Maternal and Child Health
Section Newsletter
Fall 2005

Message from the Chair

This has been one of the most distressing times for all of us, particularly for those in the wake of hurricane Katrina or those with family and friends in the area. For those of us who can only watch and listen to the reports, it has been a frustrating effort to find ways to help that do not add to the problem in the area. APHA has developed several avenues for members to join in volunteering to assist survivors, and there have been other efforts from AAP, ACNM, and other organizations, many of which are listed in the article below. If there are any Section members who need help, please let me know.

APHA leadership and staff continue to solidify plans for the Annual Meeting, rescheduled for Dec. 10-14 in Philadelphia. Check the APHA Web site for details and for any new dates and times of Section meetings and sessions. I look forward to seeing you at the MCH Business/Advocacy Meeting, likely on Sunday, Dec. 11. Perhaps instead of our usual social dinner, we could just have drinks and ask people to contribute instead to a fund to support rebuilding efforts in Louisiana and Mississippi. If anyone is interested in organizing this, please let me know.

Our membership and leadership continue to have open communication on issues and to participate in state and local initiatives to improve health access and quality for women, children, and families. For example, I represent the Association and the Section on the United States Breastfeeding Committee. There is a national meeting of state breastfeeding coalitions being held in Washington, D.C. in January 2006. If you know of a coalition, grassroots, state or locally sponsored, let me know and we can add them to the list of potential participants. Other Section members serve as links to their professional groups and will present updates at the Annual Section meeting.

We will keep you updated on important issues through the MCH listserv or here on the Web site. I appreciate all the correspondence I have received from Section members. We will be having elections again soon, so think about getting involved in the Section Council, Governing Council, or any committee.

I look forward to seeing you and continuing to represent you.

Sincerely
Jan Weingrad Smith
Chair

Hurricane News

APHA Executive Board Responds to Hurricane Needs

In a recent letter to the Executive Board, APHA Executive Director Georges Benjamin, MD, FACP, said, “It's been a challenging week for all of us, I'm sure, as we continue to react and respond to the devastation wrought by Hurricane Katrina. I want to thank all of you for your genuine concern for the affected families and communities, including many APHA members. Your dedication to public health and to this Association is inspiring.”

His letter goes on to talk about moving the Annual Meeting from New Orleans to Philadelphia, and how many of the New Orleans-based contractors have been retained, including the child-care provider, official photographer, florist and security vendor. Implications of the new date and location have been discussed with Annual Meeting program planners, speakers, Section chairs, and Affiliate leadership.

APHA is collecting donations during the Annual Meeting to assist in the recovery and rebuilding efforts. The Association has made a lead contribution of $5,000 and will ask Annual Meeting attendees to join in contributing what they can. APHA also has a link at <http://www.apha.org/preparedness/Katrina_relief.htm> to connect members with volunteer and direct action opportunities. In addition, Board Chair Linda Degutis is forming an APHA Katrina Response Task Force, chaired by board member Carmen Nevarez, to identify actions the Association can take to address the public health impact from Hurricane Katrina. The task force will identify both short-term and long-term recommendations ,with a focus on what APHA can do to help rebuild the public health infrastructure of the affected regions.

The Association has offered its assistance to federal officials and provided copies of the CD-ROM of Control of Communicable Diseases Manual, 18th Edition, to the CDC for relief teams heading to the affected areas. APHA has also posted chapters of Public Health Management of Disasters, 2nd Edition, to its Katrina response Web page above for those responding to the disaster. In Washington, APHA officials have met with Sens. Enzi (R-Wyo.) and Kennedy (D-Mass.), ranking members of the Senate Health, Education, Labor and Pensions (HELP) Committee, to discuss health concerns related to the hurricane and rebuilding the public health infrastructure. They have also met with legislative representatives from the New Orleans area. APHA has also been actively working with the news media to broadcast the public health message.

Benjamin also discussed the impact of the hurricane on both members and staff. While the staff is now faced with the daunting task of quickly changing the meeting location and dates, many are also taking advantage of staff policy that allows them to volunteer six hours a week on hurricane relief efforts.

Hurricane Relief Resources

  • The U.S. Department of Health and Human Services has created a Health Care Professionals and Relief Personnel Worker page at <https://volunteer.ccrf.hhs.gov/>. Many of the volunteer opportunities on this page require clinical skills, but many do not. There is also a link for organized groups that want to deploy together as volunteers.


  • The Peace Corps Crisis Corps, for returned Peace Corps volunteers, is operating in the United States for the first time, in response to Hurricane Katrina. For more information, contact: <http://www.peacecorps.gov/index.cfm?shell=resources.former.crisiscorps.katrina>.


  • The American Red Cross, through its Peer Partners Program, is contacting volunteers to provide mental health services for victims of Hurricane Katrina. For more information, contact: <info@usa.redcross.org>.


  • The State of Louisiana has informed APHA that medical and clerical nurses are needed to help in Special Needs shelters in Baton Rouge, Lafayette, and Lake Charles. The evacuees in these shelters need green level care for conditions such as diabetes. The shelters are seeking volunteers who can dedicate at least a week to the shelter. The requirement to have a Louisiana license has been waived, but licensure in your state must be verified before you can be scheduled to volunteer. The Emergency Operations Center in Louisiana has set up information desks for nurses (1-225-763-5640), physicians (1-225-763-5740), and mental health professionals (1-225-763-5741), to register availability and credentials. This information will be forwarded to the volunteer coordinators, who will contact individuals about when to come to volunteer. The state of Louisiana greatly appreciates everyone who can volunteer.


  • The Mississippi Chapter of the American Academy of Pediatrics (AAP) has set up a relief fund for children and families affected by Hurricane Katrina in Mississippi. This fund will also send aid to the pediatricians on the Gulf Coast, many of whom lost everything to Katrina, but are still diligently working around the clock for the children and other victims of the devastating hurricane. To donate to this relief effort, make checks payable to the Mississippi Chapter of the American Academy of Pediatrics (MSAAP) and include “Katrina's Kids in MS Relief Fund” on the memo line. Mail contributions to: MS Chapter of the American Academy of Pediatrics, c/o BankPlus, 4450 Old Canton Road, Suite 101, Jackson, MS 39211. For more information, contact Gretchen Mahan, Chapter Executive Director, at (601) 613-2503.


  • The Medical Reserve Corps (MRC), a national network of public health volunteers, recognized by DHHS and the Surgeon General is also coordinating volunteers, many from university settings. For more information, contact <www.medicalreservecorps.gov>.

Annual Meeting News

Special Session for Section to Meet Candidates, Shape Policy

The MCH Section Governing Councilors will host a two-part session during the rescheduled Annual Meeting on Sunday Dec. 11, 2005, from 2 p.m. to 3:30 p.m. (room to be announced), entitled "Maternal and Child Health Section Special Meeting."

This session will provide the membership and the Governing Councilors the opportunity to meet and ask questions of all APHA leadership candidates except the presidential candidates, who will attend the regular membership meeting.

The session will also give MCH Section members the opportunity to discuss and comment on all pending policies prior to the Special Policy Review Sessions the Governing Councilors will be attending. Please do not pass up this great opportunity to give your input about your future leaders and policies that will directly affect your organization.

