Chapter 5
Reproductive, Infant, and Child Health
Table of Contents
OBJECTIVES AND
PHILOSOPHY
OVERVIEW
HEADLINES, TIMELINES, & MILESTONES
WEB PAGES AND
INFORMATION SOURCES
REFERENCES - since publication of 8th edition
DEBATE TOPICS
STUDY QUESTIONS,
ACTIVITIES, AND EXERCISES
This chapter begins Part 2 of the book. It
builds on the foundations laid in Part 1 by taking each of the subpopulations
of the community, identified by the life span, and applying the concepts and
methods of history, ecology, demography, epidemiology and the social and
behavioral sciences to the community diagnosis and treatment of their health
needs. Beginning with maternal, infant, and child health, chapter 5 approaches
the assessment of the health needs of special populations from the perspectives
offered in Part I. It explores how the future health of individuals can be
affected by protecting the health of pregnant women, infants, and children.
Additional objectives for this chapter are to introduce the life-span concept
and the management-by-objectives approach to special populations, such as those
in the Year 2010 objectives of the U.S. Public Health Service.
Initial emphasis is placed on setting
priorities and objectives, based on assessment of needs within a subpopulation.
This approach is illustrated in the previous chapter with maternal and child
health examples. Social, epidemiological, behavioral, educational and
administrative diagnoses of community health needs are presented in sequences
for maternal, then infant, then child health. Historical and comparative
perspectives and contemporary issues are presented in boxes to highlight
discussion topics.
HEADLINES, TIMELINES, & MILESTONES
Head Start's 40th anniversary on Capital Hill. National Head Start Association, Apr 25, 2005.
US infant mortality rates by racial/ethnic groups. MMWR, Feb. 11, 2005.
News from Health & Health Care in Schools, 2005
February January
New Commission
Aims to End Disparities in Health Care
Inhalants—A
Middle-School Addiction that Kills
What Public
Health Can Do to Stop an Avian Flu Pandemic
In Congress
Worth Noting
USDA Cautions on
School Food Contracts
Updating
Hepatitis B
The State View
of the School Obesity Epidemic
Recommended
Childhood and Adolescent Immunization Schedule,
United States, January-June 2005
Worth Noting
Alcohol consumption by pregnant women and women who might become pregnant (Morbidity and Mortality Weekly Reports 53(50), Dec 24, 2004). Some 10% of pregnant women drink alcohol during their pregnancy and 2% engage in binge drinking. Over 50% of those who might become pregnant (childbearing age and not using birth control methods) are drinking. These levels of alcohol consumption produce the preventable cases of Fetal Alcohol Syndrome. See also:
- CDC. Alcohol use among women of childbearing age---United States, 1991--1999. MMWR 2002;51:273--6.
- Day NL, Richardson GA. An analysis of the effects of prenatal alcohol exposure on growth: a teratologic model. Am J Med Genet C Semin Med Genet 2004;127:28--34.
- Project CHOICES Research Group. Alcohol-exposed pregnancy: characteristics associated with risk. Am J Prev Med 2002;23:166--73.
- US Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendations statement. Ann Intern Med 2004;140:554--6.
News from Health and Health Care in Schools, 2004
November
Plan B for Influenza: Antiviral Medications
First-Year Experiences under HIPAA
Bacterial Meningitis Gets New Attention
Does Parent Notification Affect Reproductive Health Services for Minors? Worth NotingOctober
Preventing Childhood Obesity
Child Health: A Progress Report
What the Party Platforms Say about Health
How Good Are the Best Adolescent Substance Abuse Treatments?
Worth NotingSeptember
Sugar-Sweetened Soft Drinks, Obesity, and Type 2 Diabetes
Tobacco Use During Adolescence: 'The Battle Isn't Over'
Immunotherapy for Allergy to Insect Stings in Children
Athletes and Performance-Enhancing Drugs
Worth NotingAugust
Report Cites Increases in Immunization of Infants
When Schools Conduct Surveys—What’s the Law?
Controversy Grows about Steroid Use by High Schoolers
Influenza Update
Worth NotingJuly
Congress Gives Schools Two Years to Improve Nutrition/Wellness
Examining the Tragedy of Youth Suicide
Are Schools a Factor When Parents Refuse Immunization?
Young Teens and Emergency Contraception—the Debate Continues
Worth NotingJune
A Trial of School-Based Asthma Treatment
Youth Risk Behaviors Show Improvement but Concerns Continue
What Has Happened to Immunization Registries?
Health Consequences of Smoking-It's Even Worse Than We Thought
Worth Noting
May
It Takes A Village: What Happened When a State Dropped Its Youth Anti-Tobacco Program
Identifying the Risk Factors for Adolescent Overweight
A Review of Competitive Foods Available in Schools
In CongressApril
House Bill Makes Only Minor Changes in School Food
FDA Has Questions About Antidepressant Medications for Children
An Update on Health Insurance for Adolescents
On Washing Hands—A Cautionary Tale
Worth NotingMarch
'Our Voices, Our Lives'—A Report on Youth and STDs
Separate SCHIP Programs Meet Needs of Special Children
Why Did a Highly Vaccinated School Population Come Down with Chickenpox?
New Congress Addresses Health Issues
Worth NotingFebruary
The Strange Case of the Disappearing Disparities
The State of Sex Education in American Schools
Doctors Often Don't Ask, Don't Tell Young Patients about Tobacco Cessation
Fast Food and Obesity—Is There a Connection?
First Steps in Pediatric Drug Testing: Setting Ethics and Standards
Worth NotingJanuary
Flu in Children Calls Attention to Reye Syndrome
Pediatricians Take Position on Soft Drinks in Schools
Students Who Bully and Their Victims: Should They Be Treated Differently?
FDA Will Prohibit Sale of Dietary Supplements Containing Ephedra
Recommended Childhood and Adolescent Immunization Schedule—United States, January-June 2004
Worth Noting
A Contraceptive clears a hurdle to wider access (NY Times, December 17, 2003)
Debate on Selling Morning-After Pill Over the Counter (December 12, 2003)
American Academy of Pediatrics Report Sounds Alarm on Children's Obesity. (NY Times, Aug.25, 2003).
