Expand and extend postpartum Medicaid to support maternal and child health

Most early maternal deaths are preventable, with many occurring within the first year postpartum (we use the terms "maternal" and "mother" broadly to include all individuals who experience pregnancy or postpartum and frame our recognition of need and policy recommendations in gender-neutral terms. To acknowledge limitations inherent in existing policy and the composition of samples in prior research, we use the term "women" when applicable). Black, Hispanic, and Native American individuals are at the most significant risk of pregnancy-related death. They are more commonly covered by Medicaid, highlighting likely contributions of structural racism and consequent social inequities. State-level length and eligibility requirements for postpartum Medicaid vary considerably. Federal policy requires 60 days of Medicaid continuation postpartum, risking healthcare coverage loss during a critical period of heightened morbidity and mortality risk. This policy position paper aims to outline urgent risks to maternal health, detail existing federal and state-level efforts, summarize proposed legislation addressing the issue, and offer policy recommendations for legislative consideration and future study. A team of maternal health researchers and clinicians reviewed and summarized recent research and current policy pertaining to postpartum Medicaid continuation coverage, proposing policy solutions to address this critical issue. Multiple legislative avenues currently exist to support and advance relevant policy to improve and sustain maternal health for those receiving Medicaid during pregnancy, including legislation aligned with the Biden-Harris Maternal Health Blueprint, state-focused options via the American Rescue Plan of 2021 (Public Law 117-2), and recently proposed acts (HR3407, S1542) which were last reintroduced in 2021. Recommendations include (i) reintroducing previously considered legislation requiring states to provide 12 months of continuous postpartum coverage, regardless of pregnancy outcome, and (ii) enacting a revised, permanent federal mandate equalizing Medicaid eligibility across states to ensure consistent access to postpartum healthcare offerings nationwide.

The EPA's Commitment to Children's Environmental Health: History and Current Challenges

Children's environmental health (CEH) has a 25-year history at the US Environmental Protection Agency (EPA), during which the agency has advanced CEH through research, policy, and programs that address children's special vulnerability to environmental harm. However, the Trump administration took many actions that weakened efforts to improve CEH. The actions included downgrading or ignoring CEH concerns in decision-making, defunding research, sidelining the Children's Health Protection Advisory Committee, and rescinding regulations that were written in part to protect children. To improve CEH, federal environmental statutes should be reviewed to ensure they are sufficiently protective. The administrator should ensure the EPA's children's health agenda encompasses the most important current challenges and that there is accountability for improvement. Guidance documents should be reviewed and updated to be protective of CEH and the federal lead strategy refocused on primary prevention. The Office of Children's Health Protection's historically low funding and staffing should be remedied. Finally, the EPA should update CEH data systems, reinvigorate the role of the Children's Health Protection Advisory Committee, and restore funding for CEH research that is aligned with environmental justice and regulatory decision-making needs. (Am J Public Health. 2022;112(1):124-134. https://doi.org/10.2105/AJPH.2021.306537).

Application of the Food Quality Protection Act children's health safety factor in the U.S. EPA pesticide risk assessments

BACKGROUND

The Food Quality Protection Act of 1996, or FQPA, required the Environmental Protection Agency to set allowable levels for pesticides in a way that would "ensure that there is a reasonable certainty that no harm will result to infants and children from aggregate exposure to the pesticide chemical residue." The act stipulated that an additional tenfold margin of safety for pesticide risk assessments shall be applied to account for pre- and postnatal toxicity and for any data gaps regarding pesticide exposure and toxicity, unless there are reliable data to demonstrate that a different margin would be safe for infants and children.

DISCUSSION

To examine the implementation of the FQPA-mandated additional margin of safety, this analysis reviews 59 pesticide risk assessments published by the EPA between 2011 and 2019. The list includes 12 pesticides used in the largest amount in the U.S.; a group of 35 pesticides detected on fruits and vegetables; and 12 organophosphate pesticides. For the non-organophosphate pesticides reviewed here, the EPA applied an additional children's health safety factor in 13% of acute dietary exposure scenarios and 12% of chronic dietary exposure scenarios. For incidental oral, dermal and inhalation exposures, additional FQPA factors were applied for 15, 31, and 41%, respectively, of the non-organophosphate pesticides, primarily due to data uncertainties. For the organophosphate pesticides as a group, a tenfold children's health safety factor was proposed in 2015. Notably, in 2017 that decision was reversed for chlorpyrifos.

CONCLUSIONS

For the majority of pesticides reviewed in this study, the EPA did not apply an additional FQPA safety factor, missing an opportunity to fully use the FQPA authority for protecting children's health.

Advocating for Immigration Policies that Promote Children's Health

Immigration laws and policies, as well as related media and public discourse, have a direct and significant effect on the health and well-being of children and families. The purpose of this article is to identify the impact of family immigration status and immigration laws on children's health, to understand the legal system that immigrant children face, and to describe opportunities for health care professionals to engage in advocacy at the systems level, from the local community to Capitol Hill.

