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1.
Artigo em Inglês | MEDLINE | ID: mdl-39012423

RESUMO

INTRODUCTION: A life course perspective in maternal, child, and family health allows for integrated exploration of outcomes, incorporating multifactorial determinants of health to interrogate sources of inequity and identify opportunities for intervention. This article explores the historical development, integration, and implications of the contemporary life course perspective in the field of maternal and child health (MCH), and particularly the people and events which institutionalized the framework as central to national and local MCH practice and research over the last decades. METHODS: Drawing on an oral history approach, key leaders of the life course movement in MCH were interviewed. Lived experiences and personal recollections of six interviewees were recorded and synthesized using a narrative descriptive approach to portray the social ecology of the movement's origins. RESULTS: We documented systematic efforts made in the first two decades of the 21st century to consciously promote life course through convening a National MCH Life Course Invitational Meeting, incorporating life course as a foundational framework for strategic planning at the Maternal Child Health Bureau, and development of tools and resources by MCH professional organizations. DISCUSSION: The integration of life course theory into the MCH field signified a major shift towards addressing protective and social factors, which aligns with the field's historical emphasis on social justice and rights-based approaches, and parallels the broader public health movement towards social determinants of health and the need to address structural racism. The ongoing relevance of the life course approach in promoting reproductive justice and addressing inequities in health underscores the historical importance of its adoption and use in the current mainstream of MCH research, policy, and practice.

2.
Matern Child Health J ; 26(Suppl 1): 20-25, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34982329

RESUMO

INTRODUCTION: Over the past decade, foundational courses in MCH have been revised and revamped to integrate the life course perspective and social determinants of health in ways that bring these essential issues to the core of the learning experience. Yet the racial reckoning of 2020 and the racially disparate health impacts of the COVID-19 pandemic underscore that a deeper, more focused approach to anti-racist pedagogy is now imperative for MCH educators and others responsible for developing the MCH workforce. METHODS: In this paper, we discuss our experience of building a 'community of practice' of anti-racist MCH trainees through our course, 'Foundations of Maternal and Child Health Policy, Practice, and Science.' RESULTS: We identify four principles which guided our course: (1) building on students' experience, knowledge, identities and social justice commitments; (2) creating a common purpose and shared vocabulary related to racism; (3) organizing classroom activities to reflect real-world problems and professional practices related to addressing structural racism as a root cause of health inequities; and (4) building students' skills and confidence to recognize and address structural racism as MCH professionals. DISCUSSION: We hope that this description of our principles, along with examples of how they were put into practice, will be useful to MCH educators who seek to build anti-racist frameworks to guide MCH workforce development.


Assuntos
COVID-19 , Racismo , COVID-19/epidemiologia , Criança , Saúde da Criança , Humanos , Centros de Saúde Materno-Infantil , Pandemias/prevenção & controle , Estudantes
3.
Matern Child Health J ; 25(1): 66-71, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33242209

RESUMO

PURPOSE: As theories about the causes of racial inequities in infant mortality evolve, they are becoming increasingly complex. Interventions to address these inequities must be similarly complex, incorporating both upstream and downstream approaches. DESCRIPTION: The Best Babies Zone Initiative (BBZ) has been in operation since 2012 with an aim of reducing racial inequities in infant mortality. BBZ is designed to be flexible and responsive to the conditions creating toxic stress in communities of color. After seven years of operation in nine sites across the United States, and interventions implemented in housing, economic, and environmental justice, the Initiative has identified strategies to support the development and advancement of aligned programs. ASSESSMENT: Lessons learned and opportunities were identified across the Initiative's theoretical foundation (the life course perspective) and each of the four foundational strategies: place-based, community-driven, multi-sector work that contributes to broader social movements. Overarching lessons learned about advancing equity in MCH were identified including: the need to focus explicitly on racial equity, the imperative of shifting the time horizon for change, and the importance of identifying sustainable funding mechanisms. CONCLUSION: A complex initiative such as BBZ is relatively nascent in the field of Maternal and Child Health. However it represents an innovative approach to building community power and fostering strategic organizational partnerships in service of addressing root causes of racial inequities in birth outcomes. The lessons learned and opportunities identified by BBZ can serve as a foundation from which to build other programs and initiatives to advance racial justice.


