Maternal Health

Common sense as well as scientific evidence tells us that the health of women and the health of their children are closely related. Persistent infant health problems such as low birth weight and prematurity have been linked to maternal conditions that precede pregnancy, and may even be traced through previous generations in a woman's family. A woman in poor health who wants to become pregnant is more likely to experience infertility. Once she does become pregnant, she is less likely to have a healthy infant and less able to marshal the consistent energy and resources needed to promote childhood health. Women and their children share the same social and economic environments; poverty, inadequate housing, and unsafe neighborhoods create multiple stresses and potentially harmful exposures for women, children, and all family members.

In the late twentieth century there was an increase in public awareness and concern about infant health problems stemming from pregnant women's use of substances, including tobacco, alcohol, and illicit drugs, and from sexually transmitted diseases, including HIV and AIDS. Domestic violence is also understood as a public health problem affecting pregnant women and mothers. These behaviors and risks may be found throughout the entire population, but the consequences are often worse for disadvantaged women who have less access to health care and other support services.

Government programs that subsidize health care for children sometimes support women only while they are pregnant or recovering from childbirth. Gender discrimination or lack of support for women, as well as economic and racial inequities, is harmful to the health of families. Knowledge and understanding of the reciprocal needs of women, men, and children are needed to promote the physical and mental health of families and larger communities.

The developing fetus is most vulnerable to many influences soon after conception when women are often unaware of their pregnancies, especially in the case of an unintended pregnancy. Nearly half (49%) of pregnancies to women in the U.S. are not the result of conscious planning at the time of conception. Thus, healthy fetal development in the first trimester requires health screening and education among sexually active women before they become pregnant. Preconceptional health care is a model that provides guidelines for examination, counseling, and treatment of women who may be thinking about getting pregnant. Universal recommendations for all women of childbearing age are likely to reach more potential mothers and may have long-term benefits for the women themselves, regardless of their decisions about childbearing. Examples of such recommendations include smoking cessation, HIV antibody testing, and consumption of vitamins containing folic acid for prevention of birth defects. Utilization of family planning services and routine preventive health care will help women plan the timing of wanted pregnancies and maintain their own health, thus helping them to improve the health of their children.

Prenatal care provides an important opportunity to address the unmet health needs of pregnant women. Although interventions during pregnancy are too late to promote optimal reproductive outcomes for many women, surveillance and care during pregnancy are important for the medical and psychological well-being of both mothers and children. Nutritional, educational, and psychosocial services for women and families are available in comprehensive prenatal care settings. An important role of prenatal care is to engage women in ongoing relationships with health-care providers, so they will have continuing contact with caring professionals after childbirth and during the interval before subsequent pregnancies.

The postpartum period is an important time for establishing positive family relationships, particularly because the social demands on new mothers are significant. In addition to routine preventive care, developmental screening, and treatment of any special needs in childhood, the best way to promote children's health is to ensure healthy mothers and well-functioning families. Physical health is basic to child-rearing responsibilities, but psychological and other supports beyond the medical realm are also essential. Women shoulder the major burden of childcare in most families, a stressful job under the best of circumstances. Taking care of children with special health care needs is even more challenging, requiring guidance and respites for parents as well as supportive services to guarantee the best possible futures for the children.

Because motherhood has been perceived by society as central to women's identities, there is often a gap in access to and utilization of health services after women complete their childbearing years. Women live longer than men, but suffer from a higher rate of chronic diseases later in life. Some of these chronic conditions are influenced by women's reproductive histories, and the continuum of health-care needs is important throughout the life cycle. As more women have entered the workforce, they have accumulated social roles without obtaining relief from traditional responsibilities. As adults, "baby boomers" are becoming caretakers of aging parents while they are still providing support for their own children. Women in this "sandwich generation" deserve social recognition and support for maintaining their own health as they face these new physical and emotional challenges.