Policies of Exclusion: Implications for the Health of Immigrants and Their Children

Public policies play a crucial role in shaping how immigrants adapt to life in the United States. Federal, state, and local laws and administrative practices impact immigrants' access to education, health insurance and medical care, cash assistance, food assistance, and other vital services. Additionally, immigration enforcement activities have substantial effects on immigrants' health and participation in public programs, as well as effects on immigrants' families. This review summarizes the growing literature on the consequences of public policies for immigrants' health. Some policies are inclusive and promote immigrants' adaptation to the United States, whereas other policies are exclusionary and restrict immigrants' access to public programs as well as educational and economic opportunities. We explore the strategies that researchers have employed to tease out these effects, the methodological challenges of undertaking such studies, their varying impacts on immigrant health, and steps that can be undertaken to improve the health of immigrants and their families.

Defining the Best Interest of a Child: Who Comes First - The Child or the Fetus?

In 2017, a 10-year-old girl, who was allegedly raped and impregnated, was denied an abortion on the basis of the Medical Termination of Pregnancy Act 1971. This perspective re-examines this issue while prioritizing the best interest of the child. We recommend that boards should be constituted at district-level hospitals, headed by senior pediatricians, and supported by obstetricians, psychologists, neonatologists, medical social workers, and others to decide the course of action - in particular, the outcome, irrespective of the weeks of pregnancy. If not compatible with the child's life, earlier termination of pregnancy should be considered ensuring the availability of state-of-the-art care to the newborn and the young mother.

Food Additives and Child Health

Increasing scientific evidence suggests potential adverse effects on children's health from synthetic chemicals used as food additives, both those deliberately added to food during processing (direct) and those used in materials that may contaminate food as part of packaging or manufacturing (indirect). Concern regarding food additives has increased in the past 2 decades in part because of studies that increasingly document endocrine disruption and other adverse health effects. In some cases, exposure to these chemicals is disproportionate among minority and low-income populations. This report focuses on those food additives with the strongest scientific evidence for concern. Further research is needed to study effects of exposure over various points in the life course, and toxicity testing must be advanced to be able to better identify health concerns prior to widespread population exposure. The accompanying policy statement describes approaches policy makers and pediatricians can take to prevent the disease and disability that are increasingly being identified in relation to chemicals used as food additives, among other uses.

Food Additives and Child Health

Our purposes with this policy statement and its accompanying technical report are to review and highlight emerging child health concerns related to the use of colorings, flavorings, and chemicals deliberately added to food during processing (direct food additives) as well as substances in food contact materials, including adhesives, dyes, coatings, paper, paperboard, plastic, and other polymers, which may contaminate food as part of packaging or manufacturing equipment (indirect food additives); to make reasonable recommendations that the pediatrician might be able to adopt into the guidance provided during pediatric visits; and to propose urgently needed reforms to the current regulatory process at the US Food and Drug Administration (FDA) for food additives. Concern regarding food additives has increased in the past 2 decades, in part because of studies in which authors document endocrine disruption and other adverse health effects. In some cases, exposure to these chemicals is disproportionate among minority and low-income populations. Regulation and oversight of many food additives is inadequate because of several key problems in the Federal Food, Drug, and Cosmetic Act. Current requirements for a "generally recognized as safe" (GRAS) designation are insufficient to ensure the safety of food additives and do not contain sufficient protections against conflict of interest. Additionally, the FDA does not have adequate authority to acquire data on chemicals on the market or reassess their safety for human health. These are critical weaknesses in the current regulatory system for food additives. Data about health effects of food additives on infants and children are limited or missing; however, in general, infants and children are more vulnerable to chemical exposures. Substantial improvements to the food additives regulatory system are urgently needed, including greatly strengthening or replacing the "generally recognized as safe" (GRAS) determination process, updating the scientific foundation of the FDA's safety assessment program, retesting all previously approved chemicals, and labeling direct additives with limited or no toxicity data.

Legal approaches to promoting parental compliance with childhood immunization recommendations

Rates of vaccine-preventable diseases have increased in the United States in recent years, largely due to parental refusals of recommended childhood immunizations. Empirical studies have demonstrated a relationship between nonvaccination rates and permissive state vaccine exemption policies, indicating that legal reforms may promote higher immunization rates. This article reviews relevant data and considers the legal landscape. It analyzes federal and state Constitutional law, concluding that religious and personal belief exemptions to school-entry vaccine mandates are not constitutionally required. It identifies public health, bioethical, and policy considerations relevant to the choice among legal approaches employed by states to promote parental compliance. The article describes a range of legal tools that may help promote parental cooperation with immunization recommendations.

