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This chapter discusses the following topics: the burden of disease, historical development of maternal, neonatal and child health (MNCH) services; the MNCH package of interventions, the integrated management of childhood illness (IMCI); the expanded programme of immunization (EPI); nutrition; school health; family planning; and quality of MNCH services.

The formulation of the right to health in international law lists a series of explicit measures that states must pursue in order to secure the full implementation of this right. These measures, which range from an obligation to reduce infant mortality to the development of preventive health care and family planning services, are extremely broad and open textured. This chapter seeks to examine the extent to which parameters can be placed around their meaning in a way that allows states and the broader interpretative community to agree on the nature of the practical steps required to secure their implementation. Although considerable deference must be given to states' margin of appreciation to allow for a context-sensitive implementation of these specific measures, this margin remains subject to the overriding caveat that whatever measures are adopted by states must be effective.

This chapter reviews key programmes related to sexual and reproductive health, describes the current SRH situation, and highlights remaining challenges. Although strides have been made, goals remain unmet, and the achievement of reproductive rights remains limited.Inequities persist, with adverse outcomes more likely to be observed among those in northern and eastern states, rural populations, the poor, the socially excluded, the poorly educated and the young than other groups. Several challengesimpede progress:lack ofawareness of health promoting behaviours and facilities from which counselling, care and supplies may be obtained, limited health care seeking practices, constraints on female agency and wide gender power imbalances, inadequatemale involvement and the persistence of traditional notions of masculinity, limited spousal communication about sexual and reproductive health matters at individual level;and poor infrastructure,insufficienthuman resources, variable provider capacity, and limited reach and quality of services at programme level.

This chapter presents programs in maternal, child health (MCH) that improve birth outcomes by focusing on preconception health and using a life course approach to address factors in the social environment that impact health outcomes. Four key activities: 1) using key data to identify points in the life trajectory where MCH programs could intervene; 2) identifying how program resources influence life-course trajectories; 3) educating Los Angeles County Maternal, Child and Adolescent Health staff on the Life Course Framework; and 4) developing new partnerships to address issues that impact MCH populations but are beyond our scope of practice. The chapter also presents an evaluation framework and indicators of success.

This chapter presents data on reproductive and sexual health. The first table in the chapter provides national data on fertility rates, contraceptive use, maternal health status and services, and HIV/AIDS prevalence. The second set of tables provides the estimated prevalence of female genital cutting by country where this is practised. The third set of tables provides data on abortion mortality and complications.

This chapter examines colonial intervention in breastfeeding and milk distribution in the Belgian Congo. It shows that these colonial initiatives were linked to a discourse which viewed African birth spacing customs insidious and saw a solution in European women. The chapter explains that the colonial call for a crusade to combat the prejudices that separate the spouses led to the development of the most massive network of maternal and infant health programs in sub-Saharan Africa.

The Zanzibar Maternity Association (ZMA) was a charitable organisation established in 1918 to help Zanzibari women during parturition. Majority funding came from the Arab and Indian communities who, correspondingly, had considerable say in the organisation's remit and agenda. Although the colonial British government had no alternative maternity service of their own on Zanzibar, this chapter shows how anxious the colonial government was about ZMA activities and influence during the 1930s and 1940s. Struggles over ZMA control are positioned as revealing of broader anxieties over the erosion of colonial hegemony and also as demonstrative of the highly flexible way the British constructed racialised discourses about health and hygiene. Ultimately, the British rejected cooperation when it was not precisely on the terms that they wanted.

Los Angeles County faces racial/ethnic and geographic disparities in maternal and infant health. Historically, local surveillance data on the maternal population was lacking.This chapter describes how the Los Angeles County Department of Public Health developed and implemented two comprehensive, systematic perinatal surveillance systems: Los Angeles Mommy and Baby(LAMB) andLos Angeles Health Overview of a Pregnancy Event (LAHOPE). LAMB surveys mothers who recently delivered a live infant, LA HOPE surveys those who experienced a fetal or infant death. The primary goal for both surveys is to collect actionable information on the high-impact factors on the health of local women and babies, including maternal experiences before, during, and right after pregnancy. Findings from these projects enable community stakeholders to identify and prioritize effective interventionsto decrease fetal and infant morbidity and mortality across Los Angeles County’s varied demographic and geographic groups.

The livelihoods of Afghan women have been transformed by decades of war, violence, and political upheaval. Chronic fear of violence and instability shape the daily practices, perceptions, and behaviors of Afghan families in ways that directly affect maternal health outcomes. This chapter examines the multiple pathways to maternal risk as they intersect through historically rooted structural inequalities, such as lack of roads, lack of education, and poverty. Ethnographic data from 2005 to 2008 focus on the northern province of Badakshahn, which suffered the highest known maternal mortality ratio in the world. Long after the Taliban left Kabul, the draconian edicts on female education, marriage, and seclusion continue to impact how isolated Badakhshani villages police women and their bodies.

This chapter concerns family-centered care and discusses a “working model” for a midwifery practice adventure. With family-centered care at the hospital, moms would have a hospital experience that would more closely address the reasons they had wanted a home birth in the first place. Family-centered care looks just like whatever the parents wanted it to look like. The model is that students would undertake their own academic tutelage and preparation for the licensing exam. The New Mexico Department of Health provides the tests, written by the nurse-midwife who was the project manager for the Maternal Child Health Program in charge of regulating and licensing nurse and lay midwives. This model was to cement all the variations of normal into apprentices' tools for management and to teach them the cardinal signs for differentiating a condition requiring consult.

