Women and the family of the future

The complexities of current societal trends impose a daunting challenge to providers of maternal child health services. Demographers, anthropologists, sociologists, policy makers, and health care providers struggle to grasp the multiple issues in an effort to create useful strategies for the 21st century. The 1990s have been labeled the decade of women's health. Legislative and policy efforts have focused new and much-needed attention on women as recipients and providers of health care. The realities of mothers in the work force, the epidemic of adolescent pregnancy, the swelling ranks of women and children in poverty, the increasing number of women with acquired immune deficiency syndrome, the new advances in reproductive technology, and the effect of population and immigration trends greatly influence the childbearing client of the future and create enormous pressures for critical problem solving.

[State influence on the health of the child]

"This article follows the major historical steps with respect to the protection of the child aged less than three years in France and in Canada over the course of a century. Analysis focuses first on the motives behind increased intervention by political leaders on behalf of the child; next on the protection of the welfare of the mother and child; and finally on the evolution of demographic characteristics, in relation with processes of social and geographic differentiation. A remarkable convergence is observed between the two countries, despite veritable differences in political pressures and actions, traceable back to certain common structural traits, and linked with emerging patterns of international exchanges favouring the modelling of a new culture regarding childhood." (SUMMARY IN ENG AND SPA)

Care-seeking for fatal illnesses in young children in Indramayu, west Java, Indonesia

To examine patterns of seeking care for gravely ill infants and children, we studied all deaths in children under 5 in 10,000 households in Indramayu, West Java, Indonesia, between July 1, 1991, and Dec 31, 1992. 141 deaths were identified (mortality rate 80.7 per 1000), of which 139 were due to causes other than trauma. No treatment of any kind was sought outside the home for 30 (22%) of the children who died from natural causes, and for 59 (42%) others only a traditional healer or other source of non-western medical advice was consulted. Whether or not a mother sought western medical care was strongly associated with the age of the child, the duration of the terminal illness, the previous attendance of the mother at a community-based maternal-and-child-health facility, and the mother's response to a prospectively asked question about what care should be sought for a hypothetical 1-month-old baby with signs of severe pneumonia. Household income, maternal age, and education, and distance between home and government health post were not associated with whether or not western medical care was sought.

Maternal mortality in New Zealand

New Zealand's maternal mortality rate in the triennium 1986-8 was reviewed in comparison with the rates from Australia and the United Kingdom during 1985-7. The New Zealand rate of 9.6 obstetric deaths/100,000 total births was higher than that for the United Kingdom (6.2) and Australia (4.4). Six of 16 deaths in New Zealand during the triennium were caused by sepsis, including five cases of puerperal infection with group A beta-haemolytic streptococci. Careful analysis of maternal deaths in New Zealand remains an important priority to provide audit of the performance of maternity services.

Children's family circumstances: recent trends in Great Britain

"In the last two decades there have been marked changes in the structure and dynamics of families in Britain. The primary aim of this paper is to present some data on recent changes in family life from the perspective of children. Our main concern will be the family circumstances, or living arrangements, of children and their experience of living in a lone-parent family.... Such information has important policy implications for issues concerning child care and support, from the need for financial provision generally to the legal decisions concerning the custodianship of children after divorce." (SUMMARY IN FRE)

Patterns of contraceptive use and pregnancy among young Hispanic women on the Texas-Mexico border

Our objective was to identify significant family planning and health access problems of young Hispanic women on the Texas-Mexico border. Samples of 300 young Hispanic women living in each of the twin cities of El Paso and Juarez were interviewed regarding their knowledge, attitudes, and experiences with respect to birth control, pregnancy, maternal and child health, and health-care services. Knowledge and attitudes of the women about birth control technology were assessed along with their beliefs regarding the use of such technology. Results showed that contraceptive knowledge and usage patterns for young Hispanic women in Juarez and El Paso were significantly different. They relied on different types of birth control methods and also differed with respect to confidence in these methods and related medical services. Both groups reflected positive attitudes toward both child bearing and use of birth control although Juarez women were significantly more favorable toward child bearing. Both groups overwhelmingly favored female doctors. The young women studied have accepted the need for birth control, prefer fewer children, and have some degree of confidence in medical services. Their knowledge and use of reliable versus unreliable birth control devices appear to be major areas requiring culturally sensitive intervention.

