main policy goal of most publicly funded programs designated to reduce the incidence of low birth weight and infant mortality in the US is...

Getting pregnant women into prenatal care early (during the first 3 months of pregnancy)

Ideal situation with Preconception and prenatal care

Ideally, a woman will be obtaining preconception care prior to pregnancy and can transition into prenatal health care once her pregnancy begins

Pattern in Maternal Mortality ratio

In the US, the maternal mortality ratio has increased over time, yet the reason for this increase is unclear and is likely due to changes in reporting

Importance of Infant death

Infant death is an IMPORTANT measure of the nation's health because it is associated with a variety of factors, such as maternal health, quality of access to medical care, socioeconomic conditions, and public health practices.

Maternal Mortality Rate

Number of mothers dying per 100,000 live births in a given year

Low birth weight infant:

One that weighs less than 2,500 grams, or 5.5 pounds, at birth

Drug Use: Effects on Baby

Other drug use can also result in a number of deleterious effects on the developing fetus, including impaired fetal growth, increased risk for preterm birth, birth defects, withdrawal symptoms, and learning or behavioral problems

Opportunities planning for a pregnancy provides

Planning for pregnancy afford opportunities to address health issues and to adopt healthy practices, such as taking folic acid, that will help to increase the likelihood of a healthy pregnancy and deliver.

Abortion: pro-life

Pro-life groups believe life begins at conception and that an embryo is a person. Therefore, they conclude that performing an abortion is and act of MURDER

The administration of all Title X grants is through ...

State health departments or regional agencies that subcontract with local agencies and clinics

Family planning services are provided through...

State, country, and local health departments, community centers, Planned Parenthood centers, and hospital-, school-, and faith-based organizations.

Breastfeeding Recommendation by the American Academy of Pediatrics (APP)

The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first 6 months of life and continuing breastfeeding for the first year

Differences in the concept of family

The concept of family has changed over time, varies greatly depending on social and cultural norms and values, and may be conceptualized differently on an individual basis.

Progression of mortality rate of children and adolescents

The mortality rates of children and young adolescents (ages 1-14) decreased significantly in the past couple of decades, yet disparities between races and ethnicities continue

Abortion: pro- choice

The pro-choice position is that women have a right to reproductive freedom. Pro-choice advocates think that the government should not be allowed to force a woman to carry to term and give birth to an unwanted child.

Why is it difficult to determine the actual impact of teen pregnancy?

The women who face educational, economic, and social hardships may be more likely to experience a teen pregnancy in the first place

Friedman definition of Family

Two or more persons who are joined together by bonds of sharing and emotional closeness and who identify themselves as being part of the family

Pregnancy-related mortality ratio

a maternal death occurring within 1 year after the pregnancy ends, that was related to or aggravated by the pregnancy or its management)

What is one of the first step to ensure healthy children?

ensure that pregnant women have access to prenatal care early in pregnancy and that they receive proper care throughout.

Ensuring early initiation of prenatal care during maternity...

greatly contributes to reductions in perinatal illness, disability, and death for both the mother and infant

Prenatal health care

medical care provided to a pregnant woman from the time of conception until the birth process occurs

Subdivisions of Infant Death

neonatal mortality and postneonatal mortality

The Tenth Revision of the International Classification of Diseases (ICD-10) definition of Maternal death

the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy, from any cause related to or aggravated by the pregnancy or its managements but not from accidental or incidental causes.

What are high precursors of MIC morbidity and mortality

unintended pregnancies, late or no prenatal care, poor maternal and child nutrition, maternal drug use, low immunization rates, poverty, limited education, and insufficient child care - combined with a lack of access to health care services in a community