THIS SIDE up The "Back to Sleep" Campaign CHAPTER 18 pomnievic Maternal and Child Health as a Social Problem KEY TERMS Congenital anomalies Contraception Prematurity Pronatal BRE Sudden infant death syndrome
THIS SIDE up The "Back to Sleep" Campaign CHAPTER 18 pomnievic Maternal and Child Health as a Social Problem KEY TERMS Congenital anomalies Contraception Prematurity Pronatal BRE Sudden infant death syndrome
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How can we summarize chapter 18?
Transcribed Image Text:ODD
THIS
SIDE
The "Back to Sleep" Campaign
Maternal and Child Health
as a Social Problem
ayriqon
KEY TERMS
Congenital anomalies
Contraception
Developmental disabilities
Family planning
Immunization
Infant mortality rate (IMR)
Maternal mortality rates
Prematurity
Prenatal care
Preterm birth
Special Supplemental Nutrition
Program for Women, Infants,
and Children (WIC)
CHAPTER 18
The health of pregnant women and children
is traditionally one of the highest priorities of
public health. In a society concerned with the
welfare of its population, everyone should be
guaranteed adequate conditions for the best
possible start in life. The fetal and infant stages
of development provide the foundations of
good health throughout life. A growing body
of evidence indicates that conditions in utero
and during early life play a powerful role in
increasing individuals' susceptibility to the
chronic diseases that plague American adults,
including high blood pressure, obesity, car-
diovascular disease, and diabetes. Moreover,
because children are the most vulnerable seg-
ment of the population, like canaries in the
coal mine, they are the first to suffer from any
adverse conditions that affect human health
in general.
291 370W
Sudden infant death syndrome
(SIDS)
Supplemental Nutrition
Assistance Program (SNAP)
Teratogen
291209
105m
spread
Children's health first became a public
concern in the United States at the end of the
19th century, prompted by alarm at the high
infant and child death rates in the summer
from diarrheal diseases.2 Heat, poor sanitation,
and lack of refrigeration contributed to heavy
microbial contamination of milk, which was
sickening poor children. In 1893, New York
City established milk stations that provided
safe milk; similar programs soon followed in
other cities. The success of the milk programs
in improving children's health inspired the
formation of voluntary infant welfare societies
with the mission of teaching poor and immi-
grant mothers about nutrition and hygiene.
The federal government got involved in 1912
with the establishment of the Children's
Bureau, which was mandated to "investigate
and report on all matters affecting children
263
Transcribed Image Text:272
never been pregnant, but is much less effective
in women who have given birth, 34
The "morning-after pill," a form of emer-
gency contraception, can be taken as long
as five days after unprotected intercourse to
preventing
by
prevent pregnancy. It works
the release of a woman's egg for longer than
usual and is at least 85% effective. Consider
whether these medications should be available
able controversy arose in the 2000s regarding
Chapter 18 Maternal and Child Health as a Socld
organizations. As of 2019, 29 states required
insurance policies that cover prescription
drugs to provide coverage for the full range
of FDA-approved contraceptive drugs and
devices. In 2017, the Donald Trump admin-
istration issued new rules allowing insurers
and employers to opt out of the contracep-
tion coverage mandate for religious or moral
reasons; in 2019, this rollback of the mandate
was blocked by a federal judge. The fate of
the mandate remains to be seen."
10
to
without a prescription, especially
are available age
girls, but now most brands are
over
over
the counter-
gs, Du34-36 In 2017, some universities
vend-
eing the morning-after pill in
students raised concerns
began offering
ing machines
after
of
sity
343
about difficulty or confusion in obtaining the
medication. Stanford University, the Univer-
F California, Davis, and the University
of California, Santa Barbara, are among the
schools that installed the option.37 The avail-
ability of emergency contraception presum-
ably has contributed to the reduction in the
number of abortions in recent years. Insertion
of an IUD within five days of
intercourse is 99.9% effective as an emergency
contraceptive. This device is relatively expen-
sive and needs to be inserted by a healthcare
provider, but it can be left in place for years to
serve as ongoing birth control.
unprotected
Public health programs specifically aimed
at preventing teenage pregnancy include com-
prehensive sex education in the schools, which
has been found to be effective in delaying
young people's initiation of intercourse and
increasing their use of contraception when
they do have sex.37 The exact message that
should be conveyed in pregnancy prevention
programs remains a topic of debate, however.
