How long-term benefits override upfront costs: using research and evaluation to justify a female condom intervention

In a time where economic interests override public health concerns, a new study published in AIDS and Behavior shows that public health spending can reduce costs in the long run. In general, female condoms are more expensive than male condoms. However, after cost-analyzing an initiative that distributed 200,000 condoms to women in a neighborhood with high rates of HIV-diagnosis in Washington D.C., the authors found that for every $1 spent, $15 was saved.

D.C. has the highest prevalence of HIV in the United States. 1 in every 33 residents is infected with the virus, and 1 in 14 residents in their 40’s have tested positive. The sexual health initiative began two years ago after a report noted these high levels of HIV/AIDS diagnoses.

The campaign, called D.C.’s Doin’ It!, chose to target sub neighborhoods with high HIV-diagnosis rates. Officials justified the distribution using study findings that showed large numbers of African American heterosexuals in the District engaging in risky sexual behaviors: http://doh.dc.gov/doh/frames.asp?doc=/doh/lib/doh/pdf/dc_hiv_heterosexualstudy.pdf. (Something to consider: 92.3% of study’s participants self-identified as black. Is it possible to compare this to the other 7% of the study and make these same conclusions?)

The report also found that women had a higher HIV prevalence than men (6.3% versus 3.9% respectively). To empower and increase women’s autonomy, officials chose female condoms as the intervention. Female condoms give women the power to make healthy choices, even when a partner does not give them this choice.

The campaign dispensed these at convenience stores, beauty salons and community clinics and trained community members to discuss sexual health with peers in informal settings (UMN professor also used this approach, calling it “Barbershop Conversations”- check it out! http://www.advances.umn.edu/2011/06/barbersho/). The initiative plans to continue the project, by distributing between 250,000-300,000 female condoms a year.

Playing with issues of women empowerment, race, socioeconomic status, and class, critics argue that the intervention targeted a subgroup of D.C.  residents. Is this justified/ethical? Can public health interventions target subpopulations, rather than a community at large? Are there any other issues to consider when implementing a similar campaign?

Although there are concerns with the study and intervention, public health should not disregard evaluation results. Upstream care can and should be utilized to promote population health, including within the reproductive health sphere.

Healthy Homes: Lead Poisoning

Keeping the home healthy: an environmental health issue. But should it also be a concern for MCH? Where children spend time eating, drinking, playing, doing homework and sleeping, should the MCH field focus on how living spaces may influence health? Many of the hazards that affect a child’s life course may originate in the home setting. However, should the government regulate private residencies; are they overstepping their boundaries into this sphere, or is this a case to protect a special vulnerable population?

Despite these concerns, public health officials are working to ensure children live fulfilling lives. A MCH campaign in St. Louis is working to prevent lead exposure in children. Researchers there began the Heavy Metal Project, offering low-income pregnant women free home inspections and screening. Moreover, if researchers found lead, they cleaned and covered old paint and replaced windows. Here, the project aimed to prevent newborns from being exposed to lead in the first place.

Was the program effective?

Compared to babies whose homes were not cleaned, babies who lived in homes researchers intervened in had lower blood lead levels. Visit the study’s methodologies and results at: http://www.ajog.org/article/S0002-9378%2812%2900002-6/fulltext.

Why is this significant?

Lead exposure has been shown to be related to brain damage, leading to lower IQ, behavioral problems and learning disabilities, as well as cardiovascular and immune system troubles later in life. Despite the fact that campaigns have been working for decades to remove lead pain from housing, about 250,000 children each year are diagnosed with lead levels higher than the recommended 10 micrograms. According to the Centers for Disease Control and Prevention (CDC), 24 million homes in the U.S. are still thought to have paint with lead.

In January 2012, the Advisory Committee on Childhood Lead Poisoning Prevention released recommendations to decrease the limit of how much lead exposure is considered dangerous. This was cut in half for children ages 5 and younger, from 10 micrograms to 5, doubling the number of children considered in danger of high levels.

Despite this, Congress has slashed funding for the CDC’s lead prevention grant program from $30 million to $2 million (that’s 94 %!). More and more children are now screened after age 5 for lead positioning; this is in contrast to families receiving home inspections before exposure occurs.