More Moms Opt to Undergo C-Section Births, Study Finds. (USA Today, July 20, 2003).
Timing Is Everything for Kids' Successful Immunization. July 17, 2003
Many Women Gleeful at Old Friend's Encore (New York Times, March 7, 2003) - A small New Jersey pharmaceutical company announced that it will ship out new supplies of the Today Sponge, a popular over-the-counter method of birth-control that was discontinued in 1994.
'Emergency' Birth Control: Access Issues. (The New York Times, Mar 10, 2003). Use of emergency contraception is low among women 18 - 44 years old, as a result of access issues. However, this may soon change if a change in policy grants greater access.
An Extra Hour of Sleep Can Make a Big Difference for Kids. March 4, 2003
Stress During Pregnancy Can Affect Fetal Heart Rate. Feb. 12, 2003
Classes May Be Effective Treatment for ADHD Patients, Parents. Feb. 12, 2003
Most See Premature Births as Personal, Not Public Health, Problem. Jan. 30, 2003
Abortion-Rights Supporters, Opponents Mark 30th Anniversary of Roe v. Wade Ruling Jan. 22, 2003
More Women Quit Smoking During Pregnancy, but not Before and After. Jan. 15, 2003
Study Finds More Than 1 in 10 Pregnant Women Drink Alcohol. Jan. 14, 2003
Preemies' Temperaments Shift in First Year of Life. Dec. 18, 2002
Study Suggests That Tomboys May be Born, Not Made. Nov. 12, 2002
Preschoolers' Thinking, Behavior Influenced by Family Income. Nov. 12, 2002
Ethnic, Gender Differences in Blood Pressure Also Seen in Youth. Sept. 24, 2002
CDC. Use of contraception and use of family planning services in the United States, 1982--2002. Available at http://www.cdc.gov/nchs/data/ad/ad350.pdf.
Hong Kong Children Rate Smoking as Most
Revolting of Parents' Acts (Hong
Kong Council on Smoking and Health, June 20, 1999) - According to the findings
of a student survey released on the Father's Day, 20 June 1999,
"smoking" was rated top of the list of disliked acts the children in
Hong Kong would expect from their parents. They survey, conducted by the Hong
Kong Federation of Youth Groups in this May, interviewed 1,311 Primary 4 to
Secondary 3 students (age between 9-15) in 12 schools. The respondents were
asked to choose the top 10 acts they liked and disliked most from a list of 30.
The top 10 most disliked acts, as rated by the children, are:
1. Smoking (58.9%)
2. Scolding over a minor mistake (56.3%)
3. Use of violence (54.9%)
4. Bullying, being unreasonable (51.9%)
5. Comparing them with others (47.8%)
6. Hiring sex services (45.2%)
7. Having extra-marital relations (43.8%)
8. Imposing too many restrictions on them (41.3%)
9. Intruding into their private affairs (41.3%)
10.Not keeping their promises (40.4%)
More Fatalities Cited for Black Moms.
ATLANTA (AP June 18, 1999) – Black women are more than four times as likely to
die of pregnancy-related complications than white women, federal researchers
said in a report that outlines one of the sharpest racial contrasts in public
health. The mortality rate for black women was 19.6 deaths per 100,000 births,
while 5.3 whites died per 100,000 births, the Centers for Disease Control and Prevention
said Thursday. The CDC study found that a black woman's risk of dying is higher
than whites for every specific cause of death and in every age group. Data for
other minority groups were not included. See the MMWR article below under
"Other References" or go to (for the full report from CDC): http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4823a3.htm.
Clinton Calls For Ban On Abusive Child Labor. GENEVA (Reuters, June 1999) President Clinton appealed Wednesday for an
end to the forcing of children into prostitution, slavery and other abusive
work as he began a week-long European tour expected to be dominated by the
aftermath of the Kosovo conflict. ``We must wipe from the Earth the most
vicious forms of abusive child labor. Every single day, tens of millions of
children work in conditions that shock the conscience,'' Clinton told the
International Labor Organization. Clinton, who flew overnight from Washington,
became the first U.S. president to address the U.N. organization responsible
for establishing world labor standards. He threw U.S. support behind a treaty
that, when approved as expected Thursday, would require the ILO's 174 member
states to take immediate action to prohibit and eliminate the worst forms of
child labor and remove the children from them. The treaty would ban all forms
of slavery, child prostitution and pornography, use of children in drug
trafficking, and other work that would harm the health, safety or morals of
children under 18. Clinton said some children were working chained to dangerous
machines. ``These are not some archaic practices out of a Charles Dickens
novel. These are things that happen in too many places today,'' he said in the
ILO building overlooking Lake Geneva.
Abortion in the Developing World Global. (World Health Organization Press Release - May 17, 1999). Geneva,
Switzerland: Out of nearly 50 million abortions performed in the world each
year (30 million of them in developing countries), 20 million are
unsafe..." http://www.who.int/inf-pr-1999/en/pr99-28.html
Wal-Mart Rejects Contraceptive Pill. LITTLE
ROCK (AP, May 5, 1999) - Wal-Mart, the nation's largest retailer, said Friday
its pharmacies will not sell an emergency contraceptive that can be used up to
72 hours after unprotected sexual intercourse. Bentonville-based Wal-Mart did
not say why it would not sell the drug at its 2,428 pharmacies. It called the
ban a "business decision." However, family planning advocates
criticized the move, saying that some women, particularly those in small towns
where Wal-Mart has little competition, would have greater difficulty finding
the drug, Preven. This drug was approved for sale last year as a
"morning-after" pill. The drug is not the same as RU-486, which can
be used in the first seven weeks of pregnancy to cause a medically induced
abortion.
Folic Acid Deficiency Improves.
BOSTON (AP, May 13, 1999) - Folic acid deficiency has all but vanished in the
United States since the government ordered food manufacturers to add the
vitamin to flour, rice and other grain products, researchers reported Thursday.
Folic acid is found naturally in green leafy vegetables and some other foods.
