Maternal and Child Health
Section Newsletter
Winter 2004

FROM THE CHAIR

Howard Spivak-MCH Section Chair 
Howard Spivak-MCH Section Chair
As this is the first newsletter since the Annual Meeting in San Francisco, I want to start by thanking everyone for their help and participation at the meetings. Our section activities were extremely successful. The business meetings were well attended and quite productive. The scientific sessions were also well attended and of high quality. I believe the MCH section stands out as one of the most active and participatory groups in all of APHA. Everyone deserves credit for this!

A piece of news for those who have not yet heard, we had another section member elected to the APHA Executive Board - Terri Wright.

Our midyear meeting is coming up in late February (2/28) and will be held at APHA headquarters. I hope many of you will attend. The primary focus of that meeting will be to address the policy issues facing MCH programs and how we, as a section, can promote discussion about issues important to us. The two strategies we will focus on will be efforts to move MCH issues into the political debate of the upcoming national elections and the planning for activities with Congress for the upcoming national APHA meeting in Washington, D.C. in the fall. Please come to the meeting with ideas, potential partners, and concrete activities for discussion. Among other things, we will plan a visit for section members to the Hill for the fall meeting.

With respect to section business, we still need volunteers for the membership committee. This is a high priority for us as we need to work aggressive to recruit new members. Our section size is directly related to how large our budget is and how many governing councilors we are assigned. Both of these are crucial to maintaining high visibility in APHA and beyond.

I also would like ideas for this fall's Martha May Eliot Forum. At the last meeting we had an excellent session on youth violence prevention which highlighted some model programs in the San Francisco area. I would like to develop this year's forum around programs in the Washington, D.C. area, highlighting current priority areas in MCH such as obesity. All thoughts and suggestions are welcome.

I wish all of you a Happy New Year and strength and vision for the important changes needed to promote good MCH policy in the future.

MCH Section Happenings

Martha Mae Eliot Award Winner 
Martha Mae Eliot Award Winner - Dr. Bernard Guyer with MCH Section Chair Dr. Howard Spivak Photo courtesy APHA, by Lagniappe Studio Inc.
Greetings to Our MCH Section Colleagues!

We provide this brief message to update you on happenings and plans of APHA's MCH Section and alert you to important opportunities in the new year.

Both the APHA Annual Meeting scientific and business sessions of the section were highly successful, with robust attendance and engaging discussion. Members present established MCH advocacy as the section's priority focus for 2004, and identified several strategies for taking action:

1. Framing messages to be posed in the upcoming presidential election debates and legislative deliberations;
2. Strengthening ties with other national organizations that advocate for MCH populations;
3. Devising mechanisms to promote greater collaboration with state affiliates in advocacy initiatives; and
4. Designing 2004 Annual Meeting sessions around policy advocacy themes.

The agenda for the Feb. 28 Mid-Year Meeting of the Section (at APHA Headquarters in Washington, D.C.) will involve brainstorming ways of getting MCH issues into the national policy and election debates - we are hoping that many of you will be able to attend and/or provide in writing ideas for a select set of "MCH advocacy messages."

In addition, please note that the section needs volunteers to work on three committees - Membership, Program, and Nominations. Contact Howard Spivak by phone, (617) 636-4780 or e-mail, <hspivak@tufts-nemc.org>, to lend your talents to the important work of the MCH public health community.

Wishing you safe, healthy and nurturing new year,

Howard Spivak
Holly Grason

Annual Meeting Call for Topics for Invited Sessions

The MCH Section is interested in sponsoring a limited number of invited sessions at the 2004 Annual Meeting. These invited sessions should be on topics of significant importance for one of the following reasons:

•It has a direct relationship to the overall theme of the Annual Meeting: Public Health and the Environment.

•It is addressing an emerging issue in Maternal and Child Health.

•It is reporting on new breakthroughs to address pervasive health issues for the maternal and child health population.