What factors influence this environmental MCH problem?

• Social determinants related to substandard housing
  • Socioeconomic status
  • Education
  • Race/ethnicity

• Children can also be exposed to lead via:
  • Tap water
  • Older toys
  • Jewelry
  • Soil around houses

For more information

Visit the CDC’s Healthy Homes and lead information website at http://www.cdc.gov/HealthyHomes/index.html and http://www.cdc.gov/nceh/lead/ respectively.

MAMA: Motherhood Around the Globe

An online exhibition of global art, voices, and ideas, MAMA: Motherhood around the Globe is an inspiring community for anyone who is a mother, knows one, or works with one (that’s all of you!). Housed through the International Museum of Women, the website includes videos, facts, and figures promoting healthy moms and its significance with delivering healthy babies. Graphic designs describe the status of Millennium Development Goals in related to gender equity, reproductive health and maternal mortality.

Visit the art gallery for paintings, photographs, drawings and sculptures of the beauties and perils of pregnancy, childbirth and motherhood.  Read stories of motherhood from women around the world. Explore global MCH heroes and their novel ideas in preventing maternal mortality and supporting the health of women everywhere.

Do you have an experience (either domestically or globally) working with mothers you would like to share? As a mother, do you have stories you would like to tell others? What did you find most inspiring about the website? Let us know below or send us your anecdotes!

Controversy over Co-Sleeping: A PubH Campaign

A controversial public health campaign coming from Milwaukee targets infant and caregiver bed sharing. 20% of Milwaukee’s infant mortality rate is attributed to Sudden Infant Death Syndrome (SIDS) and Sudden Unexplained Death in Infancy (SUDI); it is the 7th worst in the country, with also large disparity rates (Black infant mortality rates are almost 3 times higher than whites in the city). 51% of these cases have been found to be related to bed sharing.

Outrage over the advertisements from mothers and other citizens include criticism over the provocative ad and Mayor Tom Barrett’s approval of its running. However, bringing attention to the issue was the campaign’s main objective; national news sources have started discussions even outside the Midwest.

The American Academy of Pediatrics recommends that babies be brought back to their own crib to sleep after feeding and/or comfort and advises against caregivers using in-bed co-sleepers. No studies have found bed-sharing protective of SIDS. Their policy report opposes bed-share especially if a parent is a smoker, overly tired, uses substances, if the infant is under 3 months of age, if the bed is soft/old, or if other children share the bed. However, there are also some conflicting messages; as public health campaigns increasingly encourage breastfeeding more parents are sleeping with their child. In order to prevent SIDS and other health risks to the infant, being sure to breastfeed in other areas or putting the baby back in the crib is necessary.

Coming from an MCH background, what are your thoughts on the advertisement? Too controversial? Too demanding? Just right? Leave some thoughts below. For more information on Infant Mortality Rates, see the Maternal and Child Health Bureau’s annual Child Health USA 2011 dataset: http://mchb.hrsa.gov/chusa11/city/pages/502im.html.

Health Disparities and Children in Rural Areas

The Health Resources and Services Administration (HRSA) has released a report on U.S. rural children and their health, called The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation 2007. Compared to urban areas, children living in rural locations are more likely to face adverse health outcomes.

The study uses parental responses from the 2007 National Survey of Children’s Health (NSCH) (2011 NSCH data collection is expected to be complete in March 2012). Health indicators include children’s body mass index (BMI), behaviors, skills, chronic disease status, access to health care, socioeconomic status, family structure, parental wellbeing, and community protective and risk factors. Statistically significant comparisons are at the 0.05 level.

The disparities seen in this population may be related to the fact that that children in rural areas are more likely to be poor than those in urban districts. About 23% of children living rurally are part of households with income below the federal poverty line compared to 17% of children in urban areas.  Socioeconomic status is related to poor access to care and thus health problems. Although there are other differences in this population compared to children in other areas, it will be necessary to focus efforts at these correlations.

To see the report, methodology and results, visit the Maternal and Child Health Bureau’s (MCHB) site: http://mchb.hrsa.gov/nsch/07rural/.