Maternal and Child Health: Global Challenges, Programs, and Policies

584 Pages·2009·10.46 MB·English

by  Allan Rosenfield

John Ehiri
Editor
Maternal and
Child Health
Global Challenges, Programs, and Policies
1 23
Maternal and Child Health
John Ehiri
Editor
Maternal and Child Health
Global Challenges, Programs,
and Policies
Foreword by Paul Garner
1 3
Editor
JohnEhiri,PhD,MPH,MSc(Econ.)
Director,Professor
DivisionofHealthPromotionSciences
MelandEnidZuckermanCollege
ofPublicHealth
UniversityofArizona
1295N.MartinAvenue
Tucson,AZ85724
USA
[email protected]
ISBN978-0-387-89244-3 e-ISBN978-0-387-89245-0
DOI10.1007/b106524
SpringerNewYorkDordrechtHeidelbergLondon
LibraryofCongressControlNumber:2009932149
#SpringerScienceþBusinessMedia,LLC2009
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Foreword
There has been a crying need for a compendium of teaching and learning
resourcesdedicatedtocriticalglobalhealthissuesconfrontingthemostvulner-
able members of our communities, women, infants, children, and adolescents.
This book bridges this gap in literature by taking a global perspective, but
weighting more of the content on the most pressing problems and possible
solutions in middle- and low-income countries. From the outset, the book lays
outthescene,firstbyrespectinghistoryandexploringthefoundationsofmuch
ofwhatweseetodayintheglobalhealtharenaandthenmovingontoprovide
carefullyresearchedappraisalsofsomeofthemostcriticalissuesthattheunder-
pinachievementofmaternalandchildhealth-relatedMillenniumDevelopment
Goals (MDGs) in middle- and low-income countries, including politics and
power, specific disease conditions, programs, policies, and emerging concerns.
Thus, it is right on target as a valuable educational resource for global health
scholars, agencies, and frontline operatives who are striving to reduce global
healthinequities.Acentralthemeofthebook,amongothers,isthatasystematic
returntobasic,evidence-based,cost-effective,andtime-proventechnologieswill
beanintegralpartofasustainableresponsetoglobalmaternalandchildhealth
challenges.Revitalizinghealthsystemsinless-developedcountriesbasedonthe
tenets of the Alma Ata Declaration of Primary Healthcare, presented by the
WorldHealthOrganizationandUnitedNationsChildren’sFundover30years
agoasthekeytoglobalhealthimprovement,remainsessentialforattainingthe
maternalandchildhealth-relatedMDGs.
Those who work in health care in developing countries are familiar with
poorlyequippedandscantlystaffedhealthfacilitiesthatseehundredsofpatients
each day. Daily, they see the huge and often fluctuating burden of disease, the
tragedyofinfantdeathsfrominfectiousdiseases,andthegrossinjusticeofyoung
women dying in childbirth. The result is that each year globally, more than
500,000women,99%inless-developedcountries,diefrompregnancyandchild-
birth-relatedcomplications.Anadditional15–20millionsuffervariousdebilitat-
ing consequences of pregnancy. Also globally, about 10 million children under
the age of 5 die annually, mostly from lower respiratory infections, diarrheal
diseases,malaria,measles,andundernutrition.Theironyofthisdeplorablestate
of global maternal and child health is that simple, cost-effective interventions
thatcansignificantlyimprovesurvivalandqualityoflifeofwomen,infants,and
children exist. Such interventions include access to clean water and basic
v
vi Foreword
sanitation, immunization, improved nutrition, and access to basic health-care
services. Thus, for the most part, the underlying causes of morbidity and mor-
tality among the maternal and child health population are inequity, poverty,
shortage of health professionals, and dysfunctional health systems that are ill-
equippedtoeffectivelyimplementandmaintainbasichealth-careservices.
Theconceptofaglobalcommunityisperhapsidealistic,butithelpsinterna-
tional health and development agencies, health professionals, and policy plan-
ners to consider commonalities, rather than differences, between nations.
