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The June 24, 2022 US Supreme Court decision in Dobbs v Jackson Women's Health Organization resulted in an expansive restriction on abortion access that had been constitutionally guaranteed for nearly half a century. Currently, 14 states have implemented complete bans on abortion with very limited exceptions, and an additional 7 states have implemented abortion bans at 6 to 18 weeks' gestation. It has been well demonstrated that restrictive policies disproportionately limit abortion access for minoritized people and people of low socioeconomic status; the financial and geographic barriers of these post- Dobbs restrictions will only exacerbate this disparity. Proponents of abortion restrictions, who identify as pro-life, assert that these policies are essential to protect children, women, and families. We examine whether the protection of these groups extends past conception by evaluating the association between state abortion legislation and state-based policies and programs designed to provide medical and social support for children, women, and families. We found that states with the most restrictive post- Dobbs abortion policies in fact have the least comprehensive and inclusive public infrastructure to support these groups. We suggest further opportunities for advocacy. (Am J Public Health. 2024;114(10):1043–1050. https://doi.org/10.2105/AJPH.2024.307792) [ABSTRACT FROM AUTHOR]

Background: Maternal and child malnutrition represents a public health problem in Mexico Primary care (PC) is responsible for introducing women and children under five to the health system, detecting diseases on time, and providing medical services, including pharmacological treatment if necessary. Providing these services with quality is essential to improve maternal and child health. This study evaluated the quality of nutritional care during preconception, pregnancy, postpartum, infancy, and preschool age at the PC health units across six Mexican states between 2020 and 2021. Methods: We conducted a cross-sectional study with a mixed approach in units of the Secretary of Health to assess the quality of nutritional care during preconception, pregnancy, postpartum, childhood, and preschool age. The level of quality was calculated by the percentage of compliance with 16 indicators that integrated a Quality Index of Maternal and Child Nutritional Care (ICANMI, by its Spanish acronym). Compliance by indicator, by life stage, and overall was categorized using the following cut-off points: poor quality (≤ 70%), insufficient quality (71-89%), and good quality (≥ 90%). The perceptions of the barriers and facilitators that affect maternal and child nutrition were evaluated through semi-structured interviews with health professionals (HP) and users. All qualitative instruments were developed with a gender and intercultural perspective. Results: Considering the whole sample studied, maternal and child nutritional care quality during the five life stages evaluated was bad (compliance: ≤12%), reflected in the ICANMI, which had a compliance of 8.3%. Principal barriers identified to providing high-quality nutritional care were the lack of knowledge and training of health professionals, shortages of equipment, medicine, personnel, and materials, the disappearance of the social cash transfer program Prospera, the absence of local indigenous language translators to support communication between doctor and patient, and the persistence of machismo and other practices of control over women. Conclusions: These findings underscore the need for initiatives to improve the quality of nutritional care in PC facilities across Chihuahua, State of Mexico, Veracruz, Oaxaca, Chiapas, and Yucatan. It is necessary for government and health authorities, along with various stakeholders, to collaboratively devise, implement, and assess intercultural and gender-oriented policies and programs geared towards ensuring the health infrastructure and enhancing the training of health professionals to diagnose and treat the prevalence and occurrence of diverse forms of malnutrition in both maternal and child populations. [ABSTRACT FROM AUTHOR]

The author addresses ways to move forward to achieve optimal nutritional status during the first 1000 days, which is critical because children experience more growth and development in that time period. Topics discussed include main themes that emerged in a series of international articles that drew attention to the critical impact of maternal and child nutrition during the first 1000 days, and barriers and opportunities to be considered in advancing the quality of nutrition during that period.

Copyright of Avances en Enfermería is the property of Editorial Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Globally, public health expenditure (PHE) is closely associated with Reproductive, Maternal, Newborn, Child Health, and Nutrition (RMNCHN) and Family Planning (FP) outcomes. In India, the role of PHE in shaping the progress towards the attainment of RMNCHN and FP-related Sustainable Development Goals (SDGs) is not widely documented. Using the four consecutive rounds of National Family Health Survey (NFHS), we have investigated the progress in RMNCHN and FP indicators and their association with PHE by applying robust econometric modelling. The findings suggest that although there is noticeable progress in the RMNCHN indicators from 1992–93–2015–16, India has failed to achieve RMNCHN targets related to Millennium Development Goals (MDGs). Lack of noteworthy correlation between FP indicators and PHE supports the argument that post National Rural Health Mission (2005), the core family welfare expenditure suffered a setback despite the absolute rise in PHE. However, correlation plots and the multivariate panel data regression analyses affirm that even with a moderate rise, PHE emerges as an important predictor of RMNCHN outcomes in the country. Thus, the road to achieving RMNCHN and FP-related SDGs demands to avoid austerity on PHE and strengthen the integration of RMNCHN and FP programmes at the operational level. [ABSTRACT FROM AUTHOR]

