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INTRODUCTION: A life course perspective in maternal, child, and family health allows for integrated exploration of outcomes, incorporating multifactorial determinants of health to interrogate sources of inequity and identify opportunities for intervention. This article explores the historical development, integration, and implications of the contemporary life course perspective in the field of maternal and child health (MCH), and particularly the people and events which institutionalized the framework as central to national and local MCH practice and research over the last decades. METHODS: Drawing on an oral history approach, key leaders of the life course movement in MCH were interviewed. Lived experiences and personal recollections of six interviewees were recorded and synthesized using a narrative descriptive approach to portray the social ecology of the movement's origins. RESULTS: We documented systematic efforts made in the first two decades of the 21st century to consciously promote life course through convening a National MCH Life Course Invitational Meeting, incorporating life course as a foundational framework for strategic planning at the Maternal Child Health Bureau, and development of tools and resources by MCH professional organizations. DISCUSSION: The integration of life course theory into the MCH field signified a major shift towards addressing protective and social factors, which aligns with the field's historical emphasis on social justice and rights-based approaches, and parallels the broader public health movement towards social determinants of health and the need to address structural racism. The ongoing relevance of the life course approach in promoting reproductive justice and addressing inequities in health underscores the historical importance of its adoption and use in the current mainstream of MCH research, policy, and practice.
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INTRODUCTION: Over the past decade, foundational courses in MCH have been revised and revamped to integrate the life course perspective and social determinants of health in ways that bring these essential issues to the core of the learning experience. Yet the racial reckoning of 2020 and the racially disparate health impacts of the COVID-19 pandemic underscore that a deeper, more focused approach to anti-racist pedagogy is now imperative for MCH educators and others responsible for developing the MCH workforce. METHODS: In this paper, we discuss our experience of building a 'community of practice' of anti-racist MCH trainees through our course, 'Foundations of Maternal and Child Health Policy, Practice, and Science.' RESULTS: We identify four principles which guided our course: (1) building on students' experience, knowledge, identities and social justice commitments; (2) creating a common purpose and shared vocabulary related to racism; (3) organizing classroom activities to reflect real-world problems and professional practices related to addressing structural racism as a root cause of health inequities; and (4) building students' skills and confidence to recognize and address structural racism as MCH professionals. DISCUSSION: We hope that this description of our principles, along with examples of how they were put into practice, will be useful to MCH educators who seek to build anti-racist frameworks to guide MCH workforce development.
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COVID-19 , Racismo , COVID-19/epidemiologia , Criança , Saúde da Criança , Humanos , Centros de Saúde Materno-Infantil , Pandemias/prevenção & controle , EstudantesRESUMO
OBJECTIVE: To assess the national and state prevalence of being "Healthy and Ready to Learn" (HRL) and associated sociodemographic, health, family and neighborhood factors. METHODS: Cross-sectional analysis of the 2016 National Survey of Children's Health, a nationally representative parent-reported survey administered by web and paper June 2016 to February 2017. Four domains were constructed from 18 items through confirmatory factor analyses: "Early Learning Skills", "Social-Emotional Development", "Self-Regulation", and "Physical Well-being and Motor Development." Each item and domain were scored according to age-specific standards as "On-Track", "Needs Support", and "At Risk" with overall HRL defined as "On-Track" in all domains for 7565 randomly selected children ages 3 to 5 years. RESULTS: In 2016, 42.2% of children ages 3 to 5 years were considered HRL with the proportion considered "On-Track" ranging from 58.4% for Early Learning Skills to 85.5% for Physical Well-being and Motor Development"; approximately 80% of children were considered "On-Track" in Social-Emotional Development and Self-Regulation, respectively. Sociodemographic differences were mostly non-significant in multivariable analyses. Health, family, and neighborhood factors (ie, special health care needs status/type, parental mental health, reading, singing and storytelling, screen time, adverse childhood experiences, and neighborhood amenities) were associated with HRL. HRL prevalence ranged from 25.5% (NV) to 58.7% (NY), but only 4 states were significantly different from the U.S. overall. CONCLUSIONS: Based on this pilot measure, only about 4 in 10 US children ages 3 to 5 years may be considered "Healthy and Ready to Learn." Improvement opportunities exist for multiple, modifiable factors to affect young children's readiness to start school.
