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

OBJECTIVES AND PHILOSOPHY

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.

 OVERVIEW

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
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

January
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

• New Treatment Protocol for Mental Health/Substance Abuse Disorders (1/31/05)
• Leavitt Confirmed as DHHS Secretary (1/27/05)
• Education Department Seeks Advice on IDEA (1/25/05)
• Surgeon General Salutes 'Year of the Healthy Child' (1/24/05)
• Leavitt Assured of Confirmation as DHHS Secretary (1/19/05)
• Incidence of Flu Is Low but May Increase, CDC Says (1/14/05)
• Looking Ahead to ‘Wellness Policies’ in Schools (1/13/05)
• New Dietary Guidelines Stress Reduced Calorie Consumption (1/12/05)
• Drug Companies Offer Prescription Savings to Uninsured (1/11/05)
• HHS Abstinence Programs Moved to Children and Families Administration (1/04/05)

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 Noting

October
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 Noting

September
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 Noting

August
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 Noting

July
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 Noting

June
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 Congress

April
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 Noting

March
'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 Noting

February
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 Noting

January
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

>>Click here to view previous years

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

Websites on Child Health

Websites on Parenting

REFERENCES

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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