Healthy Babies are Worth the Wait

The March of Dimes has initiated a new project called Healthy Babies are Worth the Wait (HBWW). This public health campaign strives to prevent factors related to preterm birth, including social, medical and biological influences. Children born prematurely are more likely to have vision and hearing problems, lasting physical and mental disabilities, and learning delays later in life. [i] Aiming for pregnancies that are at least 39 weeks in length decreases the likelihood of children developing health problems There has been a rise of in the number of U.S. births before week 39 over the past two decades, with 12.8% of live births in 2006 classified as a preterm birth. [ii]

The Kentucky Department for Public Health in collaboration with the March of Dimes and Johnson & Johnson Pediatric Institute helped create HBWW: a community-based, preterm birth prevention initiative. An innovative key to the campaign is engaging the community among local- and state-level clinical and public health partners. It includes targeted resources for both the public (info sheet: http://www.marchofdimes.com/pregnancy/getready_atleast39weeks.html) and professionals (toolkit: http://www.marchofdimes.com/professionals/medicalresources_39weeks.html).

How can we use these strategies in our work throughout MCH? This collaborative theory and process influences much of our work, but more can be done across sectors, fields and levels of work. Check out a webinar March 29, 2012 11:00pm CST sponsored by Healthy People 2020 Leading Health Indicators: http://goo.gl/iFJbQ. Participants will learn about how collaboration and partnerships, provider initiatives, patient support, public engagement, and progress measures helped inform HBWW’s conceptualization.

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[i] March of Dimes. (2010, April). Your premature baby. Retrieved from March of Dimes: http://www.marchofdimes.com/baby/premature_indepth.html

[ii] March of Dimes (2011). Medical Resources. Retrieved from March of Dimes: http://www.marchofdimes.com/professionals/medicalresources_hbww.html.

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.

MCH Call to Action: Child Abuse

Child abuse and maltreatment is a silent and hidden morbidity and mortality issue today. A new report has shed light on this taboo subject, the dramatic statistics we have compared to other countries and the difference domestically between states.

Currently, the child maltreatment death rate is 11 times higher than Italy’s and 3 times higher than Canada’s. In the past 10 years, more than 20,000 children have died because of household abuse. Texas has a child abuse death rate of 4.05/100,000, 4 times higher than New Hampshire and Vermont.

So why these rates, why these disparities?

Many believe the answer is in our child protection service (CPS) workforce. Employees are overworked and the system is slow and ineffective. But as the investigation explains, these critics forget the fact that these services were made to protect children after abuse, not prevent them from being harmed in the first place.

Prevention: the key public health value. Child abuse must be seen as an issue in which the public health field can intervene, even more specifically with a Maternal and Child Health focus. What can MCH leaders focus on to help this phenomenon from continuing to escalate? What are areas with low child maltreatment rates doing that work?

1. The United States has a weak public system— our home visiting programs could be expanded, and until the Affordable Care Act goes fully into effect, we have no universal health care. Texas has low taxes, and high numbers of keeping families together. Compared to other countries, the U.S. has low taxes. Children are more likely to be uninsured, incarcerated, to not finish high school, and to die from abuse if public service programs do not have funding.
2. Child abuse has been found to be interlinked with these factors affecting families, including poverty and teenage pregnancy. When families do not have resources, education, training, or an understanding, children are at greater risk. High stress is also associated with these factors.
3. Education and training of adults who work with children. Diagnosis is difficult when injuries are internal, thus it is important for workers to understand the risks of abuse. This includes pediatricians, social workers, teachers, and counselors.
4. Cutting budgets has been the major focus of 2011, and more states are reducing prevention effort funding. Legislatures are not educated on the consequences of abuse, including the future costs to states in working down-stream. If you work with families early on, it is possible to reduce child abuse and neglect, affecting the life course. States with low child abuse rates invest in working up-stream.