If women eat too little of it when they become pregnant, they risk having
babies with spina bifida and other neural tube defects. To help protect against
these birth defects, the Food and Drug Administration ordered manufacturers to
begin fortifying foods with folic acid in January 1998. The latest study,
reported in the New England Journal of Medicine (volume 340, number 19, May 13,
1999), is the first major effort to see what effect this has had. For the
current issue, visit:
http://content.nejm.org/cgi/content/abstract/340/19/1449
Health Minister launches Federal Guide to Programs and Services for Children
and Youth. (6 April 1999). Health
Minister Allan Rock launched the 1999 edition of the Guide to Federal Programs
and Services for Children and Youth. Intended for parents, caregivers,
organizations, educational institutions, and agencies working with young
people, the Guide is organized thematically with topics such as health,
families and research. For more information, see
http://www.hc-sc.gc.ca/english/media/releases/1999/99_61e.htm
Study Shows Kids' Heart Risks. LOS
ANGELES (AP, Mar. 17, 1999) - Mexican-American and black children are heavier
and have higher blood pressure and fattier diets - all risk factors for heart
disease - than white youths, researchers say. Stanford University researchers
based their study, published Wednesday in the Journal of the American Medical
Association, on data collected from more than 7,000 children and adults ages 6
to 24. The findings, "highlight the need for information about heart
disease prevention to be made available sooner, maybe as early as kindergarten,"
said Marilyn Winkleby, an epidemiologist at the Stanford Center for Research in
Disease Prevention and lead author of the study.
CDC: Premature Births up for Whites. ATLANTA (AP, March 12, 1999) - The
rate of single-born premature babies among black women decreased nearly 10%
between 1989 to 1996 but increased 8% among whites, government researchers say.
Premature births dropped from 180.4 per 1,000 live births among black women in
1989 to 162.5 in 1996, the Centers for Disease Control and Prevention said
Thursday. The rate among whites climbed from 74.8 to 80.8. Despite the
narrowing of the racial gap, black babies are still nearly twice as likely to
be born premature than white ones, the CDC said. The researchers said they were
unable to explain the changes. See full story in Morbidity and Mortality Weekly
Report, March 12, 1999/Vol. 48/No. 9: * Preterm Singleton Births ---
United States, 1989--1996
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00056645.htm
See also in the same issue:
* Decrease in Infant Mortality and Sudden Infant Death Syndrome Among Northwest
American Indians and Alaskan Natives --- Pacific Northwest, 1985--1996 http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00056637.htm
Pacifier Use Lessens Breast Feeding. ROCHESTER, N.Y. (AP, Mar. 2, 1999)-
Mothers should breast-feed their children as long as possible to best protect
their health, according to researchers who found that babies who use pacifiers
are weaned from breast-feeding sooner than other children. In a study of 265
breast-feeding mothers in New York, infants who used pacifiers were breast-fed
eight times a day on average, compared with nine times a day among babies not
given the option of sucking an artificial nipple. Pacifier-sucking babies also
spent less time overall breast-feeding. In addition, mothers who turned to
pacifiers weaned their babies off the breast one month earlier than those who
relied solely on breast-feeding. The reason, researchers said, is that
pacifiers satisfy babies' innate need to suck.
Group Won't Recommend Circumcision. CHICAGO (AP, Mar. 2,
1999) - The benefits of circumcising newborns aren't significant enough to
recommend it as a routine procedure, according to the nation's most influential
group of pediatricians. The American Academy of Pediatrics stopped short of
advising against circumcision, but on Monday recommended for the first time
that newborns get pain relief for it. "The weight of the evidence would
have to be significant for the academy to recommend an elective surgical
procedure on every newborn male, and the evidence is not sufficient for us to
make such a recommendation," said Dr. Carole Lannon, chairwoman of the
task force that wrote the new policy statement for the academy, which has
55,000 members. Opponents of circumcision, who say it leaves long-term
psychological scars and diminishes sexual pleasure, hailed Monday's
announcement.
3 Million Youths Got HIV Last Year GENEVA (AP, Feb. 26, 1999) - Six
young people are infected with the AIDS virus every minute, the United Nations
said Thursday as it launched a new campaign to slow the spread of the epidemic
among youth. Nearly 600,000 children under 15 and 2.5 million people aged 15-24
caught the Human Immunodeficiency Virus last year, it said. "Too many
children are still being deprived of AIDS information and skills because of
fears by adults - including government authorities - that education will
increase sexual activity when evidence shows the opposite is true," said
Peter Piot, head of UNAIDS. The UNAIDS campaign, called "Listen, Learn,
Live," is aimed at increasing dialogue with the young about the risks of
catching the disease through unprotected sex and other high-risk behavior like
intravenous drug use. An estimated 33.4 million people were estimated to be
living with the HIV virus last year, of whom 43% were women, according to U.N.
figures. In some of the worst-hit countries in southern Africa, More than two
out of five pregnant women attending prenatal clinics have the virus and risk
passing it on to their infants.
Japan May OK Birth Control Pills. TOKYO
(AP, Mar. 3, 1999) - A Japanese health ministry committee approved the sale of
birth control pills Wednesday, reports said. The move brings Japan closer to
the general sale of the pill almost four decades after its first use in the
West. The Central Pharmaceutical Affairs Council will submit its recommendation
to the ministry in June, meaning the pill could be available by the end of the
year, state-run NHK television and Kyodo News agency said. A spokesman for the
Health and Welfare Ministry refused to comment. The shift came after women's
groups voiced outrage over the ministry's decision in January to approve the
male impotence drug Viagra after deliberating just six months.
Lead Poisoning Threatens India Kids BANGALORE
(AP, Feb. 8, 1999) - More than half of children below age 12 in seven
major Indian cities suffer from serious lead poisoning, according to a new
study. The findings were released at an international conference on lead
poisoning prevention and treatment that began Monday in Bangalore, the capital
of the southern Indian state of Karnataka. The study of 22,000 people -
including children, pregnant women and industrial workers - was done by the
George Foundation, a child advocacy group. The major sources of lead poisoning
were automobile fuel, food can soldering, lead-based paint, leaded cooking
utensils and drinking water systems. Lead poisoning can lead to permanent brain
damage, particularly among young children.