Introduction: During natural disaster a sudden increase in infant mortality and morbidity rates are reported. Breastfeeding practices are essential to prevent malnutrition-related mortalities among infants during disaster and displacement. Methods: Findings from the undertaken critical ethnographic study in the disaster relief camps of Chitral, Pakistan, were referred to identify need-based policies to promote, protect, and support breastfeeding among displaced mothers. Policy Implications: The study identified the need for strategic policies at sociocultural, economic, and geopolitical levels to support breastfeeding and save lives of young children during natural disasters. Conclusion: This article will facilitate clinicians, healthcare providers, and national and international agencies to recognize gaps in the existing policies and services targeting breastfeeding mothers during disaster and displacement. [ABSTRACT FROM AUTHOR]

Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Each year in India, roughly 28 million women experience pregnancy and 26 million have a live birth. Of these, an estimated 67,000 maternal deaths and one million newborn deaths occur each year. In addition, millions more women and newborns suffer pregnancy and birth related ill-health. Thus, pregnancy-related mortality and morbidity continues to have a huge impact on the lives of Indian women and their newborns. [ABSTRACT FROM AUTHOR]

Women who use drugs during pregnancy are required to intersect with numerous services in relation to their and their unborn child's well-being. The purpose of this article is to stimulate practitioner debate and consideration of the ways in which substance using women engage with diverse services and specific professional groups during pregnancy and the extent to which they may comply with the various treatment plans developed for them – or not. Drawing on literature, different ways to conceptualise engagement and compliance in health and welfare interventions are discussed and key practice issues related to these concepts are identified for this client cohort. Insights from an amalgamated case exemplar informed by practice and the available literature comprehensively draws together and highlights the personal challenges women face, whilst at the same time required to navigate inconsistent expectations between the health, alcohol and other drugs treatment and child protection systems, along with the ever-present threat of removal of their infant at birth. The role of social workers in hospital and community settings in bridging the perceived divide between clients and child protection services and also in promoting collaboration is explored. Recommendations for future research are discussed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the regional variations in maternal and child health all over India. The Maternal and Child Health Index (MCHI) is constructed to find the extent of variations in maternal and child health status for the States and Union Territories (UTs) of India. Design/methodology/approach: The Wroclow taxonomic technique was used to construct the MCHI for the States and UTs of India. In all, 29 variables were selected for the construction of MCHI. All the variables were taken from National Family Health Survey-4 (NFHS, 2017) of India. Findings: The findings suggest that there are wide variations in MCHI all over India. In India, Kerala topped in terms of MCHI followed by Jammu & Kashmir. Nagaland is on the bottom of the list followed by Bihar and Uttar Pradesh. High values of MCHI (> 0.4) are posing a serious concern for all States/UTs in India. Social implications: The existence of inequality in MCHI for India is truly posing a serious inquiry regarding the healthcare system in India. The outcome of the study demands that time has come to adopt a human rights approach to the right to health in India. The findings of the study could be used by the health policy makers in India. Originality/value: This study shows the existence of wide variations in the quality of maternal and child health all over India. The quantification of the quality of maternal and child health is needed to improve the health of the population in India. Little research has been done on the issue of quality of maternal and child health in India. This study is an important contribution to the current knowledge of quality of maternal and child health in India. [ABSTRACT FROM AUTHOR]

Objective: This study was designed to discriminate between fetal growth restriction that is placentally mediated and constitutionally small fetuses depending on the measurement of placental growth factor (PlGF) in the maternal circulation. Study Design: This was a prospective case--control study. Settings: This study was conducted at the Department of Gynecology and Obstetrics at Al-Yarmouk Teaching Hospital. Patients and Methods: The study included 100 cases (11 placental intrauterine growth restriction [IUGR] and 89 constitutionally small) with singleton pregnancies. Serum PlGF was measured by ELISA technique. Concentration less than the 5th percentile for normal pregnancy was considered a positive PlGF test. Results: A positive PlGF test was found in 10 out of the 11 placental growth restriction cases and in 4 out of the 89 constitutionally small fetuses. PlGF can differentiate between IUGR due to placental dysfunction from constitutionally small fetuses with 90.1% sensitivity and 95.5% specificity. Conclusion: PlGF may serve as a promising tool to identify placental IUGR antenatally. [ABSTRACT FROM AUTHOR]

Despite health systems improvements in Tanzania, gaps in the continuum of care for maternal, newborn and child health persist. Recent improvements have largely benefited those over one month of age, leading to a greater proportion of under-five mortality in newborns. Community health workers providing home-based counselling have been championed as uniquely qualified to reach the poorest. We provide financial and economic costs of a volunteer home-based counselling programme in southern Tanzania. Financial costs of the programme were extracted from project accounts. Ministry of Health and Social Welfare costs associated with programme implementation were collected based on staff and project monthly activity plans. Household costs associated with facility-based delivery were also estimated based on exit interviews with post-natal women. Time spent on the programme by implementers was assessed by interviews conducted with volunteers and health staff. The programme involved substantial design and set-up costs. The main drivers of set-up costs were activities related to volunteer training. Total annualized costs (design, set-up and implementation) amounted to nearly US$300 000 for financial costs and just over US$400 000 for economic costs. Volunteers (n = 842) spent just under 14 hours per month on programme-related activities. When volunteer time was valued under economic costs, this input amounted to just under half of the costs of implementation. The economic consequences of increased service use to households were estimated at US$36 985. The intervention cost per mother-newborn pair visited was between US$12.60 and US$19.50, and the incremental cost per additional facility-based delivery ranged from US$85.50 to US$137.20 for financial and economic costs (with household costs). Three scale-up scenarios were considered, with the financial cost per home visit respectively varying from $1.44 to $3.21 across scenarios. Cost-effectiveness compares well with supply-side initiatives to increase coverage of facility-based deliveries, and the intervention would benefit from substantial economies of scale. [ABSTRACT FROM AUTHOR]