If you have questions about this Special Meeting, please contact Governing Councilor Whip Joseph Telfair at (205) 934-7161 or <jtelfair@uab.edu>.

Innovations in Maternity Care Committee Report

Focusing on the issues before us has been difficult over the past several weeks. The epic proportions of the ongoing disasters in the Gulf Coast make it difficult to relate to the agenda for the fall meeting. We want to express our sympathy to those who have lost loved ones and our concern for all those who have lost everything. The daily recognition of the needs of the survivors and evacuees complicates our communication.

In addition, we as individual providers have been dealing with massive cuts of public health programs. In Tennessee, where two of the co-chairs reside, the population of the state is facing the loss of publicly funded health insurance for more than 300,000 people. This will not directly affect pregnant women or children under 21, but has a serious impact on women’s health.

The mission of the Innovations Committee is to raise the “hard” questions in childbirth. Why do we do this? Is it necessary? Is it mother and child friendly? Does it help better outcomes? The continued growth of technology has caused loss of control by childbearing families of their birth options.

At this time, however, the basic fabric of childbirth may be threatened as the number of actual providers shrinks in the face of staggering increases in malpractice insurance. This year’s Annual Meeting program is planned to highlight the issues in malpractice coverage. The almost five-fold increase in malpractice is closing birth centers and forcing both low-risk and high-risk providers to reevaluate what they are doing.

“Who’s Left to Deliver the Baby?” will be held on Monday, Dec. 12, 2005 from 4:30 – 6:30 p.m. Charles Mahan has agreed to be the moderator for this session. We have several presenters looking at the issues of who is delivering and what the barriers exist to receiving adequate maternity care. The business meeting for the committee, which will follow this session, is a great time for input into what the group is doing. We are looking for increased participation from the committee, as both committee chairs have other section responsibilities within APHA for the next two years. The committee is also scheduled to have a poster session

There is a need to establish a national conversation on malpractice for essential providers. Recently Senator Frist (R-Tenn.) visited a birth center in eastern Tennessee which is a nurse midwifery practice. The visit is covered on the ACNM Web site as well as <www.BirthCenters.org> and the Senator’s own Web site. Check out our news coverage at <http://dpa.xtn.net/> and <http://mca.xtn.net/>. The birth center and other rural obstetrical providers whose practices include over 50 percent Medicaid patients are requesting Federal Tort Claim coverage for their services. However, the proposal for legislation has been somewhat put aside by the immediate needs of Katrina.

Beyond the topic for the Annual Meeting, these issues regarding access to and quality of maternity services will need to be addressed. The committee will be working with the overall Section to plan a strategic approach to these overwhelming concerns. An online survey of access problems as well as malpractice insurance increases is being considered. The loss of federal Maternal and Child Health Funding will only make these problems more difficult in each state.

Comments, questions, concerns….please email Barb Levin at <BarbL11@aol.com> or Carole Nelson at <cpmcnel@usit.net>. Thanks for the time and the effort. We look forward to seeing you at the rescheduled meeting in Philadelphia.

(Editor’s note: The problem of malpractice coverage is, of course, not limited to rural health care delivery settings – see the news story below on the D.C. Family Health and Birth Center.)

Improving Pregnancy Outcomes Committee Report

Make a difference! Join the Improving Pregnancy Outcomes (IPO) Committee of the Maternal and Child Health Section of APHA. We are a dynamic committee that is always looking for new members. We also have an opening this year for a new co-chair. This is a wonderful opportunity to become involved in public health at the national level. We would like to thank the IPO committee chairs from last year, Catherine Rohweder and Susan McLaughlin, for their leadership and diligence on behalf of the committee.

We are looking forward to the APHA Annual Meeting in Philadelphia in December. The IPO committee is planning to meet on Sunday, Dec. 11, 2005, 10-11:30 a.m. (session 220.0). The location has not been determined but will be listed in the meeting materials. Please feel free to come to our meeting even if you are not currently on our committee. We will set our goals for the coming year.

The IPO committee organized three exciting and dynamic sessions for the Annual Meeting on addressing disparities in pregnancy outcomes, evidence-based approaches to improving pregnancy outcomes, and a poster session on evidence-based practices. As of now, however, because of the change in time and location of the Annual Meeting, it is not possible to know yet what will be on the program. We suggest you monitor the APHA Web site for more information.

If you would like to join the IPO committee or receive e-mails on our activities, please e-mail either Judith Katzburg at<jkatzbur@ucla.edu> or Tyan Parker Dominguez at <tyanpark@usc.edu>.

Instead of Ban on Military Recruiters, APHA to Sponsor “Counter-Recruiting" Booth for Peace Activists

A lively debate at the MCH mid-year leadership meeting last February discussed the pros and cons of allowing exhibitors who are at odds with established APHA policy. The issue was the presence of military recruiters in the exhibit hall at the Annual Meeting, despite APHA policy 2002-11, Opposing War in Central Asia and the Persian Gulf (http://www.apha.org/legislative/policy/2002/2002-11-oposwar.pdf ). Because the proposal, put forward by incoming Governing Councilor Dick David from Chicago, was so controversial, MCH Chair Jan Weingrad Smith and other leaders at the meeting resolved to poll all MCH Section members before making any recommendation to the Executive Board. However, APHA staff refused to allow the email to be sent.

Still, David and other anti-war activists felt the issue should be kept alive, so a proposal was drafted, suggesting a peace effort in addition to the military recruiters. The Executive Board agreed to provide and staff a booth in the exhibit hall for the peace perspective to be heard.

A group of APHA members from various sections will be meeting in Chicago to plan alternative efforts, as well. They intend to provide public health professionals and students of military age with some of the harsh facts about military service and the nature of the current war before they make a decision that will impact the lives and health of themselves and many other people. Anyone interested in these anti-military activities should contact a member of the Chicago MCH group coordinating this effort: Dick David rdavid@uic.edu; Joan Kennelly jfk3722@aol.com; Mary Driscoll driscoll@hektoen.org.

Center Pampers Mothers-To-Be: Baby Ailments Lower at D.C. Birth Facility

The Family Health and Birth Center (formerly the D.C. Birth Center) is part of the D.C. Developing Families Center on 17th Street NE. In June, the District’s only independent birth center opened its door to health professionals and other interested parties. The center, housed in a former supermarket across the street from Hechinger Mall, has had low birth-weight, pre-term birth and C-section rates that are 40-50 percent lower than the overall rate for the District. MCH Section member Ruth Watson Lubic, who is in her late 70s and has been a nurse-midwife since 1972, founded the center five years ago. Knowing that the infant mortality rate in D.C. was twice the national average inspired Lubic to create a one-stop place where families – particularly low-income women in disadvantaged areas of the city – could get both child-bearing and child-rearing care. Women across D.C., including the homeless, are welcome. Lubic is the recipient of a 1994 MacArthur Fellowship for starting a birth center in the Bronx.

Soon after this story appeared in the Washington Examiner, the Center was one of two District of Columbia safety net health centers nearly forced to close because of rising malpractice costs. Only quick advocacy work by the D.C. Primary Care Association (DCPCA) kept the doors open. DCPCA is a health action organization serving medically vulnerable residents of D.C. This article is summarized from DCPCA’s Daily Health Alert, a free online newsletter that covers health issues in our nation’s capital. To subscribe, contact Karen Szulgit at <kszulgit@dcpca.org>.

