Question

Foundations for Maternal and Child Health Project Assignment- Week 3 03/26/18 Directions: Apply the Social-Ecological Model to the maternal and child public health issue described in your problem statement PART 1: Complete the table. Model Level List 2 key factors influencing the public health topic/issue? In your own words list one factor at each level that helps to promote public health and one that hinders public health as it relates to the MCH issue described in your problem statement.

Answer 1

Maternal and child health (MCH) refers to the health of mothers, infants, children, and adolescents. It also refers to a profession within public health committed to promoting the health status and future challenges of this vulnerable population. Maternal Health. At the beginning of the twentieth century, for every one thousand live births, six to nine women died of pregnancy-related complications. Sepsis was the leading cause of maternal death, with half of the cases following delivery (often performed without following the principles of asepsis), and half associated with illegally induced abortion. Hemorrhage and preeclampsia (convulsions) were other leading causes of mortality. In response to the high maternal and infant mortality rates, and to women's suffrage, Congress passed the Maternity and Infancy Act..................(also known as the Sheppard-Towner Act) in 1921. The Fetal, Newborn, and Maternal Mortality and Morbidity Report of the 1933 White House Conference on Child Health Protection called attention to the link between poor aseptic practice, excessive and inappropriate obstetrical interventions (induction of labor, use of forceps, episiotomy, and cesarean deliveries), and high maternal mortality. During the 1930s and 1940s, hospital and state maternal mortality review committees were established. At the same time, a shift from home to hospital deliveries was occurring. The proportion of infants born in hospitals increased from 55 percent in 1938 to 90 percent in 1948, which was accompanied by a 71 percent decrease in maternal mortality. Medical advances (including the use of antibiotics, the use of oxytocin to induce labor, safe blood transfusions, and better management of hypertensive disorders) accelerated the declines in maternal mortality. Liberalization of state abortion laws, beginning in the 1960s, contributed to an 89 percent decline in deaths from septic illegal abortions between 1950 and 1973. In 1979, the Centers for Disease Control and Prevention partnered with the American College of Obstetricians and Gynecologists in developing the Pregnancy-Related Mortality Surveillance System, and implementing maternal mortality review boards across the country. At the end of the twentieth century, for every 100,000 live births, only seven to eight women died of pregnancy-related complications 99 percent reduction of the rate at the beginning of the century...........CURRENT STATUS Despite significant improvements in the health of mothers, infants, and children during the twentieth century, the United States compares poorly with other developed nations on most indicators of MCH. In 1997, the United States ranked twenty-fifth in infant mortality and twenty-first in maternal mortality among developed nations. Table 2 presents a report card of selected indicators of MCH in the United States, along with national goals set for the year 2010. There are also significant disparities in MCH among racial, ethnic, and other sociodemographic categories. For example, African-American infants have twice the chance of dying, of low birth weight, and of being premature, as compared to white infants. Maternal mortality is five times higher among pregnant Africanmerican women than among pregnant white women. The teen pregnancy rate is twice as high among Hispanic women, and three times as high among African-American women, than it is among white women aged fifteen..............FUTURE CHALLENGES At the beginning of the twenty-first century, many challenges in MCH remain. Some of the most important areas of concern are described below. Maternal Mortality and Morbidity. The decline in maternal mortality in the United States has leveled off since 1982. This does not mean that it has reached an irreducible minimum, as one-third to one-half of the deaths that still occur are probably preventable. Maternal deaths are only the tip of the iceberg, however, as one in four women experience complications during pregnancy, many of which are preventable. An increased effort to assess and assure the quality of health care for pregnant women is needed. Likewise, the connection between maternal health and women's health needs to be better understood. Improving women's health over the life course, and not only during pregnancy, is likely to have the greatest impact on improving maternal and child health. Infant Mortality and Morbidity. Birth defects are the leading cause of infant death, affecting approximately 3 percent of all live births. Because many birth defects occur in the first three months of pregnancy, they are best prevented by preconceptional and early prenatal care. The causes of most birth defects are still unknown and require further research. Low birthweight and prematurity contribute to most of the infant deaths and congenital neurological disabilities not related to birth defects. They are also the leading cause of infant deaths among African Americans. To date, most interventions during pregnancy designed to prevent low birthweight and prematurity have not been effective. Prenatal and Preconceptional Care. Although widely accepted, the effectiveness of prenatal care in improving pregnancy outcomes, particularly in preventing low birthweight and prematurity, has not been conclusively demonstrated. While this may reflect methodological flaws in research on prenatal care, it could also suggest that prenatal care is not provided in the proper manner, and some researchers have begun to question the appropriateness of the content of prenatal care. Still others have argued that less than nine months of prenatal care is not enough to reverse the cumulative impact of lifelong habits and exposures on pregnancy outcomes. Most women do not obtain preconceptional care before getting pregnant, and many health care providers do not know how to provide preconceptional care, or they provide it only to women who are actively trying to get pregnant, thereby missing opportunities to improve the outcomes of pregnancies that are unintended. Breast-Feeding. The benefits of breast-feeding to the health of mothers and infants have been well documented, including enhanced immunity against infections, improved cognitive development, and stronger maternal-infant bonding. Despite these benefits, the initiation and duration of breast-feeding in the United States remains low, particularly among disadvantaged women. Efforts to promote the WHO/UNICEF "Ten Steps to Successful Breast-feeding" in hospitals have met with little success. Changes in cultural norms, workplace practices, and social policy are also needed to encourage breast-feeding among American women. Immunization. Although the up-to-date immunization rate of children in the United States has been steadily improving, it still falls short of the national goal of 90 percent by age two, particularly for poor children. There is no agreement among public health experts on a strategy to bring this up to the level at which "herd immunity" would protect those children who remain without immunization. Child Care. Over half of U.S. mothers with children under six work outside the home, and 60 percent of these children receive care outside their homes. In addition to increased risk for infections and injuries, children cared for in day-care centers may receive less support for cognitive and social development than children cared for at home. Support for parents with child-care needs is low, particularly for low-income families. Family Violence. A U.S. woman has a one-in-five chance of being physically abused at some point in her lifetime. Estimates of the prevalence of physical abuse by an intimate partner during pregnancy range from 4 to 8 percent, but it may be as high as 20 percent. Most communities have inadequate resources to help battered women. Many health care providers do not screen for, or cannot identify, domestic violence. Within communities, a shortage of shelter beds, social workers, and other basic services frequently exists, together with a lack of coordination among health care, social-service, and judicial systems. Children are abused in half of the families where women are abused. While little is known or done about primary prevention of family violence, what is clear is that family violence cannot be overcome without attention to the social and economic conditions that put children and families at risk.