Assuntos
Equidade em Saúde , Promoção da Saúde/métodos , Disparidades nos Níveis de Saúde , Direitos Humanos , Saúde Pública/métodos , Racismo/prevenção & controle , Determinantes Sociais da Saúde , Redes Comunitárias , Participação da Comunidade , Etnicidade , Humanos , Lactente , Mortalidade Infantil/etnologia , Nebraska , Formulação de Políticas , Fatores Socioeconômicos , Estados Unidos
4.
Am J Perinatol ; 34(2): 123-129, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27322668

RESUMO

Objective To determine how an adolescent's risk of cesarean varies by maternal age and race/ethnicity, and evaluate the contribution of obstetric and sociodemographic factors to mode of delivery. Study Design This is a retrospective cohort study of 604,287 births to women aged 13 to 23 years. Regression techniques were used to determine maternal ages at lowest risk of primary cesarean in each major racial/ethnic group before and after adjustment for various cesarean risk factors. Results Adolescent age was associated with lower risk of cesarean compared with young adults (17.2% at age 13 years vs 24.8% at age 23 years, p < 0.05). After stratification by race/ethnicity, Non-Hispanic Black women had the highest probability of cesarean, while Asian/Pacific Islanders had the lowest probability across all ages. When compared with young adults of the same race/ethnicity, young adolescents continued to have a lower risk of cesarean, decreased by at least 30% until age 18 years (White) and 17 years (other racial/ethnic groups). These associations persisted after adjustment for obstetric and sociodemographic risk factors. Conclusion Young maternal age is protective against cesarean delivery in all racial/ethnic groups. Adolescents also experience racial/ethnic disparities in mode of delivery similar to those observed in adults, which were unexplained by either obstetric or sociodemographic factors.


Assuntos
Cesárea/estatística & dados numéricos , Grupos Populacionais/estatística & dados numéricos , Gravidez na Adolescência/estatística & dados numéricos , Adolescente , Negro ou Afro-Americano/estatística & dados numéricos , Asiático/estatística & dados numéricos , Feminino , Macrossomia Fetal/cirurgia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Idade Materna , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Gravidez , Complicações na Gravidez/cirurgia , Fatores de Proteção , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos , População Branca/estatística & dados numéricos , Adulto Jovem
5.
Matern Child Health J ; 20(5): 968-73, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27013517

RESUMO

PURPOSE: Infant mortality reduction in the U.S. has been addressed predominantly through clinical approaches. While these efforts have reduced the infant mortality rate overall, they have not reduced disparities between different racial/socioeconomic groups. To address the interrelated social, economic and environmental factors contributing to infant mortality, a place-based approach is needed to complement existing initiatives and clinical practices. DESCRIPTION: Best Babies Zone (BBZ) is an early attempt to put life course theory into practice, taking a place-based approach to reducing infant mortality by aligning resources, building community leadership, and transforming educational opportunities, economic development, and community systems in concentrated neighborhoods. BBZ is currently in three neighborhoods: Price Hill (Cincinnati, OH), Hollygrove (New Orleans, LA), and Castlemont (Oakland, CA). Assessment In its first 4 years, each BBZ crafted resident-driven strategies for decreasing the root causes of toxic stress and poor birth outcomes. To address resident priorities, BBZ sites experimented with tools from other fields (like design thinking and health impact assessment), and emphasized existing MCH strategies like leadership development. Early challenges, including shifting from traditional MCH interventions and addressing health equity, point to areas of growth in implementing this approach in the maternal and child health field. CONCLUSION: BBZ aims to elevate local voice and mobilize multiple sectors in order to address the social determinants of infant mortality, and other initiatives working to improve MCH outcomes can learn from the successes and challenges of the first 4 years of BBZ in order to bring life course theory into practice.


Assuntos
Redes Comunitárias/organização & administração , Disparidades nos Níveis de Saúde , Mortalidade Infantil , Centros de Saúde Materno-Infantil/organização & administração , Determinantes Sociais da Saúde , California , Criança , Redes Comunitárias/economia , Feminino , Avaliação do Impacto na Saúde , Humanos , Lactente , Nova Orleans , Ohio , Projetos Piloto , Gravidez , Resultado da Gravidez/etnologia , Saúde Pública/métodos , Fatores Socioeconômicos
6.
Matern Child Health J ; 19(11): 2336-47, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26122251

RESUMO

PURPOSE: In May 2012, the Association of Maternal and Child Health (MCH) Programs initiated a project to develop indicators for use at a state or community level to assess, monitor, and evaluate the application of life course principles to public health. DESCRIPTION: Using a developmental framework established by a national expert panel, teams of program leaders, epidemiologists, and academicians from seven states proposed indicators for initial consideration. More than 400 indicators were initially proposed, 102 were selected for full assessment and review, and 59 were selected for final recommendation as Maternal and Child Health (MCH) life course indicators. ASSESSMENT: Each indicator was assessed on five core features of a life course approach: equity, resource realignment, impact, intergenerational wellness, and life course evidence. Indicators were also assessed on three data criteria: quality, availability, and simplicity. CONCLUSION: These indicators represent a major step toward the translation of the life course perspective from theory to application. MCH programs implementing program and policy changes guided by the life course framework can use these initial measures to assess and influence their approaches.


