INFANT MORTALITY: HEALTH PROBLEM

MATERNAL AND CHILD HEALTH AS A OR SOCIAL PROBLEM?

SOCIAL PROBLEM
“Infant mortality is not a health problem; it is
19th Century - Children’s health first became a a social problem with a health consequence.”
public health concern.
EPIDEMIC OF BIRTH DEFECTS:
The United States was alarmed by the high
infant and child death rates during the summer 1. Minimata, Japan
because of diarrheal diseases. ○ Mercury contamination of
the bay
FACTORS: 2. US - Lead Contamination
● Heat 3. Pesticides
4. Organic solvents
● Poor Sanitation
● Lack of Refrigeration FACTORS:
Heavy microbial infection of milk
● Poverty
1893 - New York established milk stations
● Lack of knowledge, time & energy
1912 - established Children’s Bureau ● Ignorance or lack of financial
1921 - Health services for mothers and resources
children ● Breastfeeding

MATERNAL BEHAVIOR:
MATERNAL & INFANT MORTALITY
● Smoking (SIDS - Sudden Infant Death
INFANT MORTALITY RATE (IMR) Syndrome)
● Drinking alcohol (TERATOGEN)
● Number of infant deaths within the
● Use of illegal drugs (CRACK BABIES)
first year of life.
● Indicator of the health status of a as a SOCIAL FACTORS:
whole
1. Young maternal age
DISTURBING FEATURES OF TRENDS: RACE 2. Low maternal education
3. Out-of-wedlock birth
● IMR for Black Americans is more than
4. Violence
double for White Americans.
STRESS
REASONS FOR THE DECLINE OF IMR

1. Improved socioeconomic status “A state that occurs when persons perceive

2. Housing and nutrition that demands exceed their ability to cope.”
3. Immunization
4. Clean water and pasteurized milk FACTORS THAT LINK POVERTY TO IMR:
5. Antibiotics
6. Better prenatal care and delivery 1. Poor women
7. Availability of family planning services 2. Poor housing
8. Legalization of abortion (US) 3. Mother’s ability to cope
4. Young and single mother

RESULT: MAL-ADAPTIVE BEHAVIOR

 PREVENTING INFANT MORTALITY
CONGENITAL MALFORMATIONS
DISADVANTAGES OF THE TECHNOLOGICAL
APPROACH: LEADING SPECIFIC CAUSES OF INFANT
MORTALITY:
1. Disrupts normal bonding between
parents and infants 1. Congenital Malformation
2. Leaves a significant number of 2. Disorders related to Short Gestation
survivors with long-term and Low Birth Weight
developmental disabilities 3. Sudden Infant Death (SIDS)
3. Severe handicaps
4. Very expensive OTHER DISORDERS:

FOCUS OF PUBLIC HEALTH: 1. Tay-Sachs Disease

2. Hemophilia
Pregnant Women in general 3. Down Syndrome
● Highly motivated to bear a
child NEWBORN SCREENING PROGRAMS
● Receptive to information on
how to avoid risks ● Designed to identify infants born with
High-risk women defects in body chemistry that can be
● Poor remedied by early diagnosis
● Young
● Minority
● Unmarried women

PRENATAL CARE:

● Provides women with information on

how to have a health pregnancy and
bear a healthy child PUBLIC HEALTH INTERVENTIONS
● Most public health-oriented kind of
care the medical profession provides ● FDA regulation of teratogenic drugs
● Important for the women with the such as:
lowest SES (social economic status) ○ THALIDOMIDE
○ ACCUTANE
CDC - Recommends that all pregnant women ○ DILANTIN
should be screened for common infections ● Prevention of German Measles by
and treated if infected. immunization

BARRIERS THAT DISCOURAGE WOMEN AT NATIONAL BIRTH DEFECTS PREVENTION

HIGHEST RISK FROM SEEKING PRENATAL
STUDY
CARE:

1. Lack of information about available FINDINGS:

services
2. Inconvenient hours of service
3. Rudeness and long waits at the clinics
4. Inadequate transportation
5. Lack of child care for older children
● Uncontrolled diabetes or who are
obese are at increased risk for bearing
a child with a broad range of birth
defects.
 ● Smoking during pregnancy increases
risk of premature birth.
● Drinking alcohol during pregnancy
may cause fetal alcohol syndrome.
NUTRITIONAL FACTORS:
2 of the most severe:
● Anencephaly - a lethal condition in
which all or most of the infant’s brain
is missing.
● Spina Bifida - protrusion of the spinal
cord from the spinal column
accompanied by paralysis of the lower
body.
CAUSED BY DEFICIENCY IN FOLIC ACID
(VITAMIN B)
PRETERM BIRTH
1. Prematurity - disorders of short
gestation and low birth weight.
2. 2006 - preterm birth is responsible for
many more infant deaths that are
indicated in the death certificates.
3. 6 of 11 leading causes of infant death
THE EARLIER A BABY IS BORN, THE HIGHER
THE RISK OF HEALTH CHALLENGES.
4 CLASSIFICATIONS:
● LATE PRETERM - born between 34 &
36 completed weeks of pregnancy
● MODERATELY PRETERM - born
between 32 & 34 weeks of pregnancy
● VERY PRETERM - born between 28 &
32 weeks of pregnancy
● EXTREMELY PRETERM - born before
28 weeks of pregnancy
SUDDEN INFANT DEATH SYNDROME
● 3rd leading cause of infant death
● Any unexplained death
● Common in infants of low birth weight
and in infants of smokers or drug
users
● Occurred more frequently in infants
that were sleeping on their stomachs
● “Back of Sleep” campaign
● OTHER FACTORS: soft bedding, being
overheated, and bed sharing
FAMILY PLANNING AND PREVENTION
OF ADOLESCENT PREGNANCY
TEENAGE PREGNANCY HARMFUL
CONSEQUENCES:
1. Interference with the young mother’s
education and career prospects
2. Economic hardship
3. Interference with the formation of a
strong family unit
4. Increases health risk to the child
5. Less likely to seek prenatal care
6. More likely to smoke
7. Less likely to gain adequate weight
UNINTENDED PREGNANCY IN OLDER
WOMEN:
● Only half of the pregnancies among
American women are planned
● Consequence of unintended
pregnancy is induced abortion
● 1 abortion every 4 live births
CONTRACEPTION:
● Female sterilization and vasectomy for
men
● Intrauterine device (IUD) - female
● Hormonal implants
● Pills
 ● Depo-Provera CHILDREN’S HEALTH AND SAFETY
● Condoms and cervical caps
● “Morning after pill” - plan B WELL-BABY CARE:

PUBLIC HEALTH PROGRAMS Children are vaccinated against:

● Diphtheria
1. Comprehensive sex education in ● Tetanus
school ● Pertussis (whooping cough)
2. Abstinence-only advocate ● Polio
3. Promote value of responsible and ● Measles
protective behaviors ● Rubella (German measles)
4. Family planning ● Mumps
● Hepatitis B
NUTRITION OF WOMEN AND
CHILDREN 1993 - Free vaccination coverage among
children ages 19-35 months.
● The emphasis was on breastfeeding
and safety of milk ADDITIONAL VACCINE:

REDUCING RISKS OF: ● Haemophilus Influenzae Type B

(Spinal Meningitis)
● Infectious diseases ● Varicella (Chicken Pox)
● Respiratory infections ● Pneumococcal disease
● Obesity ● Hepatitis A
● Chronic diseases (asthma and
allergies) 2008 - FDA approved the Human Papilloma
Virus (HPV)
INFANTS MUST BE EXCLUSIVELY BREASTFED - Prevent cervical cancer and genital
FOR THE FIRST 6 MONTHS. warts

DURING THE GREAT DEPRESSION (1930) 2009 - immunization rates are tracked by CDC

● Established several food assistance

CHILDREN WHO DO NOT GET REGULAR
programs. Milk, fruit juice, egg,
cereals for pregnant women, lactating
WELL-BABY CARE
mothers, infants and children up to 5
years old. 1. Tuberculosis
● Nutrition education
2. Problems with vision and hearing
● School lunches
● Electronic benefits transfer card 3. Scoliosis - curvature of spine

POOR NUTRITION INCREASES CHILDREN’S

RISK OF:

1. Inadequate cognitive stimulation

2. Iodine deficiency
3. Iron deficiency anemia
4. Overweight and obesity