Mother surrogate and nutritional status of preschool children

The study was conducted on 200 preschool children to find out the effect of mother surrogate on the nutritional status. The nutritional status of children was found to be affected by the time devoted by mother on child care activities, working status of mother and type of family independently and jointly. The children cared by mother had better nutritional status than those children who were cared by servants and any other family member in the absence of mother. It shows that no one can substitute the care provided by the mother.

Exposure to children and risk of active trachoma in Tanzanian women

The authors surveyed the trachoma status of 515 women aged 18-60 years and 527 children aged 1-7 years in the trachoma hyperendemic region of Kongwa, Tanzania, in 1989 to further describe the importance of exposure to young children as a risk factor for active trachoma in women. The women were identified as caretakers, who currently cared for children aged 1-7 years; noncaretakers, who lived with, but did not care for, children aged 1-7; or those without children aged 1-7 in the household. The age-adjusted odds ratios for active trachoma seemed to rise with greater exposure to young children, from 1.00 for women without such children, to 1.63 for noncaretakers and 2.43 for caretakers (trend test, p = 0.08). Among those who lived in households with young children, the prevalence of active trachoma in women increased with the total number of young children cared for and with the number of infected children cared for. The prevalence of active trachoma was 40% (6 of 15) for caretakers of three or more infected children, compared with 0 (0 of 88) for caretakers with no infected children (p < 0.0001). Caring for infected children also appeared to be associated with signs of chronic trachoma in caretakers. Noncaretakers who lived with infected children were not at a significantly increased risk for trachoma compared with noncaretakers who were not exposed to such children (5.4% (three of 56) vs. 5.6% (one of 18); p > 0.4). None of the facial signs observed in the children (flies on the face, nasal discharge, etc.) appeared to increase the odds ratio of active trachoma in caretakers beyond the increase associated with trachoma alone in the child. These data support the hypothesis that active disease in women is associated with direct caretaking of young children with active disease. Strategies that interrupt household transmission may affect the binding sequelae of trachoma in women.

American families: policy issues

"Increases in the number of children living in single-parent (usually female-headed) households and in the proportion of mothers who work outside their homes have raised concern in the United States about the effects of these trends on the well-being of children and the possible need for policy intervention. This paper discusses the arguments for and against policies that affect families. We review a number of such policies and what research suggests about their likely effects. The policies discussed...include those concerning child support, welfare, income taxes, child and dependent care, family leave, family planning, programs to improve parenting skills and family function, and economic growth."

Motherhood and infant health in Khartoum

The results of an analysis of the growth and illness experience of a group of infants in Khartoum townships illustrate the remarkable benefits of being the infant of a "housewife" rather than the infant of a mother who works. These benefits occurred despite the poorer domestic environments of the housewives.

Greek fathers' participation in labour and care of the infant

Greek fathers' (n = 157) reactions to their presence at the delivery, their expectations about the baby and their childcare practices were explored at the 4th-6th week postpartum. Only 10% of the sample attended the delivery. Their non-attendance was attributed, by the greatest number of fathers, to official hospital policy while the rest claimed it was entirely their decision. Half of the non-attenders expressed the desire to have been present while a large percentage of mothers were said to have wanted them to be present. The small number of fathers who attended the birth felt strong and satisfied. In respect to early fatherhood, three main themes were explored: reaction to fatherhood, enjoyment of the child and involvement in childcare. All three dimensions were strongly correlated.

