Literature Review: Health Promotion Programs for Maternal, Infant and Child Health

Jabrielle Howard
Health 634-B01: Health Communication & Advocacy
September 11, 2017
 Introduction
For the United States, the well-being of mothers, infants and children are an important
public health goal. The health of the next generation is determined by predicting future public
health challenges that are faced by families, communities, and the health care system 1. The
importance of maternal, infant and child health are that pregnancy can provide an opportunity to
identify existing health risks in women and to prevent future health problems for women and
their children. There is various health risks involved such as: hypertension and heart disease,
diabetes, depression, genetic conditions, STDs, etc. To understand maternal, infant and child
health we need to understand and know the factors.
Many factors can affect pregnancy and childbirth such as age, preconception health
status, poverty and having the appreciate access to health care facilities. Statistics of maternal
health is rising; an estimated 250,000-280,000 women die during childbirth 1. There are a large
number of women receiving not enough or the proper care during or before pregnancy. My
overall intervention will be carried out by creating activities that will involve the audience. They
will have hands on activities as well as research activities to gain knowledge on maternal child
health care.
It is important that they understand and know about maternal child health care because
approximately 67.8 per 1,000 women aged 1519 which is nearly 750,000 American teenagers
become pregnant each year1. Among pre-pregnancy interventions, family planning and
advocating pregnancies at appropriate intervals; prevention and management of sexually
transmitted infections including HIV; and peri-conceptual folic-acid supplementation have
shown significant impact on reducing maternal and neonatal morbidity and mortality 2,5. During
pregnancy, preterm, premature rupture of membranes; management of unintended pregnancy;
and home visits for women and children across the continuum of care have shown maximum
impact on reducing the burden of maternal and newborn morbidity and mortality. There has been
a period where the rate of maternal mortality has actually declined. But since the 1980s in the
United States it has increased. According to the March of dimes, there were 17.8 maternal deaths
per 100,000 live births in 2011. There are increases in the racial disparities in maternal mortality.
It was found that in 2012, the maternal mortality rate was 11.8 per 100,00 live births in non-
Hispanic black women 3.
This literature review is comprised of 3 sections: the introduction above briefly
describing the current issue; the body of evidence is supporting the need for a health promotion
intervention; and a summary of presented information and conclusions connecting the
interventions purpose with the need of health promotion programs for maternal, infant and child
health.
Body of Evidence
As mention, to reduce the high burden of neonatal mortality and morbidity it is stated that
Interventions to avert maternal mortalities can also prevent neonatal deaths; evidence suggests
that 77% of all neonatal deaths occurs where the coverage of skilled birth attendance is 50% or
even less 2. According to the American Journal of Obstetrics and Gynecology, it discusses the
trends in neonatal morbidity and mortality for low birthweight infants. In the journal they
compare the survival of infants with birthweight of 501-1500 g in the years 1995-1996 for 1997-
2002. It has been found with their study that there has been no significant increase in survival
without neonatal and long term morbidity among infants between the years 1997 and 2002 5,9. To
improve the survival without morbidity it requires determining, disseminating and applying best
practices using therapies that are currently available and identifying new strategies and
interventions.
To promote womens maternal health, reducing maternal mortality has been seen by
governments and international agencies. The studies in this review do have limitations, such as
sample size, source of the samples, and methods used to collect data which all help with the
statistics given throughout the study. According to the CDC, they collect data, operate research
centers, and finalize information to the public on birth defects. Maternal, infant and child health
can be prevented in the United States through interventions such as early diagnosis and having
the appropriate medical care for pregnancy complications. The overall objective is to lower the
maternal mortality rate to 11.4 per 100,000 live births
To reduce the high burden of neonatal mortality and morbidity, postnatal care should be
integrated into existing health programs. Community based education and health promotive
workshops on exclusive breastfeeding and preventing vertical transmission of HIV will help
increase the coverage of the postnatal interventions and improve maternal and newborn health 4.
When women become pregnant she is at an increased risk of HIV because of her physical
susceptibility and her relative disempowerment 4. The importance of this program is to inspire
and contribute to health and well-being by providing the best care to every patient through in
clinical practice, education and research.
However, interventions were organized to have a significant impact on maternal,
newborn and child survival addressing the main causes of maternal, newborn and child mortality.
Interventions were suitable low and middle income countries that had minimal essential care. In
addition, interventions were delivered through the health sector from the community 2,7.