Women Most Fear Breast Cancer, but Heart Disease Is the Top Killer

New Survey Shows What Diseases Women Fear Most

Women’s fear of heart disease has almost doubled since 2002, but breast cancer remains the single most feared disease, according to a new survey commissioned by the Society for Women’s Health Research and released today. Fear of HIV and AIDS has declined, although AIDS cases in U.S. women increased an estimated 15 percent between 1999 and 2003, compared to a one percent increase in men. The other notable change centers on Alzheimer’s disease, where 4.6 percent of women fear it most, compared to 2.8 percent in 2002.

“Women increasingly recognize that heart disease is the biggest health threat they face over the course of their life,” said Phyllis Greenberger, president and CEO of the Society for Women’s Health Research. “Through improved research, increased advocacy and better news reporting, women and their health care providers are getting the message that heart disease is the number one killer of women. Although heart disease strikes women later in life than men, there are steps we can take at all ages to reduce our risk, such as exercise and proper diet, as well as recognize and treat the condition when it develops.”

Heart disease kills 500,000 American women each year, which is over 50,000 more women than men. It strikes women on average 10 years later than men. Women are more likely than men to have a second heart attack within a year of the first one.

Of more than 1,000 adult U.S. women surveyed, 9.7 percent list heart disease, which includes heart attack, hypertension, and other heart-related disease except stroke, as the disease they fear most. That is almost double the 5.3 percent noted in an identical 2002 Society survey. More than twice as many women, 22.1 percent, say they most fear breast cancer, which is virtually unchanged from the previous survey (22.4 percent). All cancer responses combined totaled 57.1 percent. Ovarian cancer (2.7 percent) was the second most feared cancer, followed by lung cancer (2.4 percent).

“While the risk of breast cancer should not be diminished,” Greenberger said, “women need to know that lung cancer actually kills more, claiming the lives of almost 70,000 American women each year.”

Only 9.3 percent of women say they most fear HIV and AIDS, which is down from 11.3 percent in 2002. HIV and AIDS is the most feared disease among African American women, but fear of it has dropped from 34.1 to 29.3 percent. That drop may be tied to black women’s increased fear of heart disease, which has tripled from 2.7 to 8.4 percent. Fear of AIDS in the South (8.8 percent) and West (7.7 percent) is below the national average (9.3 percent).

“The Centers for Disease Control recently reported that women in the South make up 76 percent of new HIV infections in the U.S., but they represent just 30 percent of the nation’s population,” Greenberger said. “Our survey should strengthen calls for greater education on HIV and AIDS and greater access to care.”

The Society for Women’s Health Research is the nation’s only non-profit organization whose mission is to improve the health of all women through research, education and advocacy. The Society encourages the study of sex differences between women and men that affect the prevention, diagnosis and treatment of disease.

International Communications Research of Media, Pa., conducted the survey for the Society by telephone June 22-29, 2005, among a nationwide cross section of 1005 U.S. women aged 18 and older. Figures for age, income, region, education, race and size of metropolitan area were weighted where necessary to align them with their actual proportions in the population. The survey has a 95 percent confidence level.

Story courtesy Society for Women's Research, <www.womenshealthresearch.org>.

A Local Approach to Health Insurance Outreach and Enrollment

Chester County, Pennsylvania, is an affluent area with the highest household median income ($72,288) in the state. However, there are significant pockets of poverty in communities throughout the county, and poverty disproportionately affects female-headed households and women of color. Approximately one in five, or 20.4 percent, of female-headed households with children under 18 live below the poverty level (compared with 4.4 percent of non-female-headed households). Chester County is also home to a growing Latino population moving into the county to work in the mushroom farms and/or service industries. An estimated 45,000 people in Chester County lack health coverage, putting many families at risk for significant health problems. Moreover, research has shown that prenatal care, provided early in a woman’s pregnancy and consistently thereafter, plays an important role in keeping women and infants healthy, and that lack of insurance is a significant barrier to accessing prenatal care.

Since 1995, Maternal and Child Health Consortium (MCHC) of Chester County has worked to enroll pregnant and parenting women into health insurance to help ensure prompt prenatal care and to help meet the Healthy People 2010 goal of enrolling all pregnant women into health insurance. MCHC has identified and enrolled thousands of uninsured women, infants, and children into health coverage through advocacy, education, and the coordination of a countywide enrollment effort. MCHC’s Family Health Advocates, most of whom are bilingual (Spanish/English) and bicultural, work with pregnant and parenting women in their Healthy Start program to fill out the Medicaid or S-CHIP (State Children’s Health Insurance Program) application and gather the necessary supporting documents. MCHC has also partnered with several other community-based organizations in the county to provide an enrollment fund to allocate funds as an incentive for these agencies to enroll uninsured women and children. Together, MCHC and the partnering agencies enrolled 1,116 uninsured Chester County women, children, and men into health coverage in 2004.

MCHC also helps coordinate annual outreach efforts for the county. Each year, MCHC coordinates a local countywide effort as part of the national Covering Kids and Families’ Back to School Campaign, sponsored by the Robert Wood Johnson Foundation. This year, MCHC held numerous outreach activities to help increase the number of children enrolled in CHIP and Medicaid. MCHC shared health insurance information throughout the county, including through display tables, at community events and fairs, and through presentations to business and civic organizations. The display tables included a raffle for children’s backpacks with school supplies provided by Office Depot, First Presbyterian Church of West Chester, and the Exton, Penn. Exchange Club.

MCHC’s health insurance work is made possible through its federal Healthy Start grant and local funding partners including the Brandywine Health and Wellness Foundation, The Huston Foundation, Phoenixville Community Health Foundation, United Way of Chester County and others. For more information, contact Lee Ann Sullivan, Director of Development, Maternal and Child Health Consortium, (610) 344-5370, extension 112, <lsullivan@ccmchc.org>.

Closing the Gap in Infant Mortality in Mississippi

Considerable disparity exists between white and black infant mortality in Mississippi and greatly affects the health of the state. The Closing the Gap on Infant Mortality: African American-Focused Risk Reduction (CTG) program is designed to accelerate the rate of change among black populations and reduce significant disparity in infant mortality related to low birthweight, preterm birth and Sudden Infant Death Syndrome. A combination of medicinal, behavioral, educational, and service system enhancement risk reduction interventions are being implemented in two target areas of the state. Interventions are primarily geared toward eliminating disparities by maximizing access to pregnancy and inter-pregnancy care and examining trends in fetal, infant, and maternal mortality. Implementation activities are under way and preliminary findings will be disseminated as appropriate. Obstacles and barriers to access for Mississippi mothers and infants are being considered.

The CTG grant has enabled the Mississippi Department of Health to move to a higher level of intervention involving many partners working together. The grant activities are geared towards identifying and addressing gaps in provisions of care, access to services, and professional education regarding evidence-based practice and protocols. Grant staff convene groups, create appropriate data collection tools, compile and synthesize disparate information, systematically share information with the group, and write up plans of action, including any necessary protocols. In conjunction with the MDH OB/GYN Consultant, grant staff has developed a standardized checklist of evidence-based interventions which influence birth outcomes.