Little is known about nutrition and well-being indicators of pregnant adolescents and the availability and use of nutrition interventions delivered through maternal, newborn, and child health (MNCH) programs. This study compared the differences between pregnant adolescents and adult pregnant women in services received, and in maternal and child nutrition and health conditions. A survey of 2,000 recently delivered women with infants <6 months of age was carried out in 20 sub-districts in Bangladesh where MNCH program is being implemented. Differences in service use and outcomes between pregnant adolescents and adult women were tested using multivariate regression models. The coverage of antenatal care and nutrition services was similar for adolescent and adult mothers. Compared to adult mothers, adolescent mothers had significantly fewer ownership of assets and lower decision making power. Adolescent mothers weighed significantly less than adult women (45.8 vs 47.1 kg, p = 0.001), and their body mass index was significantly lower (19.7 vs 21.3, p = 0.001). Adolescents recovered later and with greater difficulty after childbirth. Infants of adolescent mothers had significant lower height-for-age z-score (-0.89 vs -0.74, p = 0.04), lower weight-for age z-score (-1.21 vs -1.08, p = 0.02) and higher underweight prevalence (22.4% vs 17.9%, p = 0.04) compared to infants of adult women. In conclusion, this study confirms that adolescent pregnancy poses substantial risks for maternal and infant outcomes, and emphasizes that these risks are significant even where services during pregnancy are available and accessed. A focus on preventing adolescent pregnancy is imperative, while also strengthening health and nutrition services for all pregnant women, whether adult or adolescent. [ABSTRACT FROM AUTHOR]

This study sought to report and to discuss the technical, operational and structural strategies for configuring the health care network for pregnant women and children exposed to toxoplasmosis, in public health services located in northwestern Paraná state, southern Brazil. A qualitative case study was conducted focusing on the configuration of care in gestational and congenital toxoplasmosis towards the health care network model recommended by the Ministry of Health. The discussion was conducted focusing on the concept of network proposed by Rovere. The study revealed the strength of the establishment of interpersonal bonds in the configuration of network services, the importance of integrating them to ensure comprehensive care and the construction of ever more consistent networks. This work represents an innovative strategy with a high degree of reproducibility in health services and is applicable to planning, management policies and actions aimed at maternal and child health. [ABSTRACT FROM AUTHOR]

Background: With an increasing prevalence of obesity in young children globally, there is an urgent need for the development of effective early interventions. A previous Healthy Beginnings Trial using a nurse-led home visiting program has demonstrated that providing mothers with evidence-based advice can improve maternal practice regarding obesity prevention, and can reduce Body Mass Index (BMI) in the first few years of life. However, the costs for scale-up of home visiting limit its population reach. This trial aims to determine the efficacy of Communicating Healthy Beginnings Advice by Telephone (CHAT) to mothers with infants in improving infant feeding practices and preventing the early onset of childhood overweight and obesity.Methods/design: We propose a 3-arm randomised controlled trial (RCT) with a consecutive sample of 1056 mothers with their newborn children in New South Wales (NSW) Australia. Pregnant women who are between weeks 28 and 34 of their pregnancy will be invited to participate in the CHAT trial. Informed consent will be obtained, and after baseline data collection, participants will be randomly allocated to the telephone intervention, text messaging intervention, or the control group. The intervention comprises telephone consultations or text messages, together with 6 intervention packages being mailed at specific times from the third trimester of pregnancy until 12 months post birth. The main trial outcome measures include a) duration of breastfeeding, b) timing of introduction of solids, c) nutrition behaviours, physical activity and television viewing, and d) weight and BMI z-score at 12 and 24 months, e) cost-effectiveness, as well as f) feasibility and acceptability of the interventions.Discussion: The results will ascertain whether early intervention using telephone consultation or text messaging together with staged mailed intervention resources can be feasible and effective in improving infant feeding practices, physical activity and reducing children's BMI in the early years of life. If proven to be feasible, effective as well as cost-effective, the trial results will inform a series of recommendations for policy and practice related to promoting healthy infant feeding and physical activity in young children in the first years of life.Trial Registration: The CHAT Trial is registered with the Australian Clinical Trial Registry ( ACTRN12616001470482p ). It was registered on October 21, 2016. [ABSTRACT FROM AUTHOR]