We cannot lobby legislatures to increase funding if we do not have the general public behind us. As MCH leaders, we must work to reverse child abuse as a taboo and silent topic. Media campaigns, outreach, and education must be expanded. In the 20^th century, breast cancer was unmentionable, and now there is a month dedicated to battling it. Spread the word-here is the link to the BBC report: http://www.bbc.co.uk/news/world-us-canada-15288865.

The ACA and U.S. Neonatal Mortality Rate

In light of the recent ambiguous rulings toward the constitutionality of the Affordable Care Act in the U.S. Circuit Courts, this contributor decided to write about implications for Maternal and Child Health.

Neonatal mortality, defined as deaths <28 days of age per 1,000 live births, is the focus of a study published in August by the Public Library of Science (PLoS) Medicine magazine. Although globally neonatal mortality rate has decreased since 1990, the United States still lags in ranking. Of the 176 countries and 3,551 country-year data analyzed, the United States ranked 41^st in neonatal mortality rate. Furthermore, even though death rate has decreased over time, it has improved at a slower rate than 117 other countries[i].

Although limited country data may hinder parts of the study, Americans should still be concerned with the researchers’ findings. The United States spends the most on health per capita compared to other developed countries. In fact, it is also has the highest rate of growth in health expenditure per capita: from 1980 to 2008, GDP health care spending proportion increased 7%[ii].

If the United States spends the most money on health care and has some of the most advanced technologies in the world, I question why newborns dying at such high rates? These queries guide my and other public health professionals’ values in prevention, and how investing in health at all ages of the lifecycle can improve outcomes for children. Quality preconception and maternal care can increase the chances of infant survival[iii]. Private insurance and out-of-pocket patient costs as sources of health expenditure are highest in the U.S. compared to other developed countries[iv]. With a lower percentage of funding from social programs and taxation, mothers, and sub sequentially their children, who do not have insurance are less likely to attend regular check-up visits. Visits help prevent premature death of infants through quality maternity care.

The Affordable Care Act signed into law last year will help fill these gaps, expand coverage to un/under insured, and hopefully change the status of U.S. babies today. In 2014, the provision that all health plans will cover pregnancy costs will go into effect. Currently, only 13% of individual health insurance plans include maternity care[v]. These debates over the legislation prevent mothers and children from getting the care they need to live happy, healthy lives. Advocacy is necessary to keep these issues in the forefront of our nation’s priorities.

Attend this free webinar sponsored by HHS’s Office on Women’s Health on “The Importance of the Affordable Care Act for Women”

Thursday Sep 29^th, 2011 at 2pm EST/1pm CST: https://services.choruscall.com/links/owhquarterly.html.

The Archived Webinar will be posted when becomes available.

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[i] Zahle Oestergaard, M., Inoue, M., Yoshida, S., Retno Mahanani, W., Gore, F. M., Cousens, S., et al. (2011). Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities. PLoS Medicine , 1-13.

[ii] Kaiser Family Foundation. (2011, April). Health Care Spending in the United States and Selected OECD Countries. Retrieved September 12, 2011, from Kaiser Family Foundation: http://www.kff.org/insurance/snapshot/OECD042111.cfm

[iii] Braveman, P., Oliva, G., Grisham Miller, M., Reiter, R., Egerter, S. (1989). Adverse Outcomes and Lack of Health Insurance among Newborns in an Eight-County Area of California, 1982 to 1986. New England Journal of Medicine, 321:508-513.

[iv] National Audit Office. (2003). International Health Comparisons: A compendium of published information on healthcare systems, the provision of healthcare and health achievement in 10 countries. London: National Audit Office.

[v] Collins, S. R., Rustgi, S. D., & Doty, M. M. (2010, July 30). How Women Will Benefit from the ACA. Retrieved September 13, 2011, from The Commonwealth Fund: http://www.commonwealthfund.org/Blog/Jul/How-Women-Will-Benefit-from-the-ACA.aspx