To promote growth and expansion of services and access, the program plans to identify the most promising and feasible activities and support the implementation of those activities in the communities with greatest need. An example of this would be the fetal fibronectin (fFn) test, a laboratory test proven highly predictive of non-imminent preterm birth. A negative test result confirms that 99.9 percent of the time, the mother will not deliver for at least 14 days. Since only a small percentage of women who present with signs of preterm labor actually deliver prematurely, it is important to be able to identify those who do not need expensive hospitalization and treatments to prevent preterm labor, to save hospital costs, prevent waste of Medicaid funds, and eliminate unnecessary use of scarce resources. Triage also provides mothers who are in need of imminent services with better access and more focused and higher quality care. The program has provided this reasonably inexpensive equipment to three hospitals in the Delta, making this service easily accessible to mothers in all five of the Delta pilot counties. Other aspects of the program include the following:
  • Service expansion plans include training radiological and obstetrical healthcare professionals in the pilot regions to perform cervical length measurements via ultrasonography.

  • Grant staff are also responsible for developing and overseeing a community health worker program. The CHWs canvass high risk neighborhoods going door to door and into community settings to locate mothers and infants in need of access to the health care system.

  • Perinatal regionalization activities include preparation of a written perinatal regionalization plan, currently being written by partners from a recent study of perinatal regionalization in Mississippi.


The Maternal Infant Mortality Surveillance System process brings together a local team of professionals and laypersons to examine de-identified cases of infant and maternal deaths. The purpose of these reviews will be to understand how a wide array of local, social, economic, public health, educational, environmental, and safety issues relate to these losses. This mechanism will help to build relationships among providers, offer educational opportunities, and identify system and infrastructure issues that need to be addressed. MDH systematically offers services to families who experience perinatal loss through the interview that is carried out by social workers.

Research activities include conducting focus groups in six of the eight pilot counties to determine culturally appropriate messages for Sudden Infant Death Syndrome (SIDS) risk reduction activities. A proposed phenomenological qualitative study seeks to “hear the voice” of the African American mother who has experienced a SIDS loss. Other SIDS risk reduction activities include contracting with a forensic nurse to expand SIDS diagnosis capacity among county coroners and promote completion of infant death scene investigations.

Finally, dissemination of information is a key component for achieving a lasting effect within the state. In years two and three of the grant, MDH will sponsor educational conferences related to grant activities and research findings focused on reducing infant mortality among African American populations. The purpose of these conferences will be to maintain a statewide focus on infant mortality and its prevention. The health of mothers and infants is of critical importance, both as a reflection of the current health status of the state and as a predictor of health for future Mississippi generations.

For more information on the CGT project, contact Juanita Graham, MSN, RN, Mississippi Department of Health, <Juanita.Graham@msdh.state.ms.us>.

FCI Initiative Boosts Skilled Birthing Care

Childbirth is a time fraught with emotion: anticipation, nervousness, fear, joy. Anger is not what most people think about or feel. But Family Care International knew that they were touching the hearts and minds of their community when its Skilled Care Initiative team in Burkina Faso presented a play about the dangers of giving birth at home. From the audience, one of the men leapt up, grabbed a stick, and started yelling, enraged at the actor who had forced his “wife” to deliver with a traditional birth attendant instead of going to the health clinic.

As the Skilled Care Initiative wraps up its fifth and final year, there is every indication that it will meet its goal of increasing skilled attendance rates in the project areas by at least 10 percent. The Initiative, which is being implemented by Family Care International with funding from the Bill and Melinda Gates Foundation, has proven to be a truly effective weapon in the battle to save women’s lives. It reaches into four rural districts in Africa (in Kenya, Tanzania, and Burkina Faso). It emphasizes skilled care before, during, and after childbirth. It focuses on better training, support, and facilities for skilled attendants, along with a multifaceted “package” of activities including ground-breaking research and evaluation tools, and a community-centered strategy to ensure that women want to, and are able to, deliver with a skilled attendant by their side.

In this way, the Skilled Care Initiative is exploring what it takes to make skilled care available to women, based on a real understanding of the constraints women and health providers face. Only five years ago in Burkina Faso, rates of skilled attendance were among the lowest in Africa. Since the Skilled Care Initiative was introduced in 2000, the proportion of women in the project district who deliver with skilled care has risen from about one-fifth to about one-third, based on health facility records. In Tanzania, clinics in the Skilled Care Initiative project district are reporting that the number of women who deliver with skilled assistance each month has increased by 20-50 percent.

The first years of the Skilled Care Initiative were dedicated to research and a range of activities to strengthen local capacity and improve care in health facilities – training, providing supplies and equipment, upgrading communication and transport mechanisms, and strengthening supervision and monitoring. The next stage was a focused Behavior Change Communication strategy to give people the specific information and support they need to help them move from their previous practices to new and healthier behaviors.

While health talks, counseling, and printed materials are used in clinics and villages in each project area, some of the most exciting elements of the strategy take full advantage of popular culture. Participatory theater, songs, and dance are effective ways to encourage discussion and to inspire deeply personal commitments to saving lives.

Local leaders have also given the Initiative tremendous personal support. In Ratanga, Kenya, one local chief has asked his wife, a trained traditional birth attendant, to stop conducting deliveries in the home because “I do not want to write statements on deaths of mothers.” Another head chief, who oversees 18 villages, has made it a weekly ritual to visit the health centers on antenatal care days to encourage the women to return to the facility for delivery.

Although the final project data will not be collected and analyzed until 2006, the Skilled Care team has noted an interesting trend: Use of skilled care increased steadily in the beginning of the project (as health services were being improved), and then began to jump more sharply once the Behavior Change Communication strategy was launched. The data has also confirmed a strong link between knowledge and planning and the use of skilled care. In fact, women who can recognize the danger signs and are aware of the importance of delivery in a health facility, and women who discuss plans for delivery with their families and put aside money to pay for costs, etc., are between two and four times more likely to seek skilled care than others (<http://familycareintl.org/pubs/PDF/SCI/TechnicalBrief_HHS_Eng.pdf>).

In the discussion following the play in Burkina Faso, the stick-wielding audience member admitted that his own wife had given birth at home without any preparation and without his involvement. Watching an actor behave the same way, and seeing how that behavior could end in a woman’s death, brought the man to the swift conclusion that, “I must turn the stick against myself; we are often blind to our own actions, and deaf to our own words.” For more information, contact Lauren A. Goddard, program assistant, Skilled Care Initiative Family Care International, <lgoddard@familycareintl.org>.

Perinatal Network in Argentina: Lessons from the Field

During the social crisis that occurred in Argentina in 2001, the need to improve the capacities of the public health sector, in the context of political and institutional responsibilities, was our primary goal. As a result, a project based on the creation of a network of perinatal units for an under-served population in the Buenos Aires Metropolitan Area was developed. This initiative was supported by the MOH of Buenos Aires Province, the Buenos Aires City, and CESTAS (Centro di Educazione Sanitaria e Tecnologie Appropriate Sanitarie, Italy). The network integrated 10 public hospitals. The main objectives of this project were to develop research capacities and the use of epidemiological tools to generate awareness, to improve the quality of health care delivery for pregnant women and to contribute to formulate comprehensive health care policies. Although less than two years have passed since the inception, there are some positive results to share:
  • Ten perinatal units are working in collaboration, recognizing each other as significant partners.