If your committee or cluster group has an issue that you would like to be considered for an invited session, we would ask you to submit the following information:

•A description of the topic area or issue including a rationale for why it should be an invited session considering the above criteria.

•The learning objectives to be achieved as a result of the session.

•Possible speakers to be invited.

IF SELECTED, THE COMMITTEE OR CLUSTER SUBMITING THE PROPOSAL WILL BE RESPONSIBLE FOR PLANNING THE SESSION.

Proposals due: Feb. 20, 2004
Decisions made: March 15, 2004
Send proposal to: janepearson@cox.net

MCH Leadership Opportunities: Call for Nominations

It is election time again...APHA MCH Section elections, that is!

From our strong membership base, the nominating committee seeks a number of candidates for key leadership positions this year. There are four Governing Council and two Section Council positions opening up; in addition, our Chair-elect and Secretary-elect positions are open for nominees. Each of these positions provides an opportunity to advance the field of MCH and promote the health of women and children in unique ways within the section and APHA. More than ever, in these challenging historical times, APHA needs the active participation of its members in order to remain an effective voice for the health of populations in our country and globally. The MCH section has an established leadership record within APHA, and as one of the largest sections we have been influential and instrumental on a number of strategic issues over time.

We invite you to share your energy and talents.We welcome your passion and vision! Nominate yourself or nominate a friend or colleague. Subcommittee chairs, can you identify untapped energy and talent on your committees? The Nominating Committee is committed to organizing a robust slate for the section this year and looks forward to your input and recommendations

Please contact the Nominating Committee if you are interested in any of the candidate positions, would like more information, or would like to nominate someone.

Nominating Committee:
Joan Kennelly (chair): <jfk3722@aol.com>
or JoAnne Fischer: <Joanne@momobile.org>

The Nomination process is electronic and will end sometime in late February.Candidates will be provided with a demographic form to complete as well as a personal statement of about 150 words. These will be submitted online to APHA for posting. Elections will take place this spring and terms of office will begin immediately following the 2004 APHA Annual Meeting.

Thank you, and we look forward to hearing from you!

Joan and JoAnne

Second Annual Outstanding Student Papers Session a Success

A Second Annual Outstanding Student Papers Session was organized at the 2003 APHA Annual Meeting in San Francisco. This session is designed to promote academic contributions and achievement in maternal and child health among students. The number of abstracts received in 2003 more than doubled from the previous year and came from 11 different academic institutions. The top five papers (see below) were selected for the special oral session based on the normal blind review process. These students were also invited to attend section meetings and activities and were recognized at the Martha May Elliot Luncheon, where this year's Martha May Elliot Award winner, Dr. Bernard Guyer, indicated that the special session was one of the best that he had ever attended at APHA. Jane Lazar of Boston University School of Public Health received a $100 award for having the highest rated paper. Thomas Vallin, the session organizer, counted 57 in attendance and received positive comments from section members, students, and student advisors. High scoring papers not selected for the special session were presented at a poster session. Activities were funded through support from the Maternal and Child Health Bureau, Centers for Disease Control and Prevention, and W.K. Kellogg Foundation. Plans for the 2004 Outstanding Student Papers in MCH session are already under way.

The 2003 Outstanding Student Authors were:

Jane Lazar
Boston University School of Public Health
"Identifying Multiple Gestation Groups Using State-Level Birth and Fetal Death Certificate Data"

Lee Chaix McDonough, MSW, MSPH & Cynthia H. Cassell, MA
University of North Carolina, Chapel Hill, School of Public Health
"Perinatal depression screening practices among OB/GYN attending physicians and residents"

Pamela Jean Surkan, MS
Harvard School of Public Health
"Growth retardation and risk of stillbirth in subsequent pregnancy"

Tricia M. Michels, MPH
University of California, Berkeley, School of Public Health and
University of California, San Francisco
"How do adolescents make decisions regarding sexual activity and safer sex?"