Maternal Mortality a Neglected Tragedy,
UN Report States (Globe and Mail
June 11, 1996). A UN report indicates that close to 600,000 women die annually
while another 300 million suffer lasting damage from pregnancy and childbirth.
China Ends Rule Allowing Couples Only One
Child (L.A. Times October 19,
1997) China's strict one child only policy has been amended so that individual
states can determine its own needs and allow families to have two children and
possibly more.
For related news stories, please click here.
WEB PAGES AND INFORMATION SOURCES
General Information Sources on Reproductive, Infant, and Child Health
Journal References
Braveman, P., Egerter, S., & Marchi, K.
(1999). The Prevalence Of Low Income Among Childbearing Women In
California: Implications For The Private And Public Sectors. AMERICAN
JOURNAL OF PUBLIC HEALTH 89 (6): 868-874.
The Journal’s Home Page is at:
http://www.ajph.org/.
ABSTRACT: Objectives. This study examined the income distribution
of childbearing women in California and sought to identify income groups at
increased risk of untimely prenatal care. This study's results indicate that
low-income women are the mainstream maternity population, not a "special
needs" subgroup; even among privately insured childbearing women, a
substantial proportion have low income. Efforts to increase timely prenatal
care initiation cannot focus solely on women with Medicaid, the uninsured,
women in absolute poverty, or those who receive care at public-sector sites.
Buller, D.B., & Borland, R. (1999). Skin
Cancer Prevention For Children: A Critical Review. HEALTH EDUCATION
& BEHAVIOR 26 (3): 317-343. For a table of contents/abstracts to HEB,
go to:
http://www.sph.umich.edu/hbhe/heb/archive_issue_v26i3.html .
ABSTRACT: Increasing sun protection for children may reduce
their risk for skin cancer, so many health authorities recommend comprehensive
sun safety for children. Sun protection of children in North America and Europe
is generally lower than desired and lower than in Australia. This article
provides a critical review of evaluations on the effects of 24 sun protection
programs for children under age 14. Programs are classified based on the target
population, setting, and features. Most programs improved sun safety knowledge,
but changes in sun protection attitude and behaviors were smaller. Multiunit
presentations were more effective than short-duration presentations. Peer
education was effective but needs further evaluation. Some programs for parents
have been shown to increase sun protection for children. Strategies to improve
sun safety policies need further study. A few community-wide programs have
effectively improved sun protection. There is no gold standard for measuring
sun protection behavior, but self-report, prospective diaries, and
observational techniques show small positive correlations.
Caldwell, J.C., Barkat-e-Khuda, Caldwell,
B., Pieris, I., & Caldwell, P. (1999). The Bangladesh Fertility
Decline: An Interpretation. POPULATION AND DEVELOPMENT REVIEW 25 (1):
67-84,203.
ABSTRACT: The claim has been made, notably in a 1994 World
Bank report, that the Bangladesh fertility decline shows that efficient
national family planning programs can achieve major fertility declines even in
countries that are very poor, and even if females have a low status and
significant socioeconomic change has not occurred. This article challenges this
claim on the grounds that Bangladesh did experience major social and economic
change, real and perceived, over the last two decades. This proposition is
supported by official data and by findings of the authors' 1997 field study in
rural southeast Bangladesh. That study demonstrates that most Bangladeshis
believe that conditions are very different from the situation a generation ago
and that on balance there has been improvement. Most also believe that more
decisions must now be made by individuals, and these include decisions to have
fewer children. In helping to achieve these new fertility aims, however, the
services provided by the family planning program constituted an important
input.
Cheng, T.L., DeWitt, T.G., Savageau, J.A.,
& O'Connor, K.G. (1999). Determinants Of Counseling In Primary Care
Pediatric Practice - Physician Attitudes About Time, Money, And Health Issues.
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 153 (6): 629-635.
ABSTRACT: The purposes of this study was to assess
pediatrician goals and practice in preventive counseling, and to use social
learning theory to examine physician attitudes about preventive health issues,
time, and reimbursement to explain physician counseling behavior. Conclusions:
Physician goals in child health supervision were primarily biomedical, with
psychosocial and safety issues of lesser importance. Concern about time for
preventive counseling was associated with less reported counseling. Physician
attitudes regarding the importance of a health issue and their confidence and
effectiveness in counseling were more predictive of physician practice than
their attitudes about time and reimbursement for preventive care.
Corwin, S. J., Sargent, R. J., Rheaume, C.
E., Saunders, R. P. (1999). Dietary Behaviors Among Fourth Graders: A
Social Cognitive Theory Study Approach. AMERICAN JOURNAL OF HEALTH
BEHAVIOR 23 (3): 182-197 .
ABSTRACT:
http://www.aahb.siu.edu/ajgb/1999/23-3-3.htm.
Evers, K. E., Harlow, L. L., LaForge, R. G.
(1998). Longitudinal Changes in Stages of Change for Condom Use
in Women. AMERICAN JOURNAL OF HEALTH PROMOTION 13 (1):
19-25.
To access the Journal's website, go to: http://www.healthpromotionjournal.com.
Franche, R. L., & Mikail, S. F. (1999). The
impact of perinatal loss on adjustment to subsequent pregnancy. SOCIAL
SCIENCE & MEDICINE 48 (11): 1613-1623.
ABSTRACT: This study compares the emotional adjustment of
pregnant couples with and without a history of perinatal loss. Couples with a
history of loss reported significantly more depressive symptomatology and
pregnancy-specific anxiety than couples in the comparison group. Women reported
more depressive symptomatology than men. Results: Regression analyses revealed
that for the group with a previous loss. depressive symptomatology was
significantly associated with self-criticism, interpersonal dependency and
number of previous losses. For the comparison group, depressive symptomatology
was significantly associated dyadic adjustment. Pregnancy-specific anxiety of
women with a previous loss was associated with their belief that their behavior
affects fetal health; for women in the comparison group, pregnancy-specific
anxiety was associated with the belief that health professionals' behavior
affects fetal health. The importance of early intervention to reduce distress
is highlighted.
Frazier, J. P., Countie, D., Elerian, L.
(1998). Parental Barriers to Weaning Infants From the Bottle.