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Saúde da Criança , Instituições Acadêmicas , Criança , Pré-Escolar , Estudos Transversais , Humanos , Prevalência , Características de Residência , Estados UnidosRESUMO
Over the past decade, increasing attention has been paid to intervening in individuals' health in the "preconception" period as an approach to optimizing pregnancy outcomes. Increasing attention to the structural and social determinants of health and to the need to prioritize reproductive autonomy has underscored the need to evolve the preconception health framework to center race equity and to engage with the historical and social context in which reproduction and reproductive health care occur. In this commentary, we describe the results of a meeting with a multidisciplinary group of maternal and child health experts, reproductive health researchers and practitioners, and Reproductive Justice leaders to define a new approach for clinical and public health systems to engage with the health of nonpregnant people. We describe a novel "Reproductive and Sexual Health Equity" framework, defined as an approach to comprehensively meet people's reproductive and sexual health needs, with explicit attention to structural influences on health and health care and grounded in a desire to achieve the highest level of health for all people and address inequities in health outcomes. Principles of the framework include centering the needs of and redistributing power to communities, having clinical and public health systems acknowledge historical and ongoing harms related to reproductive and sexual health, and addressing root causes of inequities. We conclude with a call to action for a multisectoral effort centered in equity to advance reproductive and sexual health across the reproductive life course.
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Equidade em Saúde , Cuidado Pré-Concepcional , Saúde Reprodutiva , Saúde Sexual , Justiça Social , Humanos , Autonomia PessoalRESUMO
The health and well-being of childbearing women and children in the US should set a world standard. However, women and children in the US experience higher rates of morbidity and mortality than women and children in almost all other industrialized countries, with marked racial and ethnic disparities. The unfolding effects of the coronavirus disease 2019 (COVID-19) pandemic have highlighted such disparities. In this article, which is part of the National Academy of Medicine's Vital Directions for Health and Health Care: Priorities for 2021 initiative, we draw on a life-course framework to highlight promising interventions and recommend key improvements in programs and policies to optimize health and well-being among women and children in the US. The recommendations address ensuring access, transforming health care, and addressing social and environmental determinants.
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COVID-19/epidemiologia , Saúde da Criança , Disparidades em Assistência à Saúde , Serviços de Saúde Materno-Infantil/normas , Criança , Etnicidade , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Grupos Raciais , Estados UnidosRESUMO
Maternal mortality in the United States is at an alarming rate. Research can have an important role in addressing maternal mortality, but our current understanding of its causes and prevention remains woefully incomplete. The collection of articles in this volume begin to frame a new research agenda by asking four critical questions. First, what truly makes vulnerable populations vulnerable? Second, how do we prevent pregnancy complications and their long-term sequelae? Third, how can we make maternity care safer for all women? Finally, what can we do about the social, structural, and environmental determinants of maternal health? Answers to these questions can help inform practice, systems, and policy change to reduce and ultimately eradicate maternal deaths in the United States.
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Serviços de Saúde Materna , Complicações na Gravidez , Feminino , Humanos , Saúde Materna , Mortalidade Materna , Morbidade , Gravidez , Complicações na Gravidez/prevenção & controle , Estados Unidos/epidemiologiaAssuntos
Atenção à Saúde , Equidade em Saúde , Política de Saúde , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Pais , Determinantes Sociais da Saúde , Adolescente , Adulto , Experiências Adversas da Infância , Criança , Desenvolvimento Infantil , Saúde da Criança , Pré-Escolar , Intervenção Educacional Precoce , Feminino , Segurança Alimentar , Substâncias Perigosas , Reforma dos Serviços de Saúde , Habitação , Humanos , Lactente , Recém-Nascido , Saúde Materna , Medicaid , Pediatria , Cuidado Pós-Natal , Pobreza , Cuidado Pré-Concepcional , Gravidez , Cuidado Pré-Natal , Estados UnidosRESUMO
INTRODUCTION: The purpose of this commentary is to start a national conversation about the future of maternal and child health (MCH). In the coming decades, we will have unprecedented opportunities to improve MCH, but will also face unprecedented threats. METHODS: This paper examines emerging opportunities and threats to MCH, and discusses strategies for leading the future of MCH. RESULTS: Scientific advancements will continue to drive improvements in MCH, but to unleash its full potential for improving population health future MCH research must become more transdisciplinary, translational, and precise. Technological innovations could dramatically transform our work in MCH while big data could enhance predictive analytics and precision health; our challenge will be to assure equitable access. The greatest gains in MCH will continue to come from improving social conditions, which will require advancing MCH in all policies. Climate change, infectious outbreaks and antimicrobial resistance pose increasing threats to MCH, which can be averted by reducing global warming, implementing global early warning systems, and instituting responsible antimicrobial stewardship. The growing burden of chronic diseases in children and adults need to be addressed from an ecological and life course perspective. The water crisis in Flint shined a spotlight on the growing health threats from America's decaying infrastructure. DISCUSSION: We can lead the future of MCH by starting a national conversation, improving MCH research, and preparing future MCH workforce, but the future of MCH will depend on our effectiveness in bringing about social and political change in the coming decades.