Deborah L. Dee, MPH
University of North Carolina at Chapel Hill, School of Public Health
"Increasing Breastfeeding Duration Among Low-Income Women: The Success of the In-Home Breastfeeding Support Program"

For more information, please contact Thomas Vallin, MPH <tomvallin600@hotmail.com>.

Editorial: One Member, One Vote: A Call for Real Democracy in APHA

Now it can be said. The “Affiliates” (a euphemism for state associations of public health) have got to go. Two years on the Governing Council have convinced me that the fundamental problem with APHA governance is that APHA is fundamentally undemocratic. When the founders created the United State of America, they, too came up with an undemocratic structure, namely, the U.S. Senate. That compromise may have been necessary in 1787, but there is no justification for giving 50 votes on the Governing Council to the Affiliates regardless of how many of their state members may be dues-paying members of APHA. Those of us who actually pay dues to APHA and participate in Sections are rationed votes on the Governing Council according to the size of the sections. Votes given to affiliates have no connection with membership. This situation disenfranchises Section members and contributes to the sense of powerlessness and alienation frequently heard during Section business meetings.

This past annual meeting demonstrated how ludicrous the structure is as governance continues to spin out of the control of rank-and-file APHA members. The latest outrage was a proposed constitutional amendment to give the chair of the Council on Affiliates a vote on the Executive Board. The Executive Board is the most powerful governing body within APHA, taking action as it must between Annual Meetings. The members of the Executive Board are elected by the Governing Council, after very public campaigns that involve Section members. Giving a vote to the Affiliates’ representative, who already has a non-voting seat on the Board, would further remove governing authority from the Sections and their dues-paying members. Happily, despite the 50 vote block going nearly (but not entirely) unanimously for the amendment (our own Zsolt Koppanyi, the Georgia PHA Affiliate representative, being among the few exceptions), it was defeated. But the sponsor of the amendment was elected to the Executive Board (with fewer votes than Terri Wright, thank goodness), so the danger still lurks.

We have a unique opportunity, given Howard Spivak's leadership of TFAIR, a new, open-minded Executive Director and Terri on the Board, to insist on democratizing APHA. Giving voting power to Affiliates undermines the principle of one member, one vote. Rational governance would require all members of APHA to be members of Sections, and only Sections should have votes on the Governing Council, in proportion to their size. Then, when the Governing Council elects the APHA President and the members of the Executive Board, passes resolutions and amends the bylaws and constitution, the elections would truly be democratic. Let’s think of ways of creating joint memberships for state PHA members to join APHA at the same time as they join or renew their state memberships. Let’s insist that every SPIG or caucus member also join a Section or lose his or her representation on the Governing Council. The cumbersome structure of APHA is undemocratic and out of control, and the first pass through this Augean stable requires that we disenfranchise the Affiliates.

Jonathan Kotch
jonathan_kotch@unc.edu

Editorial: A Response to "One Member, One Vote"

I would like to offer a "counterpoint" to Jonathan Kotch's position regarding Affilates. I have been a member of the MCH Section since 1984, a Section Councillor and for the last two years the Representative for the Georgia Public Health Association (third largest in the country) on the Governing Council. I have worked at the city, state and local health district level and taught in "academe", therefore I claim a rather broad perspective. I was elected by a four-to-one majority to represent my Affiliate. I have very strong feelings regarding the meaningful representation of the State Affiliates in the leadership structure of the Association. In the final count, any policies and resolutions that APHA passes are for naught, if they are not supported and implemented in the field by the "locals!" Without broad participation, we can only achieve limited success to affect large populations or the nation/world.

By vigorously opposing the Affiliates, we would be sending the wrong message to potential members. We need to take the "broad picture" approach: there are many thousands of public health workers "out there"
who need to be represented by our organization. If we offer them the warmest welcome and support, hopefully the non-members can be eventually convinced to join officially APHA, especially when they see the services
and support that we offer. That is why I also applaud the vast improvements in Membership Services brought about by Dr. Benjamin.