Globalizationisatermthatislooselyused,butoneoftheimportantoutcomes
ofthediscourseisthatithasfacilitatedaconvergenceofthoughtsinthatrather
than dichotomizing the world into developing and developed, it fosters the
understandingthatweallhaveproblemsandsolutions–whetherintherealms
ofpolicy,publichealth,orclinicalcare–thatarefundamentallycommontoall.
Yet, variations exist between nations and even between regions in the same
countries. The burden of ill health and premature death varies dramatically
betweencountriesandwithinsocialandeconomicstratainthesamecountries.
Respectingthesevariationsisessentialtoidentifyingthecommonalities.Itisthus
noteworthythatthefirstpartofthisbookisdevotedtotheissueofheterogeneity
in the world’s resources, systems of care, and health outcomes for women,
infants, and children. Moving on to the second part, readers’ attention is
drawn to the fact that health is always within a context and that maternal and
child health is critically influenced by power and politics within society. To
provide specific examples, the book addresses the challenges posed by wars/
conflicts, globalization, gender equity, harmful traditional practices, and abor-
tion.Adequateunderstandingofthesecontextsandtheirinfluencesonmaternal
andchildhealthiscentraltoidentifyingandappraisingprioritiesforaction.
Equally,understandingthemaindiseaseburdenamongwomenandchildren
and how interventions can influence health outcomes is core to global health
practice.Selectionoftheeightdiseases(malaria,HIV/AIDS,diarrhealdiseases,
malnutrition, tuberculosis, obstetric fistula, disabilities, and injuries) that are
discussedinpartthree(specificdiseaseconcerns)isrational,giventheircontri-
butiontotheglobalburdenofdiseaseamongwomen,infants,andchildren.The
inclusion of tuberculosis and disabilities as they affect women and children
globallyisnotable,giventhelimitedfocusonwomenandchildreninthecurrent
literatureontheseconditions.
How policies and programs are formulated and organized and who delivers
them is central to the identification of appropriate and sustainable solutions.
Thisisthefocusofthefourthandfinalsectionofthebook.Keychallengesand
emerging concerns in global maternal and child health programming are care-
fully chosen andsubstantivelydiscussedin thispart.Notableamongtheissues
coveredaresuchfactorsthathavereceivedminimalattentioninexistingglobal
healthtextbooks,includingtheroleofevidence-basedpolicyandpractice,chal-
lenges in making pregnancy safer, adolescent health, child maltreatment, chil-
dren in difficult circumstances, and workforce training, deployment, and
maintenance in the face of massive brain drain and health worker migration
fromdevelopingcountriestothedevelopedworld.
Whatismostexcitingaboutthisbookisthatitrepresentsaglobalcommunity
of the best people in the field, individuals who understand the issues, have
technicalexpertise,andcanprovidethereaderwithaclear,authoritativesteer.
Foreword vii
With all credit to the editor who has the global vision to bring this impressive
arrayofauthorstogetherunderacommontheme,thisbookisarealcontribution
to help those who want to learn and perhaps become a part of the global
community effort to tackle some of the biggest and most important problems
inglobalhealththatfaceustoday.
PaulGarner
LiverpoolSchoolofTropicalMedicine,England
Acknowledgments
This book was inspired by Greg R. Alexander, RS, MPH, ScD, Maternal and
Child Health Epidemiologist, and former professor and chair, Department of
Maternal and Child Health, University of Alabama at Birmingham School of
Public Health. Greg, one of the most prominent perinatal epidemiologists
nationallyandglobally,ledgroundbreakingstudiesongestationalagemeasure-
ment,prenatalcare,andracialandethnicdisparitiesinbirthoutcomesfornearly
threedecadesuntilhepassedawayinFebruary2007.Hewouldhavebeenproud
to see a profoundly researched, and well-documented textbook that is truly
global in its authorship and content and, most importantly, that is devoted to
issuesofconcerntothehealthofwomen,children,andadolescents.
Thisbookisacollaborativeenterprise.Iwouldliketothankthecontributors
andcolleagueswhohavemadethecompletionofthisworkpossible.Myspecial
thanks go to Sarah Windle, MPH, John Ilonze, MD, MPH, Katie Brigham,
MPH,RebeccaPass,MPA,andCatherineLem,MPH,fortheireditorialassis-
tanceandforkeepingtabsonreferencesintheever-changingdrafts.