Many children live in enviable conditions where income, environment, housing, health, and education allow them to achieve their potential and enjoy a good quality of life and well-being into old age. Other children experience harsh and brutal conditions, where life is an endless – often losing – struggle for survival. This variable picture needs to be understood in all its complexity if policies and services are to be effective in laying the foundations for health in childhood. The contribution of social work to health and well-being in childhood depends on a multidisciplinary analysis, within a strategic, inter-agency context. This chapter examines major differences in life chances for children and argues for holistic approaches, seeing children's needs and rights in the context of their families, social and cultural groups, and wider environment. It also discusses the impact of wide-ranging policies on health inequalities, maternal and infant health and well-being, health care, social exclusion, discrimination, racism, and emotional health and resilience.

This chapter traces the development of perinatal epidemiology. It illustrates the development of knowledge and the contribution that good epidemiology can make to improvement in maternal and child health and how epidemiological science helps in the formulation of health policy. It also demonstrates the dangers of reliance on central direction in modern heterogeneous populations.

This chapter analyses the delineation of what counts as a critical period for action and intervention in improving maternal health. Using ethnographic interviews alongside descriptive data from the Nepal Demographic and Health Survey, it analyses two critical junctures for maternal health, the antepartum and postpartum periods, in the context of a particular peri-urban community of Nepal. The postpartum period is socially recognized as sutkeri for Hindu Nepalis, a forty-day period in which a woman who gave birth is considered ritually polluted, but also particularly susceptible to long-term health problems if proper care is not taken for her body in its vulnerable state. This perception of bodily vulnerability and mandated care while sutkeri exists in stark contrast to the absence of such notions and protective practices for the period of pregnancy. Pregnancy, an outwardly visible sign of sexual activity, is a state that one should hide or minimize in order to maintain one’s reputation and honour as a woman. Women worked to conceal their pregnancies, and typically no or little extra care was provided to women to meet their nutritional needs or to enable them to avoid hard physical labour. However, intersecting statuses, such as caste and class, and contexts, such as agricultural households and multi-generational households, crosscut any simple characterizations of the pregnancy and postpartum periods—even within the confines of a subgroup of the Nepali population (Parbatiya) in a single community and place.

This introductory chapter discusses the main topic of the book: infant and maternal health care created for impoverished women in the turn-of-the-twentieth-century New York City. In particular, the text compares the health outcomes of three different groups of poor and working-class women whose stories of infant and maternal health care are linked by New York City's first citywide mortality study in 1915. Poor and working-class African American, British West Indian, and southern Italian women received some of the nation's best health care, albeit shrouded in racially gendered and classed misconceptions and stereotypes of their supposed inferiority. In relation to this, numerous historians of public health have shown that socioeconomic factors and cultural traditions have influenced how client communities have responded to the health care they received.

This chapter recounts the Health Department's decision to start health work in the black section of Columbus Hill. It focuses on the agency's devolution of power to the New York Association for Improving the Condition of the Poor (AICP), which decided to ignore the effects of tuberculosis, pneumonia, enteritis, and other respiratory diseases for infant and maternal syphilis. These AICP health officials ignored respiratory diseases for syphilis because of their acceptance of age-old stereotypes. And while changes in the diagnosis and treatment of syphilis infections were still dependent on the determinations of physicians and the efficacy of laboratories, the existence of multiple sites of maternal health care within the neighborhood made it prime territory for a public health demonstration and the subject of multiple articles on syphilis treatments, which were published in medical journals.

This chapter explains how the AICP in 1918 expanded its Columbus Hill model of public/private infant and maternal health care into Lower Manhattan's Little Italy, the Mulberry District, which the agency deemed a more “racially pure” neighborhood in its own internal documents. In this place, the AICP chose to forego the mandatory syphilis testing and treatments for parturient women to receive the prenatal care that they were mandating for black women in Columbus Hill. Instead, the agency took the Italian preference for Italian midwives in its crosshairs and implemented Anglo American physician deliveries in lieu of Italian midwife deliveries in an effort to introduce prenatal care.

This chapter discusses how concerns with maternal health prompted a change among health workers to embrace the value of smaller families. It considers the importance of having a smaller family and the use of different methods for family planning. Effective birth control methods were short in supply in early twentieth-century Latin America so Peruvians commonly used condoms and abortion to control the number of children they had. With developments between the early 1960s and 1970s in reproductive health, health workers became more effective providers of family planning services. The public health establishments became more institutionally capable after the creation of a Ministry of Public Health, Labor and Social Welfare. Through training and research, they acquired the conviction that birth control would save women’s lives and help familial economies. Besides condoms, other cheap alternative contraceptives such as diaphragms, spermicidal tablets, and foams became available.

This chapter examines developments in parental and family support services from 1997 to 2010. Informal family support refers to the multiple ways people care for one another and provide support for family roles. Informal social support within families and social networks builds social bonds and capital and is associated with practical and emotional support for parents and parental and child well-being, particularly maternal mental health. This chapter focuses on better support and services for parents, strengthening marriage, and improving support for serious family problems.