The Affiliates by no means act as a unified block, as witnessed in the last session of the Governing Council. I therefore do not share Jonathan's concern, that they would unilaterally "take over" the governance of our Association. They act more like the Senate, affording each state a basic representation. We could debate further, how we would restructure the committees. I would see this as an important initial
role for TFAIR, with discussion and vote by either the membership at large and/or the Governing Council. We also need to assure that we don't assign too much parliamentary power (?) to tiny splinter groups and
SPIGS that would diffuse the overall thrust of the Association! My personal frustration comes from the often "lumbering," Byzantive organizational structure that condems us to a reactive mode in face of
rapidly changing domestic political scenorios or world events instead of assuming a proactive, professional posture to deal with them.

Zsolt Koppanyi MD, MPH, FAAP
District Health Director
Georgia Division of Public Health

National Breastfeeding Awareness Campaign

The National Breastfeeding Awareness Campaign has been under development for two years as a collaborative effort with the United States Breastfeeding Committee, the DHHS Office of Women's Health and the Ad Council. Updated information about this project is available at . As you know, this is a "hot" topic with the New York Times article featuring a DHHS Undersecretary of Health, American Academy of Pediatrics President and Executive Director, and American Academy of Pediatrics Section on Breastfeeding Chairperson (Dec. 4, 2003) and CBC Morning Show (Dec. 31, 2003) debate between the United States Breastfeeding Committee Chairperson and the American Academy of Pediatrics President.

For more information please contact
Julia D. Block, MD, MPH, FAAP (CAPT, MC, USNR)
AAP New York 2 & Uniformed Services East Chapter Breastfeeding Coordinator AMSUS Representative, United States Breastfeeding Committee
jadblock221@pol.net

Cover the Uninsured Week 2004

Nearly 44 million Americans live without health care coverage - including 8.5 million children. Last year, the number of people without health care coverage increased by more than 2 million, the largest one-year increase in a decade.

From May 10-16, 2004, Cover the Uninsured Week will feature events from coast to coast so that Americans can learn more about why this is a crisis. The fact is, eight out of 10 people who are uninsured either work or are in working families. For them, minor illnesses can become major ones because health care is delayed, and one significant medical expense can wipe out a family's bank account.

That is why the American Public Health Association is pleased to announce our support of Cover the Uninsured Week 2004. Working with The Robert Wood Johnson Foundation and more than 800 national and local organizations, we hope to elevate this issue on the national agenda and in communities across the country.

For more information on Cover the Uninsured Week, visit <www.CovertheUninsuredWeek.org>. Sign up for updates and find events near you as activities are scheduled.

We encourage you to take part in this important effort. Stay tuned for more on Cover the Uninsured Week in the weeks ahead. If you have any questions regarding the American Public Health Association's involvement in Cover the Uninsured Week, please contact Don Hoppert at <donald.hoppert@apha.org>.

Breastfeeding Committee Update

The hottest topic of conversation at the Breastfeeding Committee meeting, throughout the conference, and continuing among breastfeeding advocates ever since, has been the delay in the launch of the National Breastfeeding Awareness Campaign.

The Ad Council in partnership with the DHHS Office on Women's Health (OWH) developed a three-year media breastfeeding promotion campaign. Development of a national campaign is one of the recommendations of the Surgeon General in the 2000 HHS Blueprint for Action on Breastfeeding. APHA has a resolution supporting the Blueprint. The Blueprint calls for an increase to 75 percent the proportion of mothers who breastfeed in the early postpartum period, and an increase to 50 percent the proportion of women who breastfeed at six months postpartum.

Unlike previous breastfeeding promotion efforts, which have promoted the benefits of breastfeeding, the Ad Council – famous for its "in-your-face" style PSAs such as the Crash Test Dummies – created a campaign to address the health risks of not breastfeeding and to stress the importance of exclusive breastfeeding for six months. The content was developed by the advertising agency McKinney and Silver based on the results of more than 30 focus groups around the country. An expert panel of breastfeeding researchers convened by the Office of Women’s Health reviewed the science behind the health claims.