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 152 (9): 889-892. For
abstracts to this issue, go to:
http://archpedi.ama-assn.org/issues/v152n9/toc.html .
Gilbert, L. K. (1999). The Female
Condom (TM) (FC) In The US: Lessons Learned. AMERICAN JOURNAL OF
PUBLIC HEALTH 89 (6): A1-A28.
The Journal’s Home Page is:
http://www.ajph.org/.
ABSTRACT: Prior to the introduction of the female condom (TM)
(FC) no effective, safe, reversible, female-controlled contraceptive methods
that prevented both unintended pregnancy and STDs, including HIV existed.
Contraceptive efficacy studies in the US found that FC compared favorably with
other female barrier options. Participants in FC acceptability studies reported
the following benefits: caused no side effects (not systemic), required no
health care services to fit, prescribe, refill, insert or remove, required no
partner consent; and provided a feeling of safety It could be inserted in advance
of sexual activity; allowed more sexual spontaneity and intercourse before full
erection of the penis; covered internal and external genitalia; and, warmed to
body temperature. Further, it was reported to feel natural and clean, had no
odor or taste, was soft, non-drying, and nonconstricting, enhanced sexual
stimulation ,and reduced painful intercourse. Finally, it increased women's
bargaining power, provided incremental gains from expanded contraceptive
choices, and was easily reversible. Reported obstacles to FC use included:
aesthetics, insertion difficulties, discomfort, dislodgment, reduced sensation,
and partner objections. Recommendations include education programs for health
care/FC providers, potential FC users and their partners.
Hackett, A., Nathan, I., Burgess, L.
(1998). Is A Vegetarian Diet Adequate For Children? NUTRITION
AND HEALTH 12(3): 189.
Haslam, C. (1999). Maternal Factors,
Obstetric History And Smoking Stage Of Change. JOURNAL OF PUBLIC
HEALTH MEDICINE 21(2): 185-191. For abstract: http://www.oup.co.uk/pubmed/hdb/Volume_21/Issue_02/210185.sgm.abs.html .
Jequier, A. M. (1998). Vasectomy
Related Infertility: A Major And Costly Medical Problem. HUMAN REPRODUCTION
13 (7): 1757-1758.
ABSTRACT (and article in PDF): http://humrep.oupjournals.org/cgi/content/abstract/13/7/1757 .
Leslie, G. I., Gibson, F. L., McMahon, C.,
Tennant, C., & Saunders, D. M. (1998). Infants Conceived
Using In-Vitro Fertilization Do Not Over-Utilize Health Care Resources After
The Neonatal Period. HUMAN REPRODUCTION 13 (8): 2055-2059.
ABSTRACT (and article in PDF): http://humrep.oupjournals.org/cgi/content/abstract/13/8/2055 .
Malcoe, L. H., Shaw, G. M., Lammer, E. J.,
Herman, A. A. (1999). The Effect Of Congenital Anomalies On Mortality
Risk In White And Black Infants. AMERICAN JOURNAL OF PUBLIC HEALTH 89
(6): 887-892.
The Journal’s Home Page is at:
http://www.ajph.org/.
ABSTRACT: Objectives. This population-based study examined
the effect of all major congenital anomalies on the mortality of White and
Black infants by infant sex, birthweight, gestational age, and lethality of the
anomaly. The study also determined the total contribution of anomalies to
infant mortality. Overall, anomalies contributed to 33% of White infant deaths,
to 19% of Black infant deaths, and to over 60% of deaths among Black and White
neonates weighing over 1499 g. Conclusions. The contribution of congenital
anomalies to mortality of both low- (<2500 g) and normal-birthweight infants
is substantially higher than previously estimated representing a large public
health problem for both Black and White infants.
Mansfield, C. J., Wilson, J. L., Kobrinski,
E. J., & Mitchell, J. (1999). Premature Mortality In The United
States: The Roles Of Geographic Area, Socioeconomic Status, Household Type, And
Availability Of Medical Care. AMERICAN JOURNAL OF PUBLIC HEALTH 89
(6): 893-898.
The Journal’s Home Page is at:
http://www.ajph.org/.
ABSTRACT: Objectives. This study examined premature
mortality by county in the United States and assessed its association with
metro/urban/rural geographic location, socioeconomic status, household type,
and availability of medical care. Conclusions. Community structure factors
statistically explain much of the variation in premature mortality. The degree
to which premature mortality is predicted by percentage of female-headed
households is important for policy-making and delivery of medical care. The
relationships described argue strongly for broadening the biomedical model.
McBride, C.M., Curry, S.J., Lando, H.A.,
Pirie, P.L., Grothaus, L.C., & Nelson, J.C. (1999). Prevention Of
Relapse In Women Who Quit Smoking During Pregnancy. AMERICAN JOURNAL
OF PUBLIC HEALTH 89 (5): 706-711.The AJPH's homepage is:
http://www.ajph.org/ .
ABSTRACT: Objectives. This study is an evaluation of relapse
prevention interventions for smokers who quit during pregnancy. Results. The
pre/post intervention delayed but did not prevent postpartum relapse to
smoking. Prevalent abstinence was significantly greater for the pre /post
intervention group than for the other groups at 8 weeks (booklet group, 30%,
prepartum group, 35%, pre/post group 39% and at 6 months (booklet group, 26%;
prepartum group, 24%; pre/post group, 33%; postpartum. A nonsignificant
reduction in relapse among the pre post group contributed to differences in
prevalent abstinence. There was no difference between the groups in prevalent
abstinence at 12 months postpartum. Conclusions. Relapse prevention interventions
may need to be increased in duration and potency to prevent postpartum relapse.
McDonnell, R., Johnson, Z., Doyle, A. &
Sayers, G. (1999). Determinants Of Folic Acid Knowledge And Use Among
Antenatal Women. JOURNAL OF PUBLIC HEALTH MEDICINE 21(2):
145-149. For abstract, go to: http://www.oup.co.uk/pubmed/hdb/Volume_21/Issue_02/210145.sgm.abs.html .
Milad, M. P., Klock, S. C., Moses, S., &
Chatterton, R. (1998). Stress And Anxiety Do Not Result In Pregnancy
Wastage. HUMAN REPRODUCTION 13 (8): 2296-2300.