Finally,Iamdeeplyindebtedtomywife,Bridget,andtoourchildren,Jenifer,
Laurence, Amanda, and Paula, for their love, patience, understanding, and
unflinchingsupport.
ix
Contents
PartI TheWorld’sHeterogeneity............................... 1
1 AHistoryofInternationalCooperationinMaternalandChild
Health ................................................. 3
AllanRosenfieldandCarolineJ.Min
2 GlobalBurdenofDiseaseAmongWomen,Children,
andAdolescents .......................................... 19
ColinMathers
3 PromotionofGlobalPerinatalHealth......................... 43
VictorY.H.Yu
4 MaternalandChildHealthintheOrganizationforEconomic
CooperationandDevelopment(OECD)Countries................ 53
IanG.ChildandJohnE.Ehiri
5 HealthSystemImpactsonMaternalandChildHealth ............ 83
NancyGerein,AndrewGreen,TolibMirzoev,
andStephenPearson
6 TheEnvironmentandMaternalandChildHealth ................ 99
MaryAnnPassandRebeccaPass
PartII Politics,Power,andMaternalandChildHealth.............. 119
7 ImpactofWarsandConflictonMaternalandChildHealth ........ 121
Emmanueld’HarcourtandSusanPurdin
8 TheImpactofGlobalizationonMaternalandChildHealth ........ 135
SarahWamala
9 GenderEquity:PerspectivesonMaternalandChildHealth......... 151
RachelTolhurst,JoannaRaven,andSallyTheobald
10 HarmfulTraditionalPracticesandWomen’sHealth:Female
GenitalMutilation........................................ 167
SarahWindle,ChuksKamanu,EbereAnyanwu,
andJohnE.Ehiri
xi
xii Contents
11 AbortionandPostabortionCare.............................. 191
AndrzejKulczycki
PartIII SpecificDiseaseConcerns.............................. 203
12 MalariainWomenandChildren ............................. 205
MartinMeremikwu,EmmanuelEzedinachi,andJohnE.Ehiri
13 TheGlobalBurdenofChildhoodDiarrhea...................... 225
CynthiaBoschi-Pinto,ClaudioF.Lanata,andRobertE.Black
14 TuberculosisinChildhoodandPregnancy ...................... 245
KrishnaReddy,DavidMoore,andRobertGilman
15 ImpactofHIVontheHealthofWomen,Children,andFamilies
inLessDevelopedCountries................................. 271
HoosenM.CoovadiaandNigelC.Rollins
16 MalnutritionandMaternalandChildHealth.................... 287
OlafMu¨llerandAlbrechtJahn
17 TheGlobalBurdenofObstetricFistulas ....................... 311
L.LewisWall
18 HealthChallengesforWomen,Children,andAdolescents
withDisabilities .......................................... 323
AmyT.Wilson
19 UnintentionalInjuriesinChildren ............................ 341
WilliamPickett,MarianneNichol,andJohnE.Ehiri
PartIV Programs,Policies,andEmergingConcerns................ 359
20 Evidence-BasedMaternalandChildHealth..................... 361
AlanTitaandJohnE.Ehiri
21 AGlobalPerspectiveonTeenPregnancy....................... 375
AndrewL.Cherry,LisaByers,andMaryDillon
22 ProgressandChallengesinMakingPregnancySafer:AGlobal
Perspective.............................................. 399
MonirIslam
23 GlobalImmunizationChallenge:ProgressandOpportunities ....... 417
RebeccaAffolder,MichelZaffran,andJulianLob-Levyt
24 AdolescentHealth ........................................ 435
ElizabethLuleandJamesRosen
25 TheGlobalBurdenofChildMaltreatment...................... 463
AndreaGottsegenAsnesandJohnM.Leventhal
26 ChildreninDifficultCircumstances........................... 479
NancyMockandElkedeBuhr
27 IntegratedManagementofChildhoodIllness.................... 497
MartinMeremikwuandJohnE.Ehiri