However, representatives of the infant formula manufacturers found out about the strategy to present the risk of not being breastfed. They approached American Academy of Pediatrics (AAP) leadership at their annual conference in November 2003, expressing concerns about this. Reports also state that the formula manufacturers heavily lobbied senators, government agencies, and the Ad Council themselves. The AAP receives substantial sponsorship from several infant formula manufacturers. Days after the AAP’s annual conference, the new AAP President, Carden Johnston, sent a letter to U.S. Secretary of Health and Human Services Tommy Thompson questioning the strategy. As a result of the concerns expressed, the campaign is under review by the Office of Women’s Health.

The United States Breastfeeding Committee (USBC) contacted Secretary Thompson to support the Campaign and requested that its member organizations do the same. APHA is represented on the USBC by Jan Weingrad Smith, who reports that Kevin Keene, assistant secretary for public relations, met with a delegation from the USBC, the AAP Breastfeeding Section and the Academy of Breastfeeding Medicine. He assured them that the campaign will be launched this spring. However, after consulting with NIH scientists, Assistant Secretary Keene’s office has made the decision to limit the campaign to addressing respiratory disease, gastrointestinal disease, and possibly obesity. Asthma, childhood cancers, and diabetes have been removed because the NIH scientists consulted did not feel the evidence was strong enough to support the claim that not breastfeeding creates a risk for these diseases.

The Breastfeeding Committee of the MCH Section is concerned that DHHS response to interference in the public health domain by an industry which has a serious commercial interest in promoting the use of infant formula is not in the best interest of public health. Committee members and others concerned about public health are urged to visit the USBC’s Web site at <www.USBreastfeeding.org> to find a full discussion of the issues, a model letter, and addresses for expressing concern to the U.S. government officials and key members of Congress.

Anne Merewood, MA, IBCLC
On behalf of the Breastfeeding Committee and co-chairs
Mary Rose Tully, MPH, IBCLC
and Laura Duckett, PhD

Innovations in Maternity Health Services Committee Update

This year Innovations in Maternity Health Services is continuing to focus on: What do pregnant women want and need? How do they make their decisions? Where do they get their information about birth options? How can health professionals facilitate their patients getting evidence based information to improve decision making. We want to stress “partnering” of practitioner and patient.

The mission of the Innovations in Maternity Health Services 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 result in better outcomes? The continued growth of technology has caused loss of control by childbearing families of their birth options. At this time, the committee feels that the underlying structure of maternal health care delivery should be evaluated.

At the 131st Annual Meeting in San Francisco Nov. 18, the session entitled “Evidence Based Practices in Maternity Care” focused on the barriers to implementation of evidence based practice. We looked into areas such as, social determinants of birth culture and why medical practice does not follow the evidence.

The Innovations in Maternity Health Services Business meeting held on Monday, Nov. 17, at 6:30-8:00 p.m. was well attended. The 2004 Annual Meeting call for abstracts will be on Evidence Based Practice in Maternity Care, exploring social determinants of birth culture. For example, why health practices do not change when evidence is found that does not support conventional practice such as the use of electronic fetal monitoring, Cesarean section, induction and episiotomy. We would also like to address the Business of Birth, Barriers to Access of Care including malpractice issues. Another important issue we would like to include is vaginal birth after cesarean (VBAC). The evidence shows with risk screening these births are safe but they are controversial and almost a practice of the past. We would like to present some evidence that shows they can be safe.

Our committee is very excited to announce that the resolution, “Safe Motherhood in the United States: Reducing Maternal Mortality and Morbidity” was passed by the full Governing Council. Thanks to the authors, Ina May Gaskin, Carol Nelson and Anne Richter for their excellent work in getting this resolution passed and entered into APHA’s permanent policies.

Barb Levin BarbL11@aol.com
Carol Nelson cpmcnel@usit.net