ABSTRACT (and article in PDF): http://humrep.oupjournals.org/cgi/content/abstract/13/8/2296 .
Moher, D., Jadad, A. R., Klassen, T. P.
(1998).Guides For Reading And Interpreting Systematic Reviews: III. How
Did The Authors Synthesize The Data And Make Their Conclusions.
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 152 (9): 915-920. For
related abstracts to this issue, go to:
http://archpedi.ama-assn.org/issues/v152n9/toc.html.
Murphy, J. M., Pagano, M. E., Kleinman, R.
E., (1998).The Relationship of School Breakfast to Psychosocial and
Academic Functioning: Cross-sectional and Longitudinal Observations in an
Inner-city School Sample. ARCHIVES OF PEDIATRICS & ADOLESCENT
MEDICINE 152 (9): 889-892. For full-text article, go to: http://www.ama-assn.org/sci-pubs/journals/archive/ajdc/vol_152/no_9/pnu7508.htm . For abstracts to this issue, go to:
http://archpedi.ama-assn.org/issues/v152n9/toc.html .
Myers, M. D., Raynor, H. A., Epstein, L. H. (1998). Predictors of Child
Psychological Changes During Family-Based Treatment for Obesity.
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 152 (9): 855-861. For
abstracts to this issue, go to:
http://archpedi.ama-assn.org/issues/v152n9/toc.html .
Paine, L. L., Lang, J. M., Strobino, D. M.,
Johnson, T. R. B., DeJoseph, J. F., Declercq, E. R., Gagnon, D. R., Scupholme,
A., & Ross, A. (1999). Characteristics Of Nurse-Midwife Patients
And Visits, 1991. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 906-909.
The Journal’s Home Page is at:
http://www.ajph.org/.
ABSTRACT: Objectives. This study describes the patient
populations seen by and visits made to certified nurse-midwives (CNMs) in the
United States. Results. We estimated that approximately 5.4 million visits were
made to nearly 3000 CNMs nationwide in 1991. Most visits involved maternity
care, although fully 20% were for cafe outside the maternity cycle. Patients
considered vulnerable to poor access or outcomes made 7 of every 10 visits.
Conclusions. Nurse-midwives substantially contribute to the health care of
women nationwide, especially for vulnerable populations.
Parazzini, F., Chatenoud, L., Di Cintio, E.,
Mezzopane, R., Surace, M., Zanconato, G., Fedele, L., & Benzi, G. (1998). Coffee
Consumption And Risk Of Hospitalized Miscarriage Before 12 Weeks Of Gestation.
HUMAN REPRODUCTION 13 (8): 2286-2291.
ABSTRACT (and article in PDF): http://humrep.oupjournals.org/cgi/content/abstract/13/8/2286 .
Paxton, R., Finnigan, S., Leonard, R.
(1998). Drug Education In Primary Schools: Putting What We Know
Into Practice. HEALTH EDUCATION JOURNAL 57 (2): 117.
Perez-Escamilla, R., & Dewey, K. G.
(1998). Hospital Infant Formula Discharge Packages.
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 152 (9): 930-931.
For abstracts to this issue, go to:
http://archpedi.ama-assn.org/issues/v152n9/ffull/plt0998-3.html.
Raube, K., & Merrell, K. (1999). Maternal
Minimum-Stay Legislation: Cost And Policy Implications. AMERICAN
JOURNAL OF PUBLIC HEALTH 89 (6): 922-923.
ABSTRACT: Recently, most state legislatures and Congress
have passed laws mandating insurance coverage for a minimum period of inpatient
care following delivery. This study analyzed the likely cost implications of
one state's law. To view the complete abstract, go to: http://www.apha.org/news/publications/journal/abraube.htm.
The Journal’s Home Page is: http://www.apha.org/news/publications/journal/AJPH2.html.
Rowland, D., Salganicoff, A., & Keenan,
P. S. (1999). The Key to the Door: Medicaid's Role in Improving Health
Care for Women and Children. ANNUAL REVIEW OF PUBLIC HEALTH 20: 403.
ABSTRACT/Full-Text: http://social.annualreviews.org/current/5.shtml.
Shepherd, C. K., Power, K. G., & Carter,
H. (1998). Characteristics Of Responders And Non-Responders In An
Infant Feeding Study. JOURNAL OF PUBLIC HEALTH MEDICINE 20 (3):
275-280.
ABSTRACT: http://www3.oup.co.uk/pubmed/hdb/Volume_20/Issue_03/200275.sgm.abs.html . For the Table of Contents of this issue, go to: http://www.oup.co.uk/pubmed/hdb/Volume_20/Issue_03/ .
Stoltenberg, C., Magnus, P., Irgens, L. M. (1998). Influence of
Consanguinity and Maternal Education on Risk of Stillbirth and Infant Death in
Norway, 1967-1993. AMERICAN JOURNAL OF EPIDEMIOLOGY 148(5):
452-459.
Sword, W. (1999). A socio-ecological
approach to understanding barriers to prenatal care for women of low income.
JOURNAL OF ADVANCED NURSING 29 (5): 1170-1177.
ABSTRACT: This paper critically examines the notion of
barriers as conceptualized in the literature and suggests an expanded
orientation to more fully appreciate its complexity. This alternative approach
not only takes into account factors and processes relevant to the individual
that create constraints to utilization, but also acknowledges influences on the
design and delivery of health care. These latter considerations determine the
availability and characteristics of programs and services that may or may not
encourage or enable participation by persons of law income. A socio-ecological
model is proposed that compels health care practitioners and researchers to
acknowledge the many influences on utilization behavior. The literature on
barriers to prenatal care is subsequently reviewed and evaluated.
Thomason, M. J., Lord, J., Bain, M. D.,
Chalmers, R. A., Littlejohns, P., Addison, G. M., Wilcox, A. H., & Seymour,
C. A. (1998). A Systematic Review Of Evidence For The
Appropriateness Of Neonatal Screening Programmes For Inborn Errors Of
Metabolism. JOURNAL OF PUBLIC HEALTH MEDICINE 20 (3): 331-343.