Compared to evidence found, according to the CDC over 23,000infants died in the United States
in 2015. The leading causes of these deaths were birth defects, preterm birth, sudden infant death
syndrome (SIDS), maternal pregnancy complications and injuries 8,10.
Among the non-Hispanic whites, the leading cause of infant death was birth defects.
Among the non-Hispanic blacks it was found that the leading cause of infant death was
prematurity and low birthweight. In 2014, more than 381,000 babies were born preterm. These
babies faced a higher risk of health problems and death than the other newborns. According to
the March of dimes, since after decades of increase, the preterm birth rate stated to decline so
they decided to establish a goal to reduce preterm birth to 8.1% by 2020 3. Evidence has shown
that early term infants have increased morbidity and mortality compared to infants born full
term.
Infant mortality rates were higher for non-Hispanic- black infants, American
Indian/Alaska Native infants, and Hispanic infants, compared with non-Hispanic white infants.
Rates were lowest among Asian/Pacific Islander infants in 2015. Similarly, in 2015 an estimated
303,000 women died as a result of pregnancy and childbirth complications 5. As discussed, most
of these deaths occurred in the low-and middle countries such as Sub-Saharan Africa, who had
the highest maternal mortality ratio in 2015 9. Countries that usually have the highest ratio or rate
of mortality and morbidity are when the population is disaggregated by income, education, or
place of residence; wide disparities in child mortality can be shown, even in those areas where
the overall mortality seems low 9.
Recommended by the WHO Integrated Management in Pregnancy and Childcare
(IMPAC) package, in 2015, 2.0 percent of indirect maternal deaths in Sub-Saharan Africa were
related to HIV, with the proportion reaching 10 percent or more in five countries. Comparing
rates of decline from 1990 through 2000 with the rates of decline from 2000 through 2011 and
found that the majority of countries (106 of 193 countries) had accelerated declines in child
mortality in the period from 2000 through 2011 6. This decline was mainly because of reduction
in post neonatal mortality, whereas the reduction in neonatal mortality was much lower. The
global MDG had a set target for child survival for 2015. Countries would need to accelerate their
efforts and achieve at least an annual rate of reduction of 5.5% to reach a projected mortality
target for children younger than 5 years of age of 35 deaths per 1000 live births by 2020 6.
Summary & Conclusions
In conclusion, the body of evidence discussed the mortality and morbidity rates that occur
often in maternal, infant and child health. It has been a long time coming, 20 years to be exact
that the leading cause of infant mortality comes from birth defects. Birth defects were
responsible for 20% of infant deaths and responsible for 38% of all infant deaths and 47% 3.
Untreated maternal mental illness affects infant and child growth and the quality of child care,
resulting in compromised child development. Birth defects is actually rank second in leading
causes of death among children aging from 5-9 and it is rank fifth among those aging from 10-
14. Throughout the literature review we compared rates starting from 1996-2015. It was found
that in 2013, the leading cause of infant death differed by race.
. To achieve the goal or many objectives there are birth defects monitoring programs. Birth
defects monitoring programs can detect birth defects at an early start and suggest areas for
further research. 42 states out of 50 including Puerto Rico have some kind of birth defect
program. The data collected from these programs are used for prevention and referral activities.
Again, CDC plays a big role in birth defects programs, being one of the main programs. CDC
funds about six centers for birth defects research prevention to collaborate on major multi-state
studies of birth defects 3.
 References
1. Maternal, Infant, and Child Health | Healthy People 2020. Healthypeoplegov. 2017. Available at:
https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health.
Accessed September 13, 2017.
2. Salam RA, Mansoor T, Mallick D, Lassi ZS, Das JK, Bhutta ZA. Essential childbirth and
postnatal interventions for improved maternal and neonatal health. Reproductive Health.
2014;11(Suppl 1). doi:10.1186/1742-4755-11-s1-s3.2017.
3. Available at: http://www.marchofdimes.org/materials/March-of-Dimes-2016-Databook.pdf.
Accessed September 13, 2017.
4. Lattof SR, Wegner MN, Langer A. Quality of Maternal Health Care: A Call for Papers for a
Maternal Health Task ForcePLoS Collection. PLoS Medicine. 2011;8(11).
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review/literature-review-on-maternal-health. Accessed September 13, 2017.
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1-4648-0348-2_ch7.
10. Maternal and Infant Health | Reproductive Health | CDC. Cdcgov. 2017. Available at:
https://www.cdc.gov/reproductivehealth/maternalinfanthealth/index.html. Accessed September
13, 2017.