Copyright of Health Policy & Planning is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Despite efforts to reduce under-5 mortality rates worldwide, an estimated 6.6 million under-5 children die every year. Community mobilisation through participatory women’s groups has been shown to improve maternal and newborn health in rural settings, but little is known about the potential of this approach to improve care and health in children after the newborn period. Methods: Following on from a cluster-randomised controlled trial to assess the effect of participatory women’s groups on maternal and neonatal health outcomes in rural Bangladesh, 162 women’s groups continued to meet between April 2010 and December 2011 to identify, prioritise and address issues that affect the health of children under 5 years. A controlled before-and-after study design and difference-in-difference analysis was used to assess morbidity outcomes and changes in knowledge and practices related to child feeding, hygiene and care-seeking behaviour. Findings: Significant improvements were measured in mothers’ knowledge of disease prevention and management, danger signs and hand washing at critical times. Significant increases were seen in exclusive breast feeding for at least 6 months (15.3% (4.2% to 26.5%)), and mean duration of breast feeding (37.9 days (17.4 to 58.3)). Maternal reports of under-5 morbidities fell in intervention compared with control areas, including reports of fever (−10.5% (−15.1% to −6.0%)) and acute respiratory infections (−12.2% (−15.6% to −8.8%)). No differences were observed in dietary diversity scores or immunisation uptake. Conclusions: Community mobilisation through participatory women’s groups can be successfully adapted to address health knowledge and practice in relation to child’s health, leading to improvements in a number of child health indicators and behaviours. [ABSTRACT FROM AUTHOR]

The article discusses the U.S. Special Supplemental Nutrition Program for Women, Infants and Children (WIC). It notes that the program provides growth monitoring, nutrition education and breastfeeding promotion to infants, low-income pregnant and postpartum women and children below five years. It indicates a report that estimates the number of eligible but not enrolled to WIC women during pregnancy and describes the prevalence of risks for poor maternal and infant health outcomes in the nation.

Social workers assist women of child-bearing age in a wide variety of settings. Although pregnancy and pregnancy loss are often associated with medical settings, the reality is that any clinical social worker will encounter women who are currently pregnant, who have been pregnant, and/or who have experience pregnancy loss. Clinical social workers need to understand the theoretical underpinnings of maternal attachment and loss to adequately meet the needs of the women who have had these experiences. Clinical social workers must be able to competently assess the problems that occur when attachment goes awry or pregnancy loss is experienced. This article provides an overview of maternal attachment and responses to pregnancy loss from the biological, psychological and social perspectives. This enables social workers to be sensitized to the impact of these issues in the work we do with all women of child-bearing age across all settings. [ABSTRACT FROM AUTHOR]

Objectives. We analyzed trends in maternal, newborn, and child mortality in Chile between 1990 and 2004, after the introduction of national interventions and reforms, and examined associations between trends and interventions. Methods. Data were provided by the Chilean Ministry of Health on all pregnancies between 1990 and 2004 (approximately 4000000). We calculated yearly maternal mortality ratios, stillbirth rates, and mortality rates for neonates, infants (aged >28 days and <1 year), and children aged 1 to 4 years. We also calculated these statistics by 5-year intervals for Chile's poorest to richest district quintiles. Results. During the study period, the maternal mortality ratio decreased from 42.1 to 18.5 per 100000 live births. The mortality rate for neonates decreased from 9.0 to 5.7 per 1000 births, for infants from 7.8 to 3.1 per 1000 births, and for young children from 3.1 to 1.7 per 1000 live births. The stillbirth rate declined from 6.0 to 5.0 per 1000 births. Disparities in these mortality statistics between the poorest and richest district quintiles also decreased, with the largest mortality reductions in the poorest quintile. Conclusions. During a period of socioeconomic development and health sector reforms, Chile experienced significant mortality and inequity reductions. {Am J Public Health. 2009;99:1220-1226. doi:10.2105/AJPH.2008.143578) [ABSTRACT FROM AUTHOR]

Background Parenting programmes are at the heart of intervention strategies for parents of children with emotional and behaviour problems. Systematic reviews and meta-analyses of randomized controlled trials have indicated that such programmes can improve many aspects of family life. However, there is currently a dearth of information concerning what it is that makes parenting programmes meaningful and helpful to parents. The aim of this paper was to examine parents' experience and perceptions of parenting programmes using the meta-ethnographic method, in order to sensitize policymakers and practitioners to the key factors that parents perceive to be of value. Methods Systematic searches of a number of electronic databases were undertaken using key search terms. Critical appraisal of included studies was conducted using standardized criteria, and the reports were synthesized using meta-ethnographic methods. Results Six reports were purposefully selected and critically appraised independently by two reviewers. Two were excluded. Based on the remaining four papers, five key concepts were identified as important when planning and delivering parenting programmes. A lines-of-argument synthesis was developed which suggests that the acquisition of knowledge, skills and understanding, together with feelings of acceptance and support from other parents in the parenting group, enabled parents to regain control and feel more able to cope. This led to a reduction in feelings of guilt and social isolation, increased empathy with their children and confidence in dealing with their behaviour. Conclusion This evaluation provides an indication of the components that parents perceive to be necessary in the provision of parenting programmes, independent of the particular type of programme being provided. It may therefore aid policymakers in decisions about which programmes to provide. [ABSTRACT FROM AUTHOR]