ABSTRACT: http://www3.oup.co.uk/pubmed/hdb/Volume_20/Issue_03/200331.sgm.abs.html . For the Table of Contents of this issue, go to: http://www.oup.co.uk/pubmed/hdb/Volume_20/Issue_03/ .
Wessel, M. A. (1998). Editorial.
The Role of the Primary Pediatrician When a Child Dies. ARCHIVES OF
PEDIATRICS & ADOLESCENT MEDICINE 152 (9): 837-838. For related
abstracts to this issue, go to: http://www.ama-assn.org/sci-pubs/journals/archive/ajdc/vol_152/no_9/toc.htm#top .
Williams, P.L., Innis, S.M., Vogel, A.M.P.,
& Stephen, L.J. (1999). Factors Influencing Infant Feeding
Practices Of Mothers In Vancouver. CANADIAN JOURNAL OF PUBLIC
HEALTH-REVUE CANADIENNE DE SANTE PUBLIQUE 90 (2): 114-119.
ABSTRACT: This study describes factors influencing infant
feeding choices of 434 mothers with 9-month-old infants in Vancouver.
Consistent with Social Cognitive Theory, both internal personal and
socio-environmental factors influence infant feeding choices. Mothers
attributed the choice to breast feed primarily to personal choice, whereas the
choice to formula feed was attributed to socio-environmental factors. Among
mothers who breastfed <3 months, the choice to wean was primarily attributed
to concern for baby's nutrition; compared to returning to work, concern about
milk supply and concern for baby's nutrition among those who breastfed greater
than or equal to 3 to <6 months; and returning to work and personal choice
among those who breastfed greater than or equal to 6 months. Initiatives to facilitate
further advances in breastfeeding promotion could address three areas; 1)
prenatal intentions, 2) early postpartum concerns, and 3) later issues
surrounding returning to work and infant nutrition.
Yaron, Y., Johnson, K. D., Bryant-Greenwood,
P. K., Kramer, R. L., Johnson, M. P., & Evans, M. I. (1998). Selective
Termination And Elective Reduction In Twin Pregnancies: 10 Years Experience At
A Single Centre. HUMAN REPRODUCTION 13 (8): 2301-2304.
ABSTRACT (and article in PDF): http://humrep.oupjournals.org/cgi/content/abstract/13/8/2301 .
Yusuf, H.R., Rochat, R.W., Baughman, W.S.,
Gargiullo, P.M., Perkins, B.A., Brantley, M.D., & Stephens, D.S. (1999). Maternal
Cigarette Smoking And Invasive Meningococcal Disease: A Cohort Study Among
Young Children In Metropolitan Atlanta, 1989-1996. AMERICAN JOURNAL OF
PUBLIC HEALTH 89 (5): 712-717. The AJPH's homepage is: http://www.apha.org/news/publications/journal/AJPH2.html .
ABSTRACT: Objectives. This study assessed the association
between maternal cigarette smoking during pregnancy and the risk of invasive
meningococcal disease during early childhood. Results. The crude rate of
meningococcal disease was 5 times higher for children whose mothers smoked
during pregnancy than for children whose mothers did not smoke (0.05% vs.
0.01%). Multivariate analysis revealed that maternal smoking (risk ratio [RR] =
2.9; 95% confidence interval [CI] = 1.5, 5.7) and a mother's having fewer than
12 years of education (RR = 2.1; 95% CI = 1.0 4.2) were independently
associated with invasive meningococcal disease. Conclusions. Maternal smoking,
a likely surrogate for tobacco smoke exposure following delivery, appears to be
a modifiable risk factor for sporadic meningococcal disease in young children.
Books and Reviews
Boston Women's Health Book Collective:
Our Bodies Ourselves for the New Century: A Book by and for Women (Boston: Boston Women's Health Book Collective,
1998).
Our Bodies, Ourselves
has been updated for the millennium and includes the latest information on
holistic health practices, relationships, birth control, and motherhood--all
with a good dose of feminism for which the book's famous. When the first
edition of Our Bodies, Ourselves hit the shelves in 1970, the term
"women's health" had yet to be coined and back-alley abortions were
commonplace. The book's been completely revised, true to its mission of
providing "women with tools to enable all of us to take charge of our
health and lives." The web link is to a book review and an excerpt from
the introduction to Part Four: Child-Bearing. See http://www.amazon.com/exec/obidos/ASIN/0684842319/002-3684165-0919815
Other References
Fetal Alcohol Syndrome--South Africa, 2001. Morbidity and Mortality Weekly Report, 52(28), July 18, 2003.
Notice to Readers: Special Mothers' Day Issue of Pediatrics. Morbidity and Mortality Weekly Report, 52(18), May 9, 2003.
State-Specific Maternal Mortality Among
Black and White Women --- United States, 1987--1996. Morbidity and Mortality
Weekly Reports 48(23), June 18 1999.
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4823a3.htm.
One of the national health objectives for 2000 is to reduce
the overall maternal mortality ratio* ([MMR] i.e., number of maternal deaths
per 100,000 live-born infants) to no more than 3.3 (objective 14.3) (1);
however, during 1982-1996, the MMR remained at approximately 7.5 (2). In
addition, the risk for maternal mortality consistently has been higher among
black women than white women. This report presents state-specific MMRs for
1987-1996, focusing on persistent disparities in maternal mortality between
black and white women. The findings indicate that in every state where MMRs
could be reliably calculated, black women were more likely than white women to
die from complications of pregnancy and that the 2000 objective will not be
met; however, for white women, it has been met in three states. References
cited:
1. Public Health Service. Healthy people 2000: national health promotion and
disease prevention objectives--full report, with commentary. Washington, DC: US
Department of Health and Human Services, Public Health Service, 1991; DHHS
publication no. (PHS)91-50212.