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Serviços de Saúde Materno-Infantil/tendências , Mudança Climática , Efeitos Psicossociais da Doença , Surtos de Doenças/estatística & dados numéricos , HumanosRESUMO
: media-1vid110.1542/5839990273001PEDS-VA_2017-4161Video Abstract OBJECTIVES: To estimate the national prevalence of parent-reported autism spectrum disorder (ASD) diagnosis among US children aged 3 to 17 years as well as their treatment and health care experiences using the 2016 National Survey of Children's Health (NSCH). METHODS: The 2016 NSCH is a nationally representative survey of 50 212 children focused on the health and well-being of children aged 0 to 17 years. The NSCH collected parent-reported information on whether children ever received an ASD diagnosis by a care provider, current ASD status, health care use, access and challenges, and methods of treatment. We calculated weighted prevalence estimates of ASD, compared health care experiences of children with ASD to other children, and examined factors associated with increased likelihood of medication and behavioral treatment. RESULTS: Parents of an estimated 1.5 million US children aged 3 to 17 years (2.50%) reported that their child had ever received an ASD diagnosis and currently had the condition. Children with parent-reported ASD diagnosis were more likely to have greater health care needs and difficulties accessing health care than children with other emotional or behavioral disorders (attention-deficit/hyperactivity disorder, anxiety, behavioral or conduct problems, depression, developmental delay, Down syndrome, intellectual disability, learning disability, Tourette syndrome) and children without these conditions. Of children with current ASD, 27% were taking medication for ASD-related symptoms, whereas 64% received behavioral treatments in the last 12 months, with variations by sociodemographic characteristics and co-occurring conditions. CONCLUSIONS: The estimated prevalence of US children with a parent-reported ASD diagnosis is now 1 in 40, with rates of ASD-specific treatment usage varying by children's sociodemographic and co-occurring conditions.
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Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Inquéritos Epidemiológicos/tendências , Pais , Adolescente , Adulto , Transtorno do Espectro Autista/psicologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pais/psicologia , Prevalência , Estados Unidos/epidemiologia , Adulto JovemAssuntos
Parto , Nascimento Prematuro , Etnicidade , Feminino , Humanos , Recém-Nascido , Gravidez , Grupos Raciais , Características de ResidênciaRESUMO
OBJECTIVES: To evaluate the impact of the Southern Public Health Regions' (Regions IV and IV) Collaborative Improvement and Innovation Network (CoIIN) to Reduce Infant Mortality, supported by the US Health Resources and Services Administration. METHODS: We examined pre-post change (2011-2014) for CoIIN strategies with available outcome data from vital records (early elective delivery, smoking) and the Pregnancy Risk Assessment Monitoring System (safe sleep) as well as preterm birth and infant mortality for Regions IV and VI relative to all other regions. RESULTS: For most outcomes, CoIIN improvements were greater in Regions IV and VI than in other regions. For example, early elective delivery decreased by 22% versus 14% in other regions, smoking cessation during pregnancy increased by 7% versus 2%, and back sleep position increased by 5% versus 2%. Preterm birth decreased by 4%, twice that observed in other regions, but infant mortality reductions did not differ significantly. CONCLUSIONS: The CoIIN approach to public health improvement shows promise in accelerating progress in intermediate outcomes and preterm birth. Impact on infant mortality may require additional strategies and sustained efforts.
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Morte Fetal/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Feminino , Promoção da Saúde , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Gravidez , Complicações na Gravidez/prevenção & controle , Nascimento Prematuro/epidemiologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
OBJECTIVES: Infant mortality remains a significant public health problem in the U.S. The Collaborative Improvement & Innovation Network (CoIIN) model is an innovative approach, using the science of quality improvement and collaborative learning, which was applied across 13 Southern states in Public Health Regions IV and VI to reduce infant mortality and improve birth outcomes. We provide an in-depth discussion of the history, development, implementation, and adaptation of the model based on the experience of the original CoIIN organizers and participants. In addition to the political genesis and functional components of the initiative, 8 key lessons related to staffing, planning, and implementing future CoIINs are described in detail. METHODS: This paper reports the findings from a process evaluation of the model. Data on the states' progress toward reducing infant mortality and improving birth outcomes were collected through a survey in the final months of a 24-month implementation period, as well as through ongoing team communications. RESULTS: The peer-to-peer exchange and platform for collaborative learning, as well as the sharing of data across the states, were major strengths and form the foundation for future CoIIN efforts. A lasting legacy of the initiative is the unique application and sharing of provisional "real time" data to inform "real time" decision-making. CONCLUSION: The CoIIN model of collaborative learning, QI, and innovation offers a promising approach to strengthening partnerships within and across states, bolstering data systems to inform and track progress more rapidly, and ultimately accelerating improvement toward healthier communities, States, and the Nation as a whole.