Abstract: This study examined relations among mothers'' discourse about experiences in their families of origin and with child protective services (CPS), attachment-related and current risk factors, and the quality of mothers'' parenting behavior with their young children during supervised visits. Twenty-nine 2- to 6-year-old children in foster care and their biological mothers participated. Clinical interviews with mothers assessed the quality of maternal discourse and the presence of risk factors. Videotaped observations of visits between mothers and their children assessed parenting behaviors. Results revealed that mothers who discussed their experiences in a coherent and flexible manner and expressed affection for their children in their discourse were more supportive of their children''s socioemotional functioning during visits. Moreover, in addition to current risk factors such as substance abuse and mental illness, mothers'' experience of attachment-related risk factors in childhood or adolescence was particularly important for understanding the quality of their discourse and parenting behavior. [Copyright &y& Elsevier]

Background: Calcium supplementation during pregnancy has been shown to reduce the incidence of hypertension in the mother, but the effects on the offspring are uncertain. Assessing the impact on the offspring is very important given the now large body of evidence indicating that blood pressure levels in childhood and young adulthood can be influenced by factors operating during fetal life. We conducted a systematic review of the literature to summarize the evidence supporting an association between maternal dietary calcium intake during pregnancy and blood pressure in the offspring. Methods: A systematic review was performed to identify randomized, quasi-randomized and cohort studies reporting the relationship between offspring blood pressure or incidence of hypertension and levels of maternal dietary calcium intake during pregnancy, either from supplements (i.e. pills) or food. MEDLINE, EMBASE and the Cochrane Library Registry were searched for relevant trials. Results: Two randomized trial and three observational studies were identified and included in this review. In 4 of the 5 studies, loss to follow-up was a serious concern. There was heterogeneity between the studies, particularly those conducted on children below 12 month of age. Results were more consistent among the studies including older children (1 to 9 years) where a higher maternal calcium intake was associated with a reduction of -1.92 mm Hg (95% CI -3.14 to -0.71) in offspring systolic blood pressure. One large randomized trial found a clinically and statistically significant reduction in the incidence of hypertension in 7-year-old children (RR = 0.59, 95% CI 0.39 to 0.90). Conclusion: There is evidence in the literature to support an association between maternal calcium intake during pregnancy and offspring blood pressure. However, more research is needed to confirm these finding given the small sample sizes and the methodological problems in many of the studies conducted so far. More studies on populations with calcium deficit are also needed. If confirmed, these findings could have important public health implications. Calcium supplementation during pregnancy is simple and inexpensive and may be a way to reduce the risk of hypertension and its sequels in the next generation. [ABSTRACT FROM AUTHOR]

OBJECTIVES. The objective of this study was to determine the attitudes of a variety of health care providers toward the recommendations that should be made to parents regarding the resuscitation of infants who are born at the margins of viability. METHODS.A written questionnaire was distributed to the medical and nursing staff at 4 tertiary perinatal centers. For each of 5 weekly gestational age intervals from 22 weeks to 26 weeks, 6 days, the health care providers were asked to describe on a scale from 1 to 5 whether they would strongly discourage through strongly encourage resuscitation. They also were queried regarding their comfort with counseling regarding these issues. The attitudes of various groups of providers were compared across weekly intervals. RESULTS. A total of 204 physicians and 539 nurses completed the survey. The majority would strongly discourage, either discourage or strongly discourage, be neutral or recommend, recommend or strongly recommend, and strongly recommend resuscitation during the 23rd, 24th, 25th, 26th, and 27th weeks of gestation, respectively. Obstetric caregivers were slightly less likely than pediatric caregivers to strongly discourage resuscitation from 22 weeks to 22 weeks, 6 days and 23 weeks to 23 weeks, 6 days. There were no significant differences in the recommendations of obstetricians and pediatricians. Pediatric nurses were more likely to strongly recommend resuscitation from 26 weeks to 26 weeks, 6 days and more likely either to discourage or to strongly discourage resuscitation from 23 weeks to 23 weeks, 6 days and to strongly discourage resuscitation from the 22 weeks to 22 weeks, 6 days than their obstetric counterparts. Obstetric nurses were slightly less likely than obstetricians to strongly recommend resuscitation at 26 weeks to 26 weeks, 6 days and less likely to strongly discourage resuscitation from 22 weeks to 22 weeks, 6 days. CONCLUSIONS. The caregivers' recommendations seem to be based logically on the current literature regarding survival and morbidity that is experienced by infants who are born at the threshold of viability. Although there are minor differences, there was a relatively consistent approach among professional groups. [ABSTRACT FROM AUTHOR]

Focuses on the Millennium Development Goals that need to be implemented to improve the lives of women and children. Description of the goals that were set as part of the United Nations Millennium Project; Goals of reducing mortality and improving maternal health; Ways that maternal health could be improved in order to reduce maternal death; Need for health systems to be improved and strengthened; Importance of investment in implementing these goals.

