The development and continuous monitoring of health status indicators reflects one of the key infrastructure services at the core of maternal and child health. Many indicators are now routinely collected by a variety of health, economic, and social services agencies, but are routinely made available by the Maternal and Child Health Bureau, through the Title V Information System (https://perfdata.hrsa.gov/mchb/mchreports/Search/search.asp).
Although maternal mortality rates have reached a very low level (recently, about 11.8 deaths per 100,000 live births), this indicator can still serve as an important sentinel of failures in the health system. More generally, maternal health is better reflected in the population rates for a range of reproductive health outcomes: fertility (intended and otherwise), therapeutic abortion, birth, miscarriage, stillbirth, and especially low birth weight. Similarly, many process measures reflect the quality of maternity care: timing and quantity of prenatal care, place of delivery, attendant at delivery, vaginal or caesarian delivery, and complications (including those from nontherapeutic abortions).
The infant mortality rate remains an important outcome measure for MCH. Linking infant birth and death records has added to the ability to assess factors associated with pregnancy outcome.4 The birth certificate form that was adopted in 1989 includes a wider array of information on both the mother and the child, offering opportunities for exploration of the relationships between sociodemographic factors, health and social services factors, and various pregnancy outcomes.
Childhood morbidity is less routinely measured. Birth defect registries, neonatal intensive care use, discharge diagnoses, and national health surveys provide some estimates of morbidity. Immunization rates, school-based health data, and the data from such programs as EPSDT and Children With Special Health Care Needs (prior to the mid-1980s referred to as Crippled Children’s Programs) are also helpful indicators of child health, although they are not collected at either the state or national level as systematically as are infant birth data.
Larger social and demographic changes are also important indicators of the status of mothers and children. Over the last 20 years there has been a dramatic increase in the percentage of mothers in the work force, creating challenges for families and service providers as the interests of mothers working outside the home have gained more prominence. The number of children in single parent families, either through divorce or the absence of marriage to begin with, continues to rise as do the numbers of homeless mothers and children. These social problems contribute directly or indirectly to most of the health problems of women and children
Principles of Services Delivery
Several principles of service delivery stem from the unique focus of MCH on children and their families. Family-Centered Care. In a recently issued statement by the Maternal and Child Health Bureau, “Family-Centered Care assures the health and well-being of children and their families through a respectful family-professional partnership. It honors the strengths, cultures, traditions and expertise that everyone brings to this relationship.
Family-Centered Care is the standard of practice which results in high quality services.”5 The child is not merely the passive recipient of the influences of the family, but, rather, plays an increasingly interactive role in the family, shaping in part the environment in which he or she lives. Similarly, the family works in partnership with the professionals providing services to children, especially where chronic diseases or disabling conditions are present.
Developmental Perspective. The fetus and child are being continuously shaped by the normal developmental processes that result in a reasonably predictable series of changes from conception through adolescence. Progress over this course is a sensitive measure both of health and disease. Singular events or continuous disruption of normal development can have progressively magnifying adverse effects on the fetus or child. Because of the importance of development, prompt identification of problems and early and continuous intervention hold the greatest promise for achieving the best outcome.
Health Promotion and Disease Prevention. Childhood is both a means to adulthood and an end in itself. There is great potential, therefore, for health promotion and disease prevention to benefit both the current child and the future adult. However, careful attention must be paid to the immediate implications of interventions that are aimed at preventing problems in the distant future, making sure that the desired long-term benefits are not counterbalanced by short-term hazards.