Assuntos
Implementação de Plano de Saúde/organização & administração , Indicadores Básicos de Saúde , Centros de Saúde Materno-Infantil/normas , Vigilância em Saúde Pública/métodos , Criança , Comportamento Cooperativo , Feminino , Humanos , Centros de Saúde Materno-Infantil/organização & administração , Saúde Pública
7.
Matern Child Health J ; 18(2): 396-404, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23793485

RESUMO

In recent years, maternal and child health professionals have been seeking approaches to integrating the Life Course Perspective and social determinants of health into their work. In this article, we describe how community input, staff feedback, and evidence from the field that the connection between wealth and health should be addressed compelled the Contra Costa Family, Maternal and Child Health (FMCH) Programs Life Course Initiative to launch Building Economic Security Today (BEST). BEST utilizes innovative strategies to reduce inequities in health outcomes for low-income Contra Costa families by improving their financial security and stability. FMCH Programs' Women, Infants, and Children Program (WIC) conducted BEST financial education classes, and its Medically Vulnerable Infant Program (MVIP) instituted BEST financial assessments during public health nurse home visits. Educational and referral resources were also developed and distributed to all clients. The classes at WIC increased clients' awareness of financial issues and confidence that they could improve their financial situations. WIC clients and staff also gained knowledge about financial resources in the community. MVIP's financial assessments offered clients a new and needed perspective on their financial situations, as well as support around the financial and psychological stresses of caring for a child with special health care needs. BEST offered FMCH Programs staff opportunities to engage in non-traditional, cross-sector partnerships, and gain new knowledge and skills to address a pressing social determinant of health. We learned the value of flexible timelines, maintaining a long view for creating change, and challenging the traditional paradigm of maternal and child health.


Assuntos
Disparidades nos Níveis de Saúde , Cuidado do Lactente/métodos , Centros de Saúde Materno-Infantil/organização & administração , Mães/educação , Pobreza/psicologia , Determinantes Sociais da Saúde , California , Pré-Escolar , Redes Comunitárias , Feminino , Grupos Focais , Visita Domiciliar , Humanos , Lactente , Cuidado do Lactente/normas , Centros de Saúde Materno-Infantil/economia , Centros de Saúde Materno-Infantil/normas , Estudos de Casos Organizacionais , Pobreza/prevenção & controle , Pobreza/estatística & dados numéricos , Populações Vulneráveis
8.
Matern Child Health J ; 18(1): 171-179, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23479336

RESUMO

In France, reducing social health inequalities has become an explicit goal of health policies over the past few years, one of its objectives is specifically the reduction of the perinatal mortality rate. This study investigates the association between infant mortality and social deprivation categories at a small area level in the Lille metropolitan area, in the north of France, to identify census blocks where public authorities should prioritize appropriate preventive actions. We used census data to establish a neighbourhood deprivation index whose multiple dimensions encompass socioeconomic characteristics. Infant mortality data were obtained from the Lille metropolitan area municipalities to estimate a death rate at the census tract level. We used Bayesian hierarchical models in order to reduce the extra variability when computing relative risks (RR) and to assess the associations between infant mortality and deprivation. Between 2000 and 2009, 668 cases of infant death occurred in the Lille metropolitan area (4.2 per 1,000 live births). The socioeconomic status is associated with infant mortality, with a clear gradient of risk from the most privileged census blocks to the most deprived ones (RR = 2.62, 95 % confidence interval [1.87; 3.70]). The latter have 24.6 % of families who were single parents and 29.9 % of unemployed people in the labor force versus 8.5 % and 7.7 % in the former. Our study reveals socio-spatial disparities in infant mortality in the Lille metropolitan area and highlights the census blocks most affected by the inequalities. Fine spatial analysis may help inform the design of preventive policies tailored to the characteristics of the local communities.


Assuntos
Disparidades nos Níveis de Saúde , Mortalidade Infantil , Características de Residência/estatística & dados numéricos , Classe Social , Teorema de Bayes , Censos , França/epidemiologia , Humanos , Lactente , Cadeias de Markov , Método de Monte Carlo , Características de Residência/classificação , Análise de Pequenas Áreas
10.
Matern Child Health J ; 16(3): 649-55, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21630077