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Mortalidade Infantil , Práticas Interdisciplinares , Inovação Organizacional , Melhoria de Qualidade , Humanos , Lactente , Avaliação de Programas e Projetos de Saúde , Saúde PúblicaAssuntos
Transtorno do Espectro Autista , Pesquisa Biomédica/organização & administração , Deficiências do Desenvolvimento , United States Health Resources and Services Administration/organização & administração , Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/terapia , Pesquisa Biomédica/legislação & jurisprudência , Criança , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/terapia , Humanos , Estados Unidos , United States Health Resources and Services Administration/legislação & jurisprudênciaRESUMO
OBJECTIVES: This study sought to determine whether women's report of gestational weight gain (GWG) advice from a health care provider is consistent with the Institute of Medicine (IOM) guidelines and the association between provider advice and women's weight gain during pregnancy. METHODS: Data came from the 2007 Los Angeles Mommy and Baby study (n = 3,402). The 1990 IOM GWG guidelines were used to define whether the provider's advice on weight gain and women's weight gain were below, within, or above the guidelines. RESULTS: Approximately 4 months after delivery, 18.8% of the women reported having not discussed weight gain with any health care providers during pregnancy. Among those who reported such discussions, 42% reported receiving weight gain advice from a health care provider within IOM guidelines, 16.5% below guidelines, and 10% above. An additional 13.5% reported the discussion but did not report the recommended weight gain amount. Compared with women who reported provider advice on weight gain within guidelines, women who reported advice below guidelines were 1.7 times (95% confidence interval [CI], 1.3-2.2) more likely to gain less than the IOM recommended amount. Women who reported provider advice above IOM guidelines were 2.0 times (95% CI, 1.4-2.9) more likely to exceed guidelines. CONCLUSIONS: There is a need for more women to receive advice consistent with the IOM GWG guidelines from their prenatal care providers. Intervention strategies are needed to educate providers about IOM guidelines and how to counsel on GWG.
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Aconselhamento/métodos , Conhecimentos, Atitudes e Prática em Saúde , Obesidade/prevenção & controle , Relações Médico-Paciente , Gestantes/etnologia , Cuidado Pré-Natal/métodos , Aumento de Peso , Adulto , California , Comunicação , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Pesquisas sobre Atenção à Saúde , Pessoal de Saúde , Hispânico ou Latino , Humanos , Entrevistas como Assunto , Obesidade/complicações , Obesidade/etnologia , Educação de Pacientes como Assunto , Gravidez , Complicações na Gravidez/psicologia , Gestantes/psicologia , Pesquisa Qualitativa , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
OBJECTIVE: The Title V Maternal and Child Health (MCH) Block Grant is the linchpin for US MCH services. The first national performance measures (NPMs) for MCH were instituted in 1997. Changing trends in MCH risk factors, outcomes, health services, data sources, and advances in scientific knowledge, in conjunction with budgetary constraints led the Maternal and Child Health Bureau (MCHB) to design a new performance measurement system. METHODS: A workgroup was formed to develop a new system. The following guiding principles were used: (1) Afford States more flexibility and reduce the overall reporting burden; (2) Improve accountability to better document Title V's impact; (3) Develop NPMs that encompass measures in: maternal and women's health, perinatal health, child health, children with special health care needs, adolescent health, and cross-cutting areas. RESULTS: A three-tiered performance measurement system was proposed with national outcome measures (NOMs), NPMs and evidence-based/informed strategy measures (ESMs). NOMs are the ultimate goals that MCHB and States are attempting to achieve. NPMs are measures, generally associated with processes or programs, shown to affect NOMs. ESMs are evidence-based or informed measures that each State Title V program develops to affect the NPMs. There are 15 NPMs from which States select eight, with at least one from each population area. MCHB will provide the data for the NOMs and NPMs, when possible. CONCLUSIONS: The new performance measurement system increases the flexibility and reduces the reporting burden for States by allowing them to choose 8 NPMs to target, and increases accountability by having States develop actionable ESMs. SIGNIFICANCE: The new national performance measure framework for maternal and child health will allow States more flexibility to address their areas of greatest need, reduce their data reporting burden by having the Maternal and Child Health Bureau provide data for the National Outcome and Performance Measures, yet afford States the opportunity to develop measurable strategies to address their selected performance measures.