  • A program of training activities (including perinatal epidemiology, clinical guidelines development and evidence based medicine) was established in order to build local teams. The network is now publishing its second perinatal epi report.

  • Two research projects are underway: one evaluating the prevalence of beneficial and harmful health practices and the other to develop of a set of indicators that will evaluate perinatal health progress at the regional level.


Research and training are potent instruments to motivate health workers, to provide valid knowledge based on their own realities, experiences and needs and to provide better quality of care to the population. For further information, contact Raul Mercer, MD, MSc (scientific coordinator), or Arile Karolinski, MD (general coordinator), at: <www.redperinatalamba.org.ar>.

People in the News

  • Elaine Borawski, PhD, Associate Professor in the Department of Epidemiology and Biostatistics at the Case Western Reserve University School of Medicine, was granted tenure at her university July 1, 2005. Dr. Borawski was also recently appointed as a standing member of the Behavioral and Social Science Approaches to Preventing HIV/AIDS (BSPH) Study Section at the NIH.

  • The Perinatal Pediatrics Section of the American Academy of Pediatrics (AAP), has announced that Stanley N. Graven, MD is this year’s recipient of the prestigious Virginia Apgar Award. This Award is given annually to an individual whose career has had a continuing influence on the well-being of newborn infants. Dr. Graven is being honored for his pioneering work in the development of regionalized systems of perinatal care, and also for his efforts to improve the developmental environment of neonatal intensive care units. The award will be presented at the National Conference and Exhibition, to be held October 8-11, 2005, in Washington, DC.

  • After three and a half years of consulting, as well as painting, exhibiting, and selling her art, Catherine Hess, former AMCHP Executive Director, has accepted a new senior position with the National Academy of State Health Policy (NASHP). Cathy has worked with states (LA, DC, NH, PA), national organizations (AMCHP, National Institute for Health Care Management, New York Academy of Medicine), and federal agencies (AHRQ, MCHB). NASHP serves state policy makers in both legislative and executive branches, and you can browse www.nashp.org to review work on early childhood development, obesity, and Medicaid. Among other current projects, Cathy is leading a new Commonwealth-funded initiative on state policies relevant to the work of its new High Performance Health Systems Commission, as well as policy analyses of child health coverage, funded by the Packard and Robert Wood Johnson Foundations. She will also be developing new program areas for NASHP. One of her recent consulting projects was a brief study for MCHB on states' practices for obtaining public input on the MCH Block Grant. That report can be found at: www.mchtaproject.comhttp://www.mchtaproject.com/.

  • In July, 2005, former MCH Section Chair Linda A. Randolph, MD, MPH, received the 2005 Distinguished Service Award from the Howard University College of Medicine. Also in July, Linda tells us, her organization, the Developing Families Center, was visited by Justice Ruth Bader Ginsberg, who shared her very positive and supportive thoughts about their work. It was described by a donor as an “intoxicating” event.

Research

Maternal and Child Health Data in the NLSY79

The National Longitudinal Surveys of Youth (NLSY79) contain information on a broad range of health issues, many of which relate to mothers, children, and adolescents. Respondents to the main youth survey have been interviewed since 1979. The children of the NLSY79 mothers have been assessed since 1986, and are now being interviewed as they become young adults.

The child data are suitable for examining the dynamic nature of both biological and social determinants of health, and the inter-cohort nature of the surveys allows researchers to examine individual and family antecedents of health behaviors and outcomes. The main survey contains extensive information about health conditions, insurance, and occupational injuries and illnesses. The dataset on children, a major source of national data on child and adolescent development, has been featured prominently in recent studies of obesity, health insurance, behavior problems, child care, and maternal employment. The child surveys contain measures of each child’s general health status and history, mental health, height and weight, limiting health conditions, accidents and injuries, stress and anxiety, depression, substance use, immunization, hospitalization, birth histories, pre/postnatal care, illnesses, menses, handedness and eye color, health care access, insurance coverage, and medical visits. The child assessments include temperament scales, the full Behavior Problems Index, and mother reports of motor and social development. The 2004 child/young adult survey round, in which 7,500 children and young adults were interviewed, included detailed questions about asthma onset and history.

The data from the NLSY79 have been used to address a range of health-related topics, including smoking behavior during pregnancy, birthweight and gestational age, differentials in access to health care, adolescent drinking, and the impact of risk factors on developmental outcomes. The data and documentation are available, at no charge via ftp at: <http://www.nlsinfo.org/web-investigator/>. For information contact: NLS User Services, Center for Human Resource Research, 921 Chatham Lane, Suite 100, Columbus, OH 43221-2418, Phone 614-442-7300; <usersvc@chrr.ohio-state.edu>.

Landmark Study Shows Giving Birth at Home is Safe

The largest prospective study of planned home birth with a direct-entry midwife shows that homebirth is as safe as hospital birth for low-risk women, yet carries a much lower rate of medical interventions, including Cesarean section.

“Outcomes of planned home births with certified professional midwives: large prospective study in North America.” Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager. BMJ 2005; 330:1416 (18 June), is published online at <http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom>.

Planning a home birth attended by a Certified Professional Midwife offers as safe an outcome for low-risk mothers and babies as does hospital birth. This study is the largest yet of its kind. The researchers used prospective data on more than 5,400 planned home births in North America attended by Certified Professional Midwives during the year 2000.

Canadian researchers Johnson and Daviss studied more than 5,400 low-risk pregnant women planning to birth at home in the United States and Canada in 2000. The researchers analyzed outcomes and medical interventions for planned home births, including transports to hospital care, and compared these results to the outcomes of 3,360,868 low-risk hospital births. According to the British Medical Journal press release, they found:
  • Eighty-eight percent of the women birthed at home, with 12 percent transferring to hospital.

  • Planned home birth carried a rate of 1.7 infant deaths per 1,000 births, a rate "consistent with most North American studies of intended births out of hospital and low-risk hospital births."

  • There were no maternal deaths.

  • Medical intervention rates of planned home births were dramatically lower than of planned hospital births, including: episiotomy rate of 2.1 percent (33.0 percent in hospital), Cesarean section rate of 3.7 percent (19.0 percent in hospital), forceps rate of 1.0 percent (2.2 percent in hospital), induction rate of 9.6 percent (21 percent in hospital), and electronic fetal monitoring rate of 9.6 percent (84.3 percent in hospital).

  • Ninety-seven percent of the more than 500 participants who were randomly contacted to validate birth outcomes reported that they were extremely or very satisfied with the care they received.


  • The Midwives Alliance of North America celebrates the publication of this groundbreaking study demonstrating the safety and satisfaction that are hallmarks of the care provided to North American women birthing at home with midwives. This study is the largest of its kind to date; it eliminates confounding factors by distinguishing between planned and unplanned birthplace; and because of the study's prospective nature, it is able to assure accounting for all outcomes. The authors' finding that Certified Professional Midwives "achieve good outcomes among low risk women without routine use of expensive hospital interventions" challenges the unnecessary proliferation of many interventions performed routinely on women and babies in low-risk hospital births. This study:
    • Provides irrefutable evidence in support of the American Public Health Association's resolution (2001) to increase access to out-of-hospital births attended by direct-entry midwives.