Taking health promotion on to the streets

In Brazil, until 1990, the authorities could legally arrest a child found alone in the streets, and put them in prison-like institutions. Their crime? To be poor, usually black and living on the streets. The Brazilian Center for the Defense of the Rights of Children and Adolescents (SOS Crianca) was set up a few years ago with the aim of changing this legislation. Together with other nongovernment organizations, SOS Crianca drew up new legislation, lobbied politicians and policymakers, and publicized the issue at a new Child and Adolescent Statute, based on the International Declaration of Children's Rights, was made law. Lawyers volunteered their services to SOS Crianca, making sure that young people had access to legal support, so that the new law could be put into practiced. AIDS has added to the difficulties of young people living on the streets. In 1988, using a strategy similar to the one above, SOS Crianca started to work with key organizations and the children themselves, to draw up an HIV prevention strategy for street children. As well as being threatened with violence and police arrest, these children lack a basic human right--access to health care. Public health services in Brazil do not reach the 40% of the population who live in absolute poverty, which includes young people on the streets. Preventing AIDS is seen by SOS Crianca to be just a part of promoting better health and providing overall healthcare. Educational activities will not work if children do not have access to treatment, or to basic needs like food and shelter. SOS Crianca does not employ doctors because it is not the role of nongovernment organizations to take over the state's responsibility to provide basic health care. But how can the public clinics, staffed with underpaid professionals and lacking basic equipment meet the needs of street children? Meetings were organized with different health professionals, involving those most sensitive to the problem in setting up a referral system. Little by little we made progress. One day a doctor would make the appointment timetable more flexible, and the next a nurse would come to help develop counselling sessions. This support has helped to change the attitude of other health professionals towards these young people. Now a child on the streets can be told: "Go to this hospital, and you will be well treated." Our street educators try to give the children themselves an awareness of their right to use public health care facilities. The educators work every night on the streets, giving advice and counselling and assessing the children's health problems. In the mornings and afternoons the educators go with them to the clinics or follow up with other types of referrals. SOS Crianca also has an ongoing prenatal care program for girls and an STD diagnosis, counselling and treatment program, which includes HIV/AIDS. How many young people does SOS Crianca reach? The answer is not only to do with the numbers seeking health care, but also how many clinic doors are open to them. More and more young people, not just those living on the streets where SOS Crianca works, but others in poor communities, are using the service. It is called "Health Maloca," because the children call their makeshift homes--shelters made of cardboard and newspaper--"malocas." The name also symbolizes that these young people need to find their own ways of taking more control over their bodies and lives.

Seroepidemiology of cytomegalovirus infection among children between the ages of 4 and 12 years in Taiwan

To determine risk factors responsible for primary cytomegalovirus (CMV) infection in Taiwan, samples of blood for antibody to CMV were obtained from 362 children aged 4 to 12 years: 58% were found to be positive for anti-CMV IgG antibody. Logistic regression analysis showed that seropositivity correlated with age, method of delivery, duration of breast feeding, and younger age of mother. Neither socioeconomic status nor crowded living conditions showed significant correlation with CMV seropositivity. Primary CMV infection in Taiwan appears to be less related to socioeconomic status shown in western countries, and, since the majority of pregnant women were seropositive in Taiwan, two of the major sources of primary CMV transmission are infected breast milk and the infected genital tract.

["Parents' salary" and "freedom of choice" between paid and unpaid work: empirical results of a controversial concept]

The author summarizes results from a study on the impact of a parents' salary in Vorarlburg, a province in western Austria. "According to this concept parents are 'paid' by the government for taking care of their children during the first years after birth, while giving up paid work in the labour market. Critics oppose this concept because of its potentially negative implications for the labour force participation of women.... It is shown that the public transfer payment substantially improves the financial situation of the families involved but also affects the distribution of money and power between the spouses within the households. Moreover, it is pointed out that the payment of a parents' salary itself has 'asymmetrical' effects, which could be balanced if more efforts were made to improve the child care facilities for children under three." (SUMMARY IN ENG)

Culturally sensitive prenatal care for Southeast Asians

OBJECTIVE

To evaluate the success of the Southeast Asian Health Project in terms of client satisfaction with the prenatal care and other services. To obtain additional data about Southeast Asian women's health practices regarding childbearing.

DESIGN

Survey through questionnaires administered as interviews.

SETTING

In clients' homes or via telephone.

PARTICIPANTS

119 women from SEAHP's case files of recently delivered clients.

MEASUREMENTS AND MAIN RESULTS

Interviews were conducted by four community workers fluent in Cambodian or Lao. The majority of women were satisfied with SEAHP, particularly the interpretation and education in native languages. Women were also satisfied with SEAHP, encouraging others to seek care.

CONCLUSIONS

SEAHP appears to meet prenatal care needs of Southeast Asian women in Long Beach, California. More objective outcome data await analyses, but the program's approach may ensure access to and use of health services.