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Saúde , Serviços de Saúde Materno-Infantil/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Adolescente , Criança , Pré-Escolar , Financiamento Governamental , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Relações Interprofissionais , Serviços de Saúde Materno-Infantil/legislação & jurisprudência , Medicina Preventiva/métodos , Estados Unidos , Saúde da MulherRESUMO
This paper describes the transformation of the Title V Maternal and Child Health (MCH) Services Block Grant. The Maternal and Child Health Bureau of the Health Resources and Services Administration led a 21-month visioning process to engage input from MCH stakeholders and other national, state and local MCH leaders, families and other partners to improve, innovate, and transform the Title V MCH Services Block Grant. The process has helped inform the development of a new grant guidance for the next 5-year cycle beginning in fiscal year 2016. The triple aims of the transformation are to reduce burden, maintain flexibility, and increase accountability. State reporting burden is reduced by aligning and streamlining the needs assessment, annual report and application, reducing the number of forms States have to fill out, eliminating Health Systems Capacity Indicators, and prepopulating the annual report and application with State data using national data sources. State flexibility is maintained through the needs assessment process whereby State needs and priorities drive the selection of National Performance Measures and State-specific Performance Measures, and the development of State Action Plan and Evidence-based/informed Strategy Measures. Accountability is increased through the new three-tiered performance measurement framework, which will help States tell a more coherent and compelling story about the impact of Title V on the health of the Nation's mothers, children, and families. The ultimate success of the transformation will be measured by how much the transformed Title V program moves the needle in MCH in the States and for the Nation.
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Financiamento Governamental/organização & administração , Organização do Financiamento/organização & administração , Serviços de Saúde Materno-Infantil/organização & administração , Adolescente , Criança , Saúde da Criança/economia , Proteção da Criança/economia , Pré-Escolar , Humanos , Lactente , Relações Interinstitucionais , Relações Interprofissionais , Responsabilidade Social , Governo Estadual , Estados UnidosRESUMO
We examined the association between life events stressors during pregnancy and low birth weight (LBW) among African Americans and Whites, while systematically controlling for potential confounders including individual characteristics and city-level variations and clustering. We analyzed data from 4970 women with singleton births who participated in the 2007 and 2010 Los Angeles Mommy and Baby Surveys. Multilevel logistic regression was used to assess the association between emotional, financial, spousal and traumatic stressors and LBW among African Americans and Whites. Potential confounders included were: the city-level Economic Hardship Index, maternal demographics, pre-pregnancy conditions, insurance, behavioral risk factors and social support. African Americans were significantly more likely to experience any domain of stressors during their pregnancy, compared to Whites (p < 0.001). Only the association between financial stressors and LBW was significantly different between African Americans and Whites (p for interaction = 0.015). Experience of financial stressors during pregnancy was significantly associated with LBW among African Americans (adjusted odds ratio = 1.49; 95 % confidence interval = 1.01-2.22) but not Whites. Differential impact of financial stressors during pregnancy may contribute to racial disparities in LBW between African Americans and Whites. We showed that financial life event stressors, but not other domains of stressors, were more likely to impact LBW among African Americans than Whites. Initiatives aimed at mitigating the negative impacts of financial stress during pregnancy may contribute to reducing disparities in birth outcomes between African Americans and Whites.
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Negro ou Afro-Americano/psicologia , Recém-Nascido de Baixo Peso , Acontecimentos que Mudam a Vida , Complicações na Gravidez , Fatores Socioeconômicos , Estresse Psicológico/complicações , População Branca/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Feminino , Humanos , Los Angeles/epidemiologia , Análise Multinível , Gravidez , Fatores de Risco , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , População Branca/estatística & dados numéricosRESUMO
Maternal mortality and severe morbidity are on the rise in the United States. A significant proportion of these events are preventable. The Maternal Health Initiative (MHI), coordinated by the Maternal and Child Health Bureau at the Health Resources and Services Administration, is intensifying efforts to reduce maternal mortality and severe morbidity in the U.S. Through a public-private partnership, MHI is taking a comprehensive approach to improving maternal health focusing on five priority areas: improving women's health before, during and beyond pregnancy; improving the quality and safety of maternity care; improving systems of maternity care including both clinical and public health systems; improving public awareness and education; and improving surveillance and research.