2. CDC. Maternal mortality--United States, 1982-1996. MMWR 1998;47:705-7.
Cigarette Smoking During the Last Months
of Pregnancy Among Women Who Gave Birth to Live Infants. Morbidity and Mortality Weekly Report, 48 (20), May
28, 1999.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4820a3.htm
Cigarette smoking during pregnancy is associated with
adverse birth outcomes (e.g., low birthweight and preterm delivery) (1). The
adverse effect of smoking on birthweight occurs primarily during the last
trimester of pregnancy (1). This report indicates that despite the overall
decline in smoking prevalence in Maine among women who gave birth to live
infants, smoking prevalence remains high during the last 3 months of pregnancy
among young women and low-income women, particularly those participating in the
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
References cited:
1. US Department of Health and Human Services. The healthy benefits of smoking
cessation. Atlanta, Georgia: US Department of Health and Human Services, Public
Health Service, CDC, 1990; DHHS publication no. (CDC)90-8416.
Prenatal Discussion of HIV Testing and
Maternal HIV Testing --- 14 States, 1996--1997. Morbidity and Mortality Weekly Reports 48(19), May
21, 1999.
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4819a4.htm
In July 1995, the Public Health Service recommended that
health-care providers counsel all pregnant women about human immunodeficiency
virus (HIV) prevention and encourage testing for HIV infection (1) and, if
indicated, initiate zidovudine therapy (2). To evaluate compliance with these
recommendations, CDC analyzed population-based data on HIV counseling and
testing during 1996-1997 from 14 states participating in the Pregnancy Risk
Assessment Monitoring System (PRAMS). This report presents an analysis of
survey data collected from 1996 through 1997; results indicate that HIV
counseling and testing of pregnant women were common but varied by state, type
of prenatal health-care provider, Medicaid status, and maternal demographic
characteristics. References cited:
1. CDC. US Public Health Service recommendations for human immunodeficiency
virus counseling and voluntary testing for pregnant women. MMWR 1995;44(no.
RR-7):1-14.
2. Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant
transmission of human immunodeficiency virus type 1 with zidovudine treatment.
N Engl J Med 1994;331:1173-80.
Knowledge and Use of Folic Acid by Women
of Childbearing Age --- United States, 1995 and 1998. Morbidity and Mortality Weekly Report 48(16), April
30, 1999. http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00056982.htm
In the United States, approximately 4000 pregnancies are
affected by neural tube defects each year; 50%-70% of these developmental
defects could be prevented with daily intake of 400 ug of the B vitamin folic
acid throughout the periconceptional period (1). In 1992, the Public Health
Service recommended that all women capable of becoming pregnant consume 400 ug
of folic acid daily throughout their childbearing years to reduce their risk
for having a pregnancy affected by neural tube defects (2). In 1998, the
Institute of Medicine recommended that all women of childbearing potential
consume 400 ug of synthetic folic acid per day from fortified foods and/or a
supplement in addition to food folate from a varied diet (3). This report
summarizes the findings of a survey conducted during July-August 1998 to assess
folic acid knowledge and practices among women of childbearing age in the
United States (4) and compares these results with those from a similar survey
conducted in 1995. The findings indicate that 7% of women know folic acid
should be taken before pregnancy to reduce the risk for neural tube defects.
References cited:
1. Johnston RB Jr. Folic acid: new dimensions of an old friendship. In:
Advances in pediatrics. Vol 44. St. Louis, Missouri: Mosby-Year Book, Inc.,
1997.
2. CDC. Recommendations for the use of folic acid to reduce the number of cases
of spina bifida and other neural tube defects. MMWR 1992;41(no.RR-14).
3. Institute of Medicine. Dietary Reference Intake: folate, other B vitamins,
and choline. Washington, DC: National Academy Press, 1998.
4. CDC. Knowledge and use of folic acid by women of childbearing age—United
States, 1995. MMWR 1995;44:716-8.
5. Henshaw SK. Unintended pregnancy in the United States. Fam Plan Perspect
1998;30:24-9,46.
Vaginal Birth After Cesarean Birth---California, 1996-2000. Morbidity and Mortality Weekly Report 51(44). November 8, 2002. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5144a3.htm. In 2000, of all births in the United States, 23% were cesarean, approximately 37% of which were repeat cesarean births (i.e., births to women who had a previous cesarean birth). Approximately 60% of cesarean births might be by elective repeat cesarean delivery (ERCD). Because cesarean birth is associated with higher maternal morbidity than routine vaginal birth, two of the national health objectives for 2010 are to reduce the cesarean birth rate among women at low risk to 15% of women who are giving birth for the first time and to 63% of women with previous cesarean births. A key strategy to reduce the repeat cesarean birth rate is to promote vaginal birth after cesarean (VBAC) as an alternative to ERCD. Achieving the national health objective for 2010 will require increasing VBAC rate to 37%. During 1989-1999, VBAC rates in the United States increased from 19% in 19890to 28% in 1996 and then decreased to 23% in 1999. This report summarizes an analysis of California's VBAC rates during 1996-2000, which indicates that the VBAC rate in California decreased by 35% from 23% in 1996 to 15% in 2000. Strategies to improve VBAC rates might include educating omen about the risks for complications and benefits of VBAC, ensuring careful selection of VBAC candidates, developing guidelines for management of labor, and educating health-care providers about reducing VBAC risks.
STUDY QUESTIONS, ACTIVITIES, AND EXERCISES
1. Progress in maternal health
promotion. Since the turn of the century, developed countries have made
considerable progress in reducing child-bearing risks and improving infant
survival rates. The United States and Canada are among the most technologically
advanced nations in the world; yet, countries such as Sweden and Japan have
considerably lower infant mortality rates than those of the U.S. How do you
account for this?
2. Legalized abortion.
Consider the decline in maternal deaths due to abortion since it was legalized
in the United States more than a decade ago. How do you think demographic
variables such as age, marital status and race effect this decline?
3. Maternity leave. Identify
maternity leave policies for parents at worksites in your community. Among the
policies components, determine what arrangements are made for those who choose
to breastfeed their infants. Establish whether support groups exist for
remedying related problems.
4. Immunization policy. Determine
state and local policy for immunizing day care, preschool, and school aged
children. Then write a proposal for legislation to improve the present status.
5. Service for special needs.
Interview a public health or school nurse to determine what local efforts are
being made to identify, diagnose, and treat children suffering from physical
handicaps, psychological disorders, and parent neglect or abuse.
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