    • Supports the World Health Organization 1996 statement that “midwives are the most appropriate primary healthcare provider to be assigned to the care of normal birth.”

    • Supports the Coalition for Improving Maternity Services (CIMS) 1996 statement that, “midwives attend the vast majority of births in those industrialized countries with the best perinatal outcomes.”

    • Supports what midwives have always asserted: that planned home birth with a trained midwife is a safe, high-quality, satisfying, cost-effective choice for healthy women and their babies that results in superior outcomes. The Midwives Alliance of North American (MANA) recommends making midwifery care the gold standard in maternity care in North America.


    For more information about midwifery in North America, contact the Midwives Alliance of North America, Abby J. Kinne, 1st Vice President, (888) 317-8841, <1stvp@mana.org>.

    Building on Family Strengths: Parent Education for Families with Special Needs Kids

    The 2001 National Children with Special Health Care Needs (CSHCN) Survey reported that 12.8 percent of America’s children have special needs. Comprehensive care management for these children is an essential part of health care, improving outcomes, and lowering long-term costs of care (Starfield & Shi, 2004). Parents are the primary care providers and experts on day-to-day management of their child‘s condition, while health professionals may have disease-specific expertise, and children have the potential to contribute to the long-term management of the condition.

    The family’s ability to manage the child’s illness has been shown to improve maternal emotional health (Ireys, Chernoff, DeVet & Kim, 2001), but to effectively cope and master management over the years, parents must view their role in chronic illness management within the larger context of their developing family life. The family’s ability to change their focus from the chronic illness and medical needs during specific times of crisis to maintenance of normative goals and community involvement during times of stability is critical to effective management of the illness, its emotional consequences, and achievement of desired quality of life. (Kieckhefer & Trahms, 2000; Broome, Knafl, Pridham & Feetham, 1998; Gustafsson, Bjorkstein & Kjellman, 1994; Knafl, Breitmayer, Gallo & Zoller, 1996). In addition, drawing the child into developmentally appropriate management activities with the parent can help move the family forward toward reaching their long-term family goals.

    Specialty medical clinics teach illness-specific care techniques and provide illness-specific support groups, but it is rare for these clinics to address the management of a child’s illness in the context of family life (Knafl, et al., 1996), managing parents’ own reactions and emotions (Whyte, Baggaley, & Rutter, 1995), or educating their child over time to become developmentally appropriate partners in shared management of the chronic condition (Austin, 1990; Kieckhefer & Ratcliffe, 2000; Knafl et al., 1996; Thomas, 1987). Families who can acquire these skills can affect the child’s long-term care, and have the potential to develop positive life long illness management behaviors in their child regardless of the specific illness. Balance and flexibility can be fostered through interactions with other parents who have children with chronic illnesses when they openly share concerns, issues and successful strategies. Few programs, however, have been created and formally tested to see if they can help families achieve these important goals.

    One interdisciplinary research project in Seattle, funded by the Agency for Healthcare Research and Quality (Grant No 5 R01 HS013384-02), is attempting to address this need by testing a parent education program, titled Building on Family Strengths, for parents of children with ongoing health needs. The seven-session class is offered jointly by the Center for Children with Special Needs of Children’s Hospital & Regional Medical Center and the School of Nursing and Center for Human Health and Disability at the University of Washington.

    The essence of this project was founded on the principle of family-centered care. To insure the quality, effectiveness, applicability and success of the project, families were and continue to be involved at every level of the research project, including roles as consultants, focus groups, pilot participants, facilitators and Co-Investigator. These roles have contributed to the original concept formation, grant application, curriculum development, implementation processes and evaluation approaches. To learn more about the involvement of families in this research, view slides from a recent presentation: <http://cshcn.org/presentations/FamilyInvolvementResearch.htm>.

    The Building on Family Strengths curriculum offers parents the opportunity to learn new ways of coping and managing family activities impacted by the illness. This includes: skills to work with health and school systems, ways to involve their child in his or her own care, tips to achieve difficult goals, and a safe place to share how their child's health impacts them, their parenting and their family. Learn more about the project at <www.familystrengths.org>. We look forward to sharing results of the evaluation at a later date.

    American Indian and Alaska Native Children: Findings From the Base Year of the Early Childhood Longitudinal Study, Birth Cohort

    This report provides descriptive information about American Indian and Alaska Native (AIAN) children born in the United States in 2001. It presents information on characteristics of their families, on children's mental and physical skills, on children's first experiences in child care, on the fathers of these children, and on their prenatal care. The report profiles data from a nationally representative sample of children at about 9 months of age both overall, and for various subgroups (i.e., male and female, AIAN children living in different types of families, AIAN children living in poverty). This report tells us that about one-third of AIAN children live in poverty (34 percent), about one-third live in households where the mother has less than a high school education (34 percent); three-quarters live in households with two parents, and about one in 10 (11 percent) were born to teen-aged mothers. Nonetheless, AIAN children at about 9 months of age do not perform significantly differently from the general population of children in terms of early mental and physical skills, such as exploring objects in play, babbling, eye-hand coordination and pre-walking skills. To view the full report, go to: <http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2005116>.

    Firsthand or Secondhand, Smoke Imperils Fetus

    Cigarette smoking and being exposed to secondhand smoke during pregnancy are equally likely to cause permanent genetic mutations in the fetus, according to a New York Times article published Aug. 2, 2005. Reporting on a new study by Stephen G. Grant, PhD, an associate professor of environmental and occupational health at the University of Pittsburgh, the article said that babies born to [a] active smokers, [b] women who were exposed to secondary smoke during pregnancy, and [c] women who quit smoking when they found out they were pregnant, all had similar and significant increases in gene mutations. The mutations were found by examining umbilical cord blood.

    According to the report, a woman who quits smoking when she discovers she is pregnant is more likely to be exposed to second-hand smoke because she is likely to continue to socialize with friends and family who smoke and to frequent places where others continue to smoke, thinking that exposure to other smokers is not serious.

    Grant told the Times that his findings have significant implications for public health policy. If secondhand smoke does as much damage as smoking, then it may be essential to protect pregnant women and women who intend to become pregnant by banning smoking in the workplace and other public spaces. Moreover, people should probably be barred from smoking anywhere in the presence of a pregnant woman.

    The citation for Grant’s study is: Grant, SG. Qualitatively and quantitatively similar effects of active and passive maternal tobacco smoke exposure on in uteromutagenesis at the HPRTlocus. BMC Pediatrics 2005, 5:20 doi:10.1186/1471-2431-5-20. June 29, 2005.

    Resources

    Folic Acid Guide Available Online

    Advocating For Folic Acid: A Guide For Health Professionals (www.folicacid.net), is a free, Web-based course designed for current and emerging health professionals. It provides information on the benefits of folic acid and strategies for counseling individuals regarding folic acid intake. Users are presented with numerous interactive elements that allow them to learn and test their knowledge, including a case study and a virtual kitchen. The module also includes a section that contains detailed information for specific health professionals (allied health, dentistry, dietetics, medicine, nursing, optometry, pharmacy and public health), including why and when individuals should receive counseling. Special features allow educators to view student performance.