Objectives. To determine whether infants who are fed initially and advanced at 30 mL/kg per day (intervention) take fewer days to get to full feedings than those who are fed initially and advanced at 20 mL/kg per day (control), without increasing their incidence of feeding complications and necrotizing enterocolitis (NEC). We also examined whether these infants regain birth weight earlier, have fewer days of intravenous fluids, and a have shorter hospital stay. Methods. A randomized, controlled, single-center trial was conducted in a Neonatal Intensive Care Unit of a community-based county hospital in Houston, Texas. Infants between 1000 and 2000 g at birth, gestational age ≤35 weeks, and weight appropriate for gestational age were allocated randomly to feedings of expressed human milk or Enfamil formula starting and advanced at either 30 mL/kg per day or 20 mL/kg per day. Infants remained in the study until discharge or development of stage ≥IIA NEC. Results. A total of 155 infants were enrolled: 72 infants in the intervention group and 83 in the control group. Infants in the intervention group achieved full-volume feedings sooner (7 vs 10 days, median), regained birth weight faster (11 vs 13 days, median), and had fewer days of intravenous fluids (6 vs 8 days, median). Three infants in the intervention group and 2 control infants developed NEC for an overall incidence of 3.2% (relative risk: 1.73; 95% confidence interval: 0.30--10.06). Conclusion. Among infants between 1000 and 2000 g at birth, starting and advancing feedings at 30 mL/kg per day seems to be a safe practice and results in fewer days to reach full-volume feedings than using 20 mL/kg per day. This intervention also leads to faster weight gain and fewer days of intravenous fluids. [ABSTRACT FROM AUTHOR]

Infant mortality review (IMR), the forerunner of fetal and infant mortality review (FIMR), emerged at the national level in the mid-1980s as a promising method to improve understanding of local factors contributing to infant mortality and to motivate community response. Building on federal efforts to enhance data capacity and early state and local infant mortality case review studies, the federal Maternal and Child Health Bureau (MCHB) initiated its IMR Program in 1988. Key actions taken to refine and diffuse the IMR/FIMR method include forging a public–private partnership between MCHB and the American College of Obstetricians and Gynecologists in 1990 to develop the National Fetal and Infant Mortality Review Program, recruiting prominent leaders to advocate for FIMR, seeding community projects in geographically dispersed states and localities, and routinely reporting best practices information to the field. In concert with the articulation of core public health functions and a growing emphasis on accountability, attention at the national level has turned to promoting and institutionalizing FIMR in state systems. Efforts are underway in states to build on the FIMR model and coordinate multiple maternal and child health-related review programs. Increasingly, FIMR is recognized as a strategy for contributing to implementation of the core public health functions of assessment, policy development, and quality assurance. The recent national evaluation of FIMR sheds new light on the role of FIMR in community and state maternal and child health systems and marks a new phase in the evolution of FIMR. [ABSTRACT FROM AUTHOR]

Comments on the results of a national evaluation of Fetal and Infant Mortality Review programs conducted by the John Hopkins University's Women's and Children's Health Policy Center in 1996–1999. Changes in the practice approaches of individual physicians to legislative or administrative changes to improve the delivery services to women and infants; Evaluation of the public health performance of Fetal and Infant Mortality Review programs; Examination of factors associated with the public health delivery systems.

Objective: An evaluation of fetal and infant mortality review (FIMR) programs nationwide was conducted to characterize their unique role in improving the system of perinatal health care. The aim of this paper is to examine intermediate outcomes of the FIMR, in particular the development and implementation of recommendations produced by the FIMRs and the conduct of essential MCH services by the FIMRs. Methods: We report on 74 FIMRs whose communities were selected for the nationwide evaluation and for whom we had data from the FIMR director or comparable respondent. We focus on the recommendations of the FIMRs and the essential maternal and child health (MCH) services conducted by the FIMRs as intermediate outcomes (or outputs) and then examine how selected characteristics of the FIMR may influence these. Results: FIMRs developed recommendations on a broad range of topics but there were some areas for which nearly all programs had developed recommendations. The FIMRs relied primarily on strategies related to programs and practices, with few FIMRs reporting attention to policy-oriented approaches. Implementation of recommendations was high. Factors that influenced likelihood of implementing recommendations and conduct of essential MCH services included structure of the FIMR and training received by FIMR directors and staff. Conclusions: The focus of FIMR recommendations and the likelihood of implementation vary across FIMRs as does the conduct of essential MCH services. FIMR team structure and training of the director and staff are important areas to consider in efforts to maximize the impact of FIMR. [ABSTRACT FROM AUTHOR]

Focuses on the strategy of the Maternal and Child Health Bureau to improve the health services systems for pregnant women, infants, and their families. Evaluation of the Fetal and Infant Mortality Review programs; Rationale for the study design and outcomes of the evaluation; Factors contributing to the effectiveness of Fetal and Infant Mortality Review in improving community resources and perinatal service systems.

Objectives: The aim of this paper is to explore the involvement of state Title V programs in fetal and infant mortality review (FIMR) programs. Methods: On the basis of information from four data sources, this article explores interactions among state Title V and FIMR programs, and considers recommendations regarding how these connections can be fostered for their mutual benefit. Results: A brief history of state Title V engagement with FIMR programs is reviewed. Examples of state Title V–FIMR interactions are provided as suggestions for consideration by other states. Conclusions: Fetal and infant mortality review programs are, by design, local interventions, but there are many instances in which state Title V agencies can play roles in individual local, regional, or statewide FIMRs. [ABSTRACT FROM AUTHOR]

The article discusses how to appropriately prepare for the delivery and immediate care of the preterm infant. Author's view that when preterm delivery can be anticipated, relevant historical details should be taken to anticipate problems and prepare appropriately for the arrival of the preterm infant; Relation between the level of resuscitation need and the gestation of the preterm infant; Overview of necessary equipment.