RESUMO

For many decades, early access to prenatal care has been considered the gold standard for improving birth outcomes. In Contra Costa County, a diverse urban and suburban county of over one million people in the San Francisco Bay Area, the Family Maternal and Child Health Programs of Contra Costa Health Services (CCHS) have seen high rates of early entry into prenatal care since 2000. Yet despite our best efforts to increase access to quality prenatal care, our rates of low birth weight and infant mortality, especially among African Americans, continue to be high. When we were introduced to the Life Course Perspective in 2003 as an organizational framework for our programmatic activities, we recognized that emerging scientific evidence in the literature demonstrated the importance of social and environmental factors in determining health and health equity, and supported a general impression in the field that prenatal care was not enough to improve birth outcomes. The Life Course Perspective suggests that many of the risk and protective factors that influence health and wellbeing across the lifespan also play an important role in birth outcomes and in health and quality of life beyond the initial years. In this article, we describe the Life Course Perspective and how one local Maternal and Child Health Program adopted and adapted this paradigm by creating and launching a Life Course Initiative to guide our programs and services. The Life Course Initiative implemented by CCHS is designed to reduce inequities in birth outcomes, improve reproductive potential, and change the health of future generations by introducing a longitudinal, integrated, and ecological approach to implementing maternal and child health programs.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Disparidades em Assistência à Saúde , Centros de Saúde Materno-Infantil/organização & administração , Cuidado Pré-Natal/métodos , Meio Social , Negro ou Afro-Americano , Criança , Feminino , Educação em Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Modelos Teóricos , Gravidez , Resultado da Gravidez , Cuidado Pré-Natal/organização & administração , Cuidado Pré-Natal/estatística & dados numéricos , Desenvolvimento de Programas , Características de Residência , São Francisco , Fatores Socioeconômicos , População Branca
11.
Matern Child Health J ; 15(3): 333-41, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20232126

RESUMO

Pregnant women who use drugs are more likely to receive little or no prenatal care. This study sought to understand how drug use and factors associated with drug use influence women's prenatal care use. A total of 20 semi-structured interviews and 2 focus groups were conducted with a racially/ethnically diverse sample of low-income women using alcohol and drugs in a California county. Women using drugs attend and avoid prenatal care for reasons not connected to their drug use: concern for the health of their baby, social support, and extrinsic barriers such as health insurance and transportation. Drug use itself is a barrier for a few women. In addition to drug use, women experience multiple simultaneous risk factors. Both the drug use and the multiple simultaneous risk factors make resolving extrinsic barriers more difficult. Women also fear the effects of drug use on their baby's health and fear being reported to Child Protective Services, each of which influence women's prenatal care use. Increasing the number of pregnant women who use drugs who receive prenatal care requires systems-level rather than only individual-level changes. These changes require a paradigm shift to viewing drug use in context of the person and society, acceptance of responsibility for unintended consequences of public health bureaucratic procedures and messages about effects of drug use during pregnancy.


Assuntos
Consumo de Bebidas Alcoólicas , Atitude Frente a Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Complicações na Gravidez/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Agendamento de Consultas , California/epidemiologia , Medo , Feminino , Grupos Focais , Acessibilidade aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Gravidez , Complicações na Gravidez/epidemiologia , Pesquisa Qualitativa , Fatores de Risco , Apoio Social , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Fatores de Tempo
12.
Matern Child Health J ; 8(2): 95-102, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15198177

RESUMO

OBJECTIVE: (1) To introduce photovoice, a participatory action research methodology, for use by MCH program managers to enhance community health assessments and program planning efforts, (2) to enable community people to use the photovoice methodology as a tool to record, reflect, and communicate their family, maternal, and child health assets and concerns, and (3) to educate community leaders about family, maternal, and child health issues from a grassroots perspective. METHODS: Photovoice is based upon the theoretical literature on education for critical consciousness, feminist theory, and community-based approaches to documentary photography. Picture This Photovoice project took place in Contra Costa, an economically and ethnically diverse county in the San Francisco Bay area. Sixty county residents of ages 13-50 participated in 3 sessions during which they received training from the local health department in the techniques and process of photovoice. Residents were provided with disposable cameras and were encouraged to take photographs reflecting their views on family, maternal, and child health assets and concerns in their community, and then participated in group discussions about their photographs. Community events were held to enable participants to educate MCH staff and community leaders. RESULTS: The photovoice project provided MCH staff with information to supplement existing quantitative perinatal data and contributed to an understanding of key MCH issues that participating community residents would like to see addressed. Participants' concerns centered on the need for safe places for children's recreation and for improvement in the broader community environment within county neighborhoods. Participants' definitions of family, maternal, and child health assets and concerns differed from those that MCH professionals may typically view as MCH issues (low birth weight, maternal mortality, teen pregnancy prevention), which helped MCH program staff to expand priorities and include residents' foremost concerns. CONCLUSIONS: MCH professionals can apply photovoice as an innovative participatory research methodology to engage community members in needs assessment, asset mapping, and program planning, and in reaching policy makers to advocate strategies promoting family, maternal, and child health as informed from a grassroots perspective.


Assuntos
Proteção da Criança , Redes Comunitárias , Saúde da Família , Planejamento em Saúde , Bem-Estar Materno , Fotografação , Adolescente , Adulto , California , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Formulação de Políticas
13.
San Francisco; Aids Health Project;Celestial Arts; 1990. 400 p.
Monografia em Inglês | Sec. Munic. Saúde SP, EMS-Acervo | ID: sms-10381
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