    A number of health professional schools are currently using this education tool. A special section of the Web site describes relevance of folic acid to the public health professionals.

    This project was made possible through funding from the March of Dimes. The course was developed with the assistance of numerous subject matter experts and professionals in maternal and child health. For more information about the Web site, contact Kalpana Ramiah at <Kramiah@asph.org>. Please see how <www.folicacid.net> can be used within your classes.

    Rocky Mountain Public Health Education Consortium

    Are you interested in continuing education in MCH? The Rocky Mountain Public Health Education Consortium (RMPHEC) is a consortium of academic and practice partners in the Rocky Mountain and frontier west. The overall purpose of this consortium is to increase the leadership skills of MCH professionals in the Rocky Mountain region and surrounding areas by facilitating the timely transfer of new information and research findings related to MCH, and updating and improving the knowledge and skills of the MCH workforce using a variety of educational formats and offerings.

    Collaborators of the RMPHEC include graduate public health programs at University of Alaska Anchorage, University of Arizona, University of Colorado Health Sciences Center, University of New Mexico, University of Utah, and Utah State University. Other collaborators include local, state and tribal MCH practitioners and programs, LENDs/UCEDDs and MCH/CSHCN Agencies/Associations.

    The following are active programs of the RMPHEC:
    • Annual MCH Summer Institute (in Tucson, July 2006)

    • MCH Certificate Program (post-baccalaureate traineeship)

    • MCH Continuing Education – Distance Learning Opportunities


    The RMPHEC Web site includes links to many distance learning opportunities, including those developed by the Consortium. The overall aim of the newest RMPHEC project based at University of Alaska Anchorage is to utilize distance learning methods to build leadership capacity and support community based systems of care to serve the needs of geographically isolated MCH public health practitioners.

    This new CE project will provide a unique focus and content specifically tailored to meet the continuing education needs of those serving ethnically diverse frontier, border and tribal areas using innovative problem-based methods reflective of the issues of the Rocky Mountain west. For more information about RMPHEC, see our Web site at <http://services.tacc.utah.edu/rmphec>. For more information about the new distance learning project, contact Dr. Rhonda Johnson at <afrmj@uaa.alaska.edu> or Bridget McCleskey at <confcoor@gci.net>.

    Public Health Reports Covers Disparities in Care for Children

    The July/August 2005 issue of Public Health Reports is devoted to articles about disparities in children’s health. The issue is Volume 120 Issue No. 4. For more information, contact editor Robert A. Rinsky, PhD, at <http://www.publichealthreports.org/>. Articles include the following:

    • Guest Editorial: Use of Evidence to Reduce Child Health Disparities in the U.S.: An Introduction to this Issue of Public Health Reports -- Edward F. Donovan, MD and Barbara Rose

    • Moving Beyond the Status Quo in Reducing Racial and Ethnic Disparities in Children's Health -- Dennis P. Andrulis, PhD, MPH

    • Health Disparities in Children: A Lasting Legacy -- Barbara Rose

    • Racial and Ethnic Differences in ADHD and LD in Young School-Age Children: Parental Reports in the National Health Interview Survey -- Patricia N. Pastor, PhD and Cynthia A. Reuben, MA

    • Discrepancies Between Published Data on Racial Classification and Self-Reported Race: Evidence from the 2002 North Carolina Live Birth Records -- Paul A. Buescher, PhD, Ziya Gizlice, PhD, andKathleen A. Jones-Vessey, MS

    • Intergenerational Health Disparities: Socioeconomic Status, Women's Health Conditions, and Child Behavior Problems -- Robert S. Kahn, MD, MPH, Kathryn Wilson, PhD, and Paul H. Wise, MD, MPH

    • Trends in Maternal and Infant Health in Poor Urban Neighborhoods: Good News from the 1990s, but Challenges Remain -- Embry M. Howell, MSPH, PhD, Kathryn L. S. Pettit, MPP, and G. Thomas Kingsley, MCP

    • Limited English Proficiency, Primary Language at Home, and Disparities in Children's Health Care: How Language Barriers are Measured Matters -- Glenn Flores, MD, Milagros Abreu, MD, and Sandra C. Tomany-Korman, MS

    • Disparities in Access to Care and Satisfaction Among U.S. Children: The Roles of Race/Ethnicity and Poverty Status -- Leiyu Shi, DrPH, MBA and Gregory D. Stevens, PhD, MHS

    • Poverty Experience, Race, and Child Health -- Jennifer Malat, PhD, Hyun-Joo Oh, MS, and Mary Ann Hamilton, MA

    • Demographic and Socioeconomic Factors Associated with Blood Lead Levels Among Mexican-American Children and Adolescents in the United States -- Leo S. Morales, MD, PhD, Peter Gutierrez, MA, and Jose J. Escarce, MD, PhD
    • Disparities in Children's Use of Oral Health Services -- Dana C. Hughes, DrPH, Karen G. Duderstadt, RN, MS, NP, Mah-Jabeen Soobader, PhD, and Paul W. Newacheck, DrPH

    Emerging Issues in MCH Conference Call Series

    NACCHO and CityMatCH have partnered to present the Emerging Issues in Maternal and Child Health (E-MCH) Conference Call Series. These monthly conference calls highlight research and information on different MCH topics. Guest speakers from national organizations and state and local public health agencies discuss their experiences and share information on programs related to the featured topic. The 2005-2006 call series will include discussions on breast and cervical cancer prevention, issues of healthy weight, youth smoking prevention, eliminating disparities in health, Medicaid, and workforce development. For the full schedule of calls, visit <www.naccho.org/topics/hpdp/mch/emch.cfm/>. For additional information, contact Angela Ablorh-Odjidja, MHS, Senior Analyst, at (202) 783-5550, Ext. 262, or <aablorh@naccho.org>.

    Of Note

  • America's Children: Key National Indicators of Well-Being 2005 --
    <http://www.childstats.gov/americaschildren/index.asp>
    This is a biennial report to the nation on the condition of children in America. Nine contextual measures describe the changing population, family, and environmental context in which children are living, and 25 indicators depict the well-being of children in the areas of economic security, health, behavior and social environment, and education.


  • Going Without: America’s Uninsured Children, A 31-page Robert Wood Johnson Foundation report documenting that among the millions of uninsured children, many of them black and Latino, one in three goes an entire year without seeing a doctor. Aug. 2, 2005 marked the kick-off for “Covering Kids and Families,” the foundation’s sixth annual campaign encouraging parents to make health insurance enrollment a back-to-school priority. In D.C., 10 percent of children were without insurance in 2002-03, the time covered by the report, and 25 percent of uninsured children didn’t see a doctor for a year – lower than the 33 percent national average. Bilingual information, outreach efforts, and streamlining government eligibility requirements could increase primary care enrollment. Many children don’t go to see a doctor – they go to the emergency room for treatment. For more information, go to <www.coveringkidsandfamilies.org>.