Features information on the outstanding recipients of the 2003 National Maternal and Child Health (MCH) Epidemiology Awards. Achievements of researcher Michael Kogan in advancing knowledge in the field of MCH; Successful effort of the Countryside Lead Prevalence Study, a collaborative venture of the Minnesota Department of Health, Local Primary Care Providers and other health organizations; Accomplishments of Garland Land in the MCH field.

This study examined the relationship between the use of maternal-child health (MCH) care and the use of contraceptives. The high correlation between the two may be due to the independent effect of one on the other or to an association of both with the same or similar background factors. We used structural equation models to examine the relationship between these two interventions. The data were derived from six Demographic and Health Surveys: Zimbabwe from Sub-Saharan Africa, Thailand from Asia, Egypt and Tunisia from North Africa, and Guatemala and Colombia from Latin America. The results show that in all six countries, the use of contraceptives and MCH care are significantly associated, independent of intervening factors; this finding suggests that families develop a joint demand for better-quality health and limited family size and translate these demands into action by using health services for mothers and for children and by voluntarily regulating fertility. [ABSTRACT FROM AUTHOR]

A review of the article "Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis" is presented.

The article emphasizes the major policy issues which were met in the development and administration of the maternal and child health programs in the U.S. The legislative history of the Maternity and Infancy Act pf 1920-1929 made it clear that it was the intent of the Congress that the findings of its studies and reports should be used to help state and local groups to take appropriate action to improve the care of pregnant women and children. It has been debated on whether the country have a national social policy for children that is the basis for the development and continued support of child health and welfare services.

The Bohol Project (1975-1979) sought to improve maternal and child health and to increase the use of family planning among a rural Philippine population of 400,000. Research indicated that maternal and child health (MCH) services did become more available during the Project period and coverage of the priority populations improved. Family planning (FP) use, particularly of less effective methods, increased and fertility declined although some change could have been expected even without the Project. Deaths due to neonatal tetanus were almost eliminated but mortality rates did not decline for a number of reasons, including the fact that services were probably not tailored closely enough to local health problems, especially respiratory diseases. The Project showed that it was possible to increase health and family planning services by using low-cost strategies (such as setting up community drug stores) and by employing paramedical workers, in this case, midwives. Preventive MCH-FP services were not overwhelmed by curative services as had been feared. Perhaps the most significant contributions of the Project were the lessons learned about delivering health and family planning services and conducting evaluation research. In general, if developing countries could maintain well-evaluated field laboratories for working out health and family planning delivery approaches before going nationwide, it is likely that time and money would be saved in the long run. [ABSTRACT FROM AUTHOR]

There is controversy extending beyond that of whether family planning or population control measures should be promoted among various populations. Even when the decision has been made to provide family planning advice, information and service, debate often arises as to the best method of administering a family planning programme—whether to integrate it with maternal and child health (MCH) services, offer it post-partum, or provide it independently of all other health activities.The Danfa Comprehensive Rural Health and Family Planning Project, Ghana, is investigating the general problem of health service delivery, including family planning, and is doing so with a firm commitment to efficient management, staff training and supervisory maintenance. An established research design and ongoing evaluation efforts, including cost and functional analyses, are an integral part of the project. While it is believed that the integrated MCH/Family Planning approach will yield optimal results in family planning acceptance (as well as reduction in morbidity and mortality), other alternatives of health care and family planning service delivery are being evaluated. [ABSTRACT FROM PUBLISHER]

The National Maternal and Infant Health Survey provides new data on the prevalence of unintended childbearing in the United States: Thirty-six percent of births in 1988 were mistimed and 7% were unwanted while 57% were intended. Although the level of unintended childbearing is high in almost all socioeconomic subgroups of women, the proportion of births that were mistimed or unwanted was 50% or more among age-groups 15-17 (78%), 18-19 (68%) and 20-24 (50%), and among never-married women (73%), formerly married women (62%), black women (66%), women living below the federal poverty level (64%) or at 100-149% of the poverty level (52%), women with less than 12 years of education (58%) and women who already had two children (53%) or three or more children (60%). Multivariate analyses indicate that births to unmarried women—whether formerly married or never-married—are less likely than those to married women—whether formerly married or never-married—are less likely than those to married women to be wanted and more likely to be mistimed. Poverty status has no independent effect on the odds that a birth is unwanted or on the odds that a birth to an unmarried women is mistimed. Among currently married women, those who are poorer are more likely than women above 150% of the poverty level to have a mistimed birth. Black women are more likely than either Hispanic or white women to report a birth as unwanted and are more likely than white women to say a wanted birth was mistimed. [ABSTRACT FROM AUTHOR]

Abstract. Medical and social protection of mothers, infants, and children began in France more than a century ago. A number of laws and regulations have improved the system, which is discussed in detail. The discussion includes an overview of health policy, service delivery, and the financing of care. Is the current French system of Maternal and Child Health responsible for the good health of today's children? This question is addressed through selected examples. Finally, failures and shortcomings of the system are described, including the persistence of underserved groups, unequal access to care, and other problems. Solutions are feasible, and some are now being implemented. [ABSTRACT FROM AUTHOR]

The concept of central place theory is examined and a method is described for determining the optimal locations for Maternal and Infant Care Projects so that health services are accessible to and utilized by the greatest number of eligible persons. [ABSTRACT FROM AUTHOR]

This article describes a syndrome of inadequate maternal coping with childrearing identified in three widely differing ethnic and cultural settings in Israel. It is suggested that in all three settings, the common feature is abandonment of the mother by traditional family and social supports, and the failure of the health services to fill the gap. The three settings are the development town, the Bedouin Arabs, and the Kibbuts.