The federal welfare reform bill implemented
in 1998 included funding for programs that
teach sexual abstinence only. Many states were
reluctant to apply for this money because they
believe such programs are much less effective
than those that include education on contra-
ception as well. A 2004 congressional review
found that commonly used abstinence-only
curricula contained "multiple scientific and
Female sterilization and vasectomy for
men are the most effective methods of contra-
ception and are commonly used in the United
include
States, but they are permanent and therefore
inappropriate for young people. Other highly
effective methods for women-incl
intrauterine devices (IUDs) and some hor-
monal implants and patches. These methods
have a failure rate of less than 1 pregnancy
per 100 women per year. Equally effective
when used correctly are combination oral
contraceptives-t
aceptives-the Pill-and other hor-
monal contraceptives, such as Depo-Provera
shots and the hormone-laden vaginal ring.
Pills must be taken every day, however,
and the other hormonal methods must be
renewed at regular intervals. The effective-
ness of hormonal methods may be reduced
in women who are taking certain medica-
tions and supplements. 34
All of these methods have drawbacks,
although the general public tends to overes-
Emate their health risks. Barrier methods,
cluding the male and female condoms and
e female diaphragm, can be fairly effective
used correctly (failure rates of 2 to 6 preg-
cies per 100 women per year), and con-
ms have the added advantage of reducing
risk of sexually transmitted diseases. How-
- barrier methods are often used inconsis-
y and incorrectly. Spermicides used alone
s, creams, and jellies) have failure rates
pregnancies per 100 women per year for
t use and much worse failure rates for
use. The cervical cap has a failure rate
Oregnancies per 100 women who have
example,
medical inaccuracies,"37(p 2014) For
they teach that condoms are ineffective. Some
of these programs encourage teenagers to sign
virginity pledges; studies have shown that
those who do sign may delay sex, but when
they do initiate intercourse, they are less likely
to use protection.38
Abstinence-only advocates took credit
for the significant decline in adolescent
pregnancy rates since 1991 described pre-
viously. However, despite hundreds of mil-
lions of dollars of federal funds spent on
abstinence-only programs each year, stud
ies have found no measurable impact on
sexual behavior. An analysis of data
from national surveys of young women
teen
ages 15 to 19 found t
decline in
pregnancy
that only 14% of the
could be attributed to
Nutrition of Women and Children
infants the healthiest start in life, reducing
risks of infectious diseases, ear infections,
respiratory infections, obesity, and chronic
diseases such as asthma and allergies. Med-
ical and public health organizations recom-
mend that infants he exclusively breastfed
for the first 6 months of their lives, and that
breastfeeding should continue at least until
their first birthday as new foods are intro-
duced. The CDC tracks rates of breastfeed-
ing at discharge from the hospital and at
follow-up times through telephone surveys.
The percentage of infants who were ever
breastfed increased from 54% in 1986-1988
to 84% in 2016: in addition, in 2016. 57% of
infants were still breastfed at 6 months and
36% were still breastfed at 12 months. How-
ever, these rates vary depending on the age
d education of the mothers, from a rate of
only 72% among women with a high school
diploma or less, to a rate of 88%
women with at least a bachelor's degree.
among
Approximately 69% of women younger than
age 20 initiate breastfeeding. The rate of
breastfeeding in 2016 for white mothers was
78%, compared to 60% for black mothers
and 85% for Hispanic mothers.40.41
and
delayed initiation of sexual activity, while
86% of the decline was due to increased use
of contraceptives.
5.38 The authors con
concluded
that "abstinence promotion is a worth-
while goal, particularly among younger
teenagers. "39p 155)-but it is insufficient
help adolescents prevent unintended preg-
nancies and sexually transmitted diseases.
"Public policies and programs should
vigorously promote provision of accurate
information on contraception and on sexual
behavior and relationships, support increased
availability and accessibility of contraceptive
services and supplies for adolescents, and
promote the value of responsible and protec-
tive behaviors, including condom and contra-
ceptive use and pregnancy planning."39(p. 155)
273
During the Great Depression of the
1930s, the federal government established
several food assistance programs to ensure
adequate nutrition for poor families. They
formed the basis of current federal programs,
run by the U.S. Department of Agriculture
(USDA), which originated in the 1960s.42
The Special Supplemental Nutrition
Program for Women, Infants, and
Children (WIC) provides vouchers for milk,
fruit juice, eggs, cereals, and other nutritious
foods for pregnant women, lactating moth-
ers, infants, and children up to five years
old. Nutrition education is also provided,
and WIC centers often become a source of
many support services for poor, young fam-
ilies. The USDA has evaluated the WIC pro-
gram and found it to be effective in saving
medical costs for the women and infants who
participated.
Nutrition of Women
and Children
Since the establishment of milk stations in
the 1890s, nutrition has been an important
component of maternal and child health pro-
grams. At first, the emphasis was on breast-
feeding and the safety of milk and baby
foods. Public health is still concerned with
promoting breastfeeding, which offers most
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