  • La guía esencial sobre sexualidad adolescente was released on Sept. 15, 2005, and made available for young people, parents, educators, physicians and to all those who have been searching for a science and reality-based sexuality resource for Spanish speaking populations. Chapter include: Sexual Anatomy; Things to Expect During the Teen Years; Love, Love, Love; Healthy and Unhealthy Relationships; How to Make Love; How are Babies Made; Contraception (Birth Control); STDs and HIV/AIDS; Abortion; How to Say No to Sex; Drinking, Drugs, and Rape; Preventing Adult Sexual Contact and Harm; Being Gay; Dealing with Sadness and Depression; How to Make it through Tough Times; How to Raise Happy and Successful Parents; and How to be Your Best. A press release in Spanish is available to help spread the word. If you work with Hispanic populations and would like to order a copy for yourself or are interested in ordering copies for your institution, please contact Steve Deger at Fairview Press, (612) 672-4774, <SDeger1@fairview.org>.


  • The Children's Partnership is pleased to announce the launch of their redesigned Contentbank Web site, <www.contentbank.org>. Contentbank is dedicated to supporting the development of online content for and by low-income and under-served communities. The Contentbank site has been re-tooled to more effectively support our advocacy work and provide easier access to our rich collection of Online Resources, Program Examples, News Articles, and more. We are also pleased to announce the launch of The Children's Partnership's new website that includes a new look, improved navigation, and easy ways to support the work of The Children's Partnership. We invite you to visit this site in addition to our other revamped program sites: <www.childrenspartnership.org> -information about The Children's Partnership; <www.techpolicybank.org> -- information and resources to promote digital opportunity for young people; <www.expresslaneinfo.org> -- information and resources on how to use public programs to enroll uninsured children into health insurance. We welcome your questions and comments. Contact us at <comments@contentbank.org>.


  • Non-English Materials and Resources is an index page that provides new, easy access to information in the MCH Library that is available in over 60 languages. The index page lists each language for which information is available and provides automated searching of library databases. The index is available at <http://www.mchlibrary.info/nonenglish.html>.


  • Maternal and Child Health Thesarus: The third edition thesaurus provides the MCH professional community with a standard vocabulary that serves as a tool for indexing and retrieving materials in any MCH research center, library, or special collection. The thesaurus Web site provides an introduction; an alphabetical list of terms; a rotated list of terms; a set of subject categories; and a search function to search. A PDF version of the full thesaurus is also available on the Web site at <http://www.mchthesaurus.info>.


  • Federal regulations originally designed to streamline the health care system may unintentionally limit coverage for vital child developmental services, a new Commonwealth Fund report finds. According to How Medical Claims Simplification Can Impede Delivery of Child Developmental Services, by George Washington University researchers Anne Markus PhD, Sara Rosenbaum JD, Alexandra Stewart, JD, and Marisa Cox, MA, provisions in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) that require health insurers and providers to use standardized billing codes for medical claims leave little discretion to individual insurers. To comply with HIPAA, state Medicaid agencies must eliminate some payment codes that have been tailored to the special needs of Medicaid-enrolled children; this process can lead to reduced coverage for mental health services, early intervention, physical and speech therapy, home care, case management, transportation, and other services not usually provided in private physician practices. The authors say that federal policymakers should consider revising the law so that states can preserve coverage of services targeting children at risk for developmental problems. For more information, go to the website of the Commonwealth Foundation at <commonwealthfund@cmwf.org>.


  • The Adolescent Brain: A Work in Progress, authored by international experts in adolescent brain development Drs. Daniel Weinberger, Jay Giedd, and Brita Elvevååg, is now available from the National Campaign To Prevent Teen Pregnancy. This new publications examines neurological development as an important dimension of overall adolescent development, and suggests that efforts to understand, guide, and help teens should be based in part on a deeper appreciation of adolescent neurobiology. To view the article, go to: <www.teenpregnancy.org/resources/reading/pdf/BRAIN.pdf>.


  • New "Science Says" Released on Teen Attitudes Toward Sex: About two-thirds of all teens aged 15-19 disapprove of unmarried 16-year-olds having sex. Teens young and old -- and of all racial/ethnic groups -- generally do not think it is appropriate for unmarried 16-year-olds to have sex. As a general matter, however, teens are less likely to disapprove of unmarried 18-year-olds having sex. These are just some of the findings from the latest “Science Says” research brief released by the National Campaign To Prevent Teen Pregnancy. The brief uses the recent round of the National Survey of Family Growth, collected in 2002, to examine teens' attitudes about sexual activity outside of marriage. The research brief was prepared with support form the Office of Population Affairs, U.S. Department of Health and Human Services, although its contents are solely the responsibility of the authors. To view the research brief, go to:
    <www.teenpregnancy.org/works/pdf/Science_Says_14_Attitudes_Toward_Sex.pdf>.


  • New Book Edited by Child Trends: One of the fruits of a Child Trends conference held in 2003 on Indicators of Positive Development is a new book entitled What Do Children Need to Flourish: Conceptualizing and Measuring Indicators of Positive Development, edited by Child Trends' Kristin Moore and Laura Lippman. The book has been published by Springer Science+Business Media and includes 21 of the papers presented at the conference. For more information, go to:
    <www.springeronline.com/sgw/cda/frontpage/0,11855,4-102-22-34958016-0,00.html?changeHeader=true>.


  • Rights vs. Responsibilities: Professional Standards and Provider Refusals: Health care providers have an obligation to act in the best interest of their patients, even when doing so requires acting against their personal beliefs, according to this new study by Adam Sonfield, which appears in the August 2005 issue of The Guttmacher Report on Public Policy. The author reached this conclusion after studying providers' professional codes of ethics, which define providers' rights and responsibilities and specify what is and is not appropriate when caring for patients. Health care associations generally uphold providers’ rights to decline to perform a service that violates their moral or religious beliefs. However, they also accept that providers' rights are limited by the responsibility of ensuring that patients receive the information, services and respect to which they are entitled. Providers do not have the right to obstruct access, impose their own beliefs on a patient or attempt to use personal beliefs to block or deny a patient's right to care. To view the article, go to: <www.guttmacher.org/pubs/tgr/08/3/gr080307.html>.


  • Politicizing Statutory Rape Reporting Requirements: A Mounting Campaign? The body of law governing reporting requirements for incidents of sexual intercourse involving an underage minor -- often referred to as statutory rape -- is complex and sometimes unclear, according this study by Chinue Turner Richardson and Cynthia Dailard. When dealing with such requirements, providers of reproductive health services are expected to balance their ethical duty to ensure that minors have access to confidential health care with their legal obligation to report statutory rape when it is detected. Complicating this is an effort by certain social conservatives to use statutory rape reporting requirements to deter adolescents from seeking services and to undermine the providers who offer care. To view this article, go to: <www.guttmacher.org/pubs/tgr/08/3/gr080301.html>.


  • The newsletter of the National Women's Health Information Center (NWHIC) Healthy Women Today for August 2005 is now available at: <www.womenshealth.gov/newsletter/2005.08.htm>. Topics in the newsletter include: NWHIC Breastfeeding Web Site Voted #1; NWHIC Resource Center: A Helping Voice; Medicare Prescription Drug Coverage: It's All Coming Together; and August is World Breastfeeding Month.