Yugoslavia has received many visitors from the U.S. who have come to investigate pertinent health problems and to establish friendly contacts which would lead to a continuing exchange of ideas. For example, maternal and child health has been explored extensively by U.S. health specialists and students for the purpose of gathering and sharing useful information. An essential component of maternal and child health is family planning, which, in Yugoslavia, has been integrated into the maternal and child health program. A key figure on their health team in the delivery of family planning services is the public health nurse.

The article discusses the development of health care services for mothers and children in the U.S. In 19th century, social action for the welfare of children has led to the concept of maternal and child health services. Several organizations were formed to improve the condition of abused children. Due to the desire to improve children welfare, advances in medicine especially in pediatrics and obstetrics and in medical education were developed. Then, the state established several health departments that provide governmental framework for maternal and child health programs.

In this article, the authors discuss the increased risk of adverse neurological development for late preterm infants and the maternal medical conditions on their morbidity risk in the U.S. They attribute maternal medical conditions or pregnancy complications to early deliver or obstetric intervention. They note the study showing that late preterm infant is at risk for adverse neurological outcomes in childhood. They point out that the risk follows the gestational age.

Argues in favor of creating an international fund for maternal, neonatal, and child health. Claim that world leaders will meet in September, 2005 to review progress toward the United Nations' (UN) Millennium Development Goals; Creation of a fund for greater health investment in Africa and Asia in 2001; Health conditions of women, infants, and children worldwide; Importance of foreign aid to the improvement of public health in Africa and Asia; Description of UN programs aimed at improving economic and social conditions in the developing world; Estimated cost of a global fund for maternal and child health; Assessment of the UN's existing global fund for public health; Recommendations for public health policies to improve maternal and child health.

Costs and savings of child health services were studied in a private mining company in Peru. Despite considerable outlays for medical services, few children under age 5 were vaccinated, and half of their illnesses went untreated. Children who were attended at the company clinic usually received unnecessary medication. As a result of the study, the company hired additional staff to provide integrated maternal-child preventive health care and family planning and contracted for intensive training and periodic on-site supervision. In less than 2 years, vaccination coverage reached 75%, and virtually all children under age 1 were enrolled in growth monitoring. Prescriptions were reduced by 24%, including a 67% drop in antimicrobials. The cost of the new services was $13,200 for the first 2 years. Approximately $6800 has been saved in pharmaceuticals prescribed for respiratory infection and diarrhea. Recently, two more mines adopted maternal and child health and family planning services. It is hoped that cost-benefit arguments will encourage other companies to incorporate aggressive child survival measures into their health plans. [ABSTRACT FROM AUTHOR]

Describes the maternal and child care services in Soviet Union. Observation that services for mothers and children are directed by the deputy chief of the Department of Specialized Medical Care in the Ministry of Health; Role of the different ministries of health's sub-department in the maintenance and supervision of women's and children's consultation centers and of health services in crèches, kindergartens, schools and other institutions for children.

Background: Pediatric anaphylaxis is commonly misdiagnosed in the Emergency Department (ED). We aimed to determine the impact of inaccurate diagnosis on the management and follow-up of pediatric anaphylaxis presenting to the ED.Methods: Retrospective chart review of ED management of children aged 0-18 years with allergic presentations to three EDs in Melbourne, Australia in 2014. Cases were included if an ED diagnosis of anaphylaxis was recorded, or the presentation met international consensus criteria for anaphylaxis.Results: Of the 60,143 pediatric ED presentations during the study period, 1551 allergy-related presentations were identified and reviewed. 187 met consensus criteria for anaphylaxis, and another 24 were diagnosed with anaphylaxis without meeting criteria. Of the 211 presentations, 105 cases were given an ED diagnosis of anaphylaxis and 106 cases were given an alternative diagnosis in ED. Those diagnosed with anaphylaxis were more likely to receive epinephrine [85.7% vs 31.1% (OR = 13.27, 95% CI: 6.09-26.3)], to be observed for the recommended four hours [56.2% vs 29.2% (OR = 3.10, 95% CI 1.76-5.48, p < 0.001)], to have an epinephrine autoinjector available on discharge [81.9% vs 35.8% (OR = 4.12, 95% CI 2.07-8.22, p < 0.001)] and to be referred to an allergist [35.2% vs 16.0% (OR = 2.85, 95% CI 1.48-5.49, p < 0.01)]. Provision of anaphylaxis action plans and allergen avoidance advice was poorly documented for all patients.Conclusion: Accurate diagnosis of anaphylaxis in ED has a significant impact on observation times, prescription of epinephrine autoinjectors and referral to an allergist. These factors are key to reducing mortality and the significant morbidity that results from childhood anaphylaxis. [ABSTRACT FROM AUTHOR]