1. Maternal, Infant, and
Child Health
Chapter 7

2. Introduction
• Using age-related profiles helps identify risks
and target interventions
• Infants <1 year
• Children 1-14 years
• Maternal, infant, and child health (MIC)
encompasses health of women of childbearing age
from pre-pregnancy through pregnancy, labor and
delivery, and the postpartum period, & the health
of the child prior to birth through adolescence

3. MIC Health
• MIC statistics important indicators of
effectiveness of disease prevention and health
promotion services in a community
• Decline in US MIC mortality in recent
decades, but significant racial disparities

4. U.S. Infant Mortality Rate by
Race/Ethnicity

5. Death from Pregnancy-Related
Complications

6. Death Rates, Children 1-4 by Race

7. Death Rates, Children 5-14

8. National Infant Mortality

9. Family and Reproductive Health
• Families are the primary unit in which infants
and children are nurtured and supported
regarding healthy development
• Various definitions of “family”
• U.S. Census Bureau definition of family
• A group of two people or more (one of whom is
the householder) related by birth, marriage, or
adoption and residing together; all such people
(including related subfamily members) are
considered as members of one family.

10. Family
• Marriage, or having two parents, important
family characteristic to a child’s well-being
• Research indicators
• Increased health risks for infants and children
who are raised in single-parent families
• Adverse birth outcomes
• Low birth weight
• Higher infant mortality
• More likely to live in poverty

11. Unmarried Mothers
• Compared to married counterparts, generally
have:
• Lower education
• Lower incomes
• Greater dependence on welfare assistance

12. Teenage Births
• Teens who become pregnant and have a child
are more likely to
• Drop out of school
• Not get married or to have a marriage end in
divorce
• Rely on public assistance
• Live in poverty
• Substantial economic consequences for society

13. Teenage Pregnancies
• Teen mothers less likely to receive early
prenatal care
• Teen mothers more likely to
• Smoke during pregnancy
• Have preterm birth
• Have low-birth-weight babies
• Have pregnancy complications
• 1/3 teenage girls gets pregnant at least once
before age 20

14. Selected Characteristics of Teenage
Mothers

15. Unintended Pregnancies
• ~½ of pregnancies in U.S. are unintended
• 40% of those end in abortion
• Unintended pregnancy
• Mistimed or unwanted
• Unintended pregnancy associated with
negative health behaviors
• Delayed prenatal care, inadequate weight gain,
smoking, alcohol and other drug use

16. Family Planning
• Determining the preferred number and spacing
of children and choosing the appropriate
means to accomplish it
• Community involvement in family planning
and care includes governmental and
nongovernmental organizations

17. Title X – Family Planning Act
• Federal program that provides funds for family
planning services for low-income people
• Nation’s major program to reduce unintended
pregnancy by providing contraceptive and
other reproductive health care services to low-
income women
• Supports 61% of the 4,000+ family planning
clinics in U.S.
• Over 5 million women receive care at clinics
funded by Title X

18. Family Planning Clinic Services

19. Success of Community Health Family
Planning Programs
• Clinics have improved MIC health indicators
• Have shown large reductions in unintended
pregnancies, abortions, and births
• Each year, publicly subsidized family planning
clinics help prevent 1.9 million unplanned
pregnancies that would result in:
• 860,000 unintended births, 810,000
abortions, and 270,000 miscarriages
• Each public health $ spent saves $4 in
Medicaid costs

20. Abortion
• Legal in early stages of pregnancy since 1973
(Roe V. Wade)
• Majority of abortions
• Unmarried women (83.5%)
• 55% white
• 52% under age 25

21. Number, Ratio, and Rate of Legal
Abortions Performed by Year, U.S.

22. Abortion by Age Group

23. Maternal Health
• Effect of pregnancy and childbirth on women
important indicator of health
• Pregnancy and delivery can lead to serious
health problems
• Maternal death
• Maternal mortality and morbidity rates
• Causes include poverty and limited education

24. Prenatal Health Care
• Medical care from time of conception until
birth process
• Three major components
• Risk assessment
• Treatment of medical conditions, or risk
reduction
• Education
• Early and continuous prenatal care leads to
better pregnancy outcomes

25. Reducing Maternal and Infant Mortality

26. Racial Disparities in Prenatal Care

27. Infant Health
• Depends on many factors
• Mother’s health and her health behavior prior
to and during pregnancy
• Mother’s level of prenatal care
• Quality of delivery
• Infant’s environment after birth (home and
family, medical services)
• Nutrition
• Immunizations

28. Infant Mortality
• Measure of a nation’s health
• Decline in infant mortality due to
• Improved disease surveillance
• Advanced clinical care
• Improved access to health care
• Better nutrition
• Increased education
• Leading causes of infant death: congenital
abnormalities, preterm/low birth weight, SIDS

29. Early-Life Mortality Time Periods

30. Improving Infant Health
• Premature births
• Low birth weight
• Cigarette smoking
• Alcohol and other drugs
• Breastfeeding
• SIDS

31. Childhood Mortality
• Most severe measure of health in children
• Rates have generally declined in past few
decades
• Unintentional injuries leading cause of death
in children
• Specifically, motor vehicle related deaths,
especially those not wearing seat belts/restraints

32. Leading Causes of Death in Children

33. Childhood Morbidity
• Unintentional injuries
• Significant economic, emotional, and disabling
impact
• Child maltreatment
• Strong community response needed
• Infectious diseases
• Importance of immunization schedule

34. Community Programs
• Federal government has over 35 programs in
16 different agencies to serve needs of nation’s
children
• Many are categorical programs
• Only available to people who fit into a specific
group
• Many fall through the cracks

35. Maternal and Child Health Bureau
• Title V
• Only federal legislation dedicated to promoting
and improving health of mothers and children
• Maternal and Child Health Bureau (MCHB)
• Established in 1990 to administer Title V
funding
• Accomplishes goals through 4 core public
health services
• Infrastructure building, population-based,
enabling, and direct health care services

36. MCH Pyramid of Health Services

37. WIC
• A special supplemental food program for
women, infants, and children sponsored by the
USDA; established in 1974
• Eligibility requirements
• Residency in application state, income
requirements, at “nutritional risk”
• 2008: 9.5 million participants; nearly half of
all infants born in U.S., ¼ of children ages 1-5

38. WIC Enrollees

39. Health Insurance
• Children without insurance more likely to have
necessary care delayed or receive no care for
health problems
• Medicaid – low-income individuals and
families; children are slightly more than half of
all Medicaid beneficiaries
• CHIP – targets uninsured children whose
families don’t qualify for Medicaid

40. Child Care
• FMLA – Family and Medical Leave Act
• Grants 12 weeks unpaid job protected leave to
men or women after birth of child, adoption, or
illness in immediate family
• Only affects certain businesses
• 13 million children younger than 6 in child care
every day
• Family Support Act
• Child Care and Development Block Grant

41. Advocates for Children
• Numerous groups advocate for children’s
health and welfare
• Children’s Defense Fund (CDF)
• United Nations Children’s Fund (UNICEF)
• American Academy of Pediatrics (AAP)

42. Discussion Questions
• What are ways community programs can
increase participation in early prenatal care
services?
• What kind of impact do programs such as WIC
have on community health outcomes?