[IMPLEMENTATION OF THE RIGHT FOR HEALTH CARE FOR CHILDREN - INTERNALLY DISPLACED PERSONS (CERTAIN ASPECTS)]

The aim of the article is to do a research on selected issues related to realizing the right for health сare for the children - internally dislocated persons. In order to achieve the given aim statistical data of the quantity of involuntarily dislocated persons including children and also the quantity of children registered with the health-care authority as well as the quantity of their requests for medical care have been analized. It has been determined that in case of involuntary dislocation children are more often exposed to trauma than adults which leads to different emotional disorders. The concepts of «the right for health care» in international legal acts, national legislation of Ukraine and scientific works have been analized. There have been defined three levels of the provision of the right for health care of internally dislocated persons. It has been substantiated that the fact that a child has not been registered with the health-care authority as IRP can't be a ground for limitations in realization of his right on health care. During the research process it has been defined that children IRP need medical care more often than other internally dislocated persons and in realization of the right for health care they come across a number of problems that need urgent solution, including access to free of charge professional medical care, regardless of the fact of medical registration of a child IRP, insufficient funding for provision of the needs of children IRP with medications, absence of obligatory primary medical examination of children IRP, etc.

Protection of children's rights in the health care: problems and legal issues

OBJECTIVE

Introduction: Among all categories of patients children (minors) must be protected first. It is caused so by the specificity of the treatment, their vulnerability, the need of further protection and supervision. Providing of medical care services for children are often connected with the risks of the process of treatment, and of the drug usage. The aim: To identify the problems associated with the protection of the rights of minors and, on the basis of this, the basic guarantees of their rights, as well as mark the trends in the practice of ECHR.

PATIENTS AND METHODS

Materials and Methods: The study is based on its own theoretical and empirical basis. The theoretical basis include scientific articles, expert reviews of legislation and communications of non-governmental organisations, and empirical - decisions of the ECHR, international legal acts and directives of the EU.

RESULTS

Results: The main violations of the rights of minor children include the following: - legal representatives of children do not take to the account their interests (refusal of medical intervention or the choice of certain method of interference); - medical intervention under the influence of coercion; - providing of unwarranted medical care without the corresponding testimony; - providing of inadequate medical care: when the patient was only examined and ineffective treatment was prescribed, and others. As for mentally ill children, the following rights are usually violated: for life, for a fair trial. It has been proved that defects in the provision of health care are often predetermined by the poor state logistics of hospitals, lack of financing and appropriate pediatric medicines, outdated methods of treatment, and incompetence of some doctors.

CONCLUSION

Conclusions: From the point of view of protecting the rights of minors, the rights of children in medicine can be classified into universal and special. The rights correspond not only to the corresponding duties of medical staff, but also of their parents (legal representatives). Violations of their rights are usually related to improper representation of the interests of children and disadvantages of providing medical services (defects in their provision), in particular, regarding the treatment of mentally ill, as well as in clinical trials. It has been proven that the practice of the ECHR on the protection of the rights of the child in the field of health is of particular importance.

Two Decades of Enhancing Children's Environmental Health Protection at the U.S. Environmental Protection Agency

This article provides an overview of public health efforts by the U.S. Environmental Protection Agency (EPA) during the past two decades to protect children’s health from environmental hazards. It highlights examples of concrete steps and accomplishments toward improving environmental protection and health outcomes achieved through public policy, rules and regulations, increased scientific understanding, and public health messaging. Additionally, examples of future challenges for better understanding and improving children’s environmental health are discussed.

Legislative Gaps in Implementation of Health related Millennium Development Goals: a case study from Pakistan

Numerous health legislations concerning child mortality, maternal health and life-threatening diseases such as polio and tuberculosis are crafted in the health sector of Pakistan. A critical assessment of health legislations points to their in-effective or sub-optimal implementation. By engaging with the concept of public law, there is a strong relationship of public health and health legislations. While the basic purpose of health legislations is to craft and enforce essential health legislations for improving public health, an examination of health legislations across Pakistan indicate an extensive health engagement which is facing certain challenges indicating traditional health practices, enforcement constraints arising due to political compulsions and complexities, and systematic problems in the health sector, reflecting issue of governance. Through focus group discussions and in-depth interviews held with policy-makers, senior health officials private health entities and parliamentarian tasks forces on millennium development goals, this study engages with health-sector legislations. In so doing, it focuses on the problematic health sector and interventions. It is observed that unless an overarching legislative framework and a shift from programmatic approach to a human rights approach is adopted, the targets of millennium development goals 4, 5 and 6 would remain off-track in Pakistan.

[The awareness of pediatricians about ethical legal issues of medical care provision]

The implementation of rights of under-age patients in medical institutions in many ways depends on level of awareness of pediatricians about availability and mechanisms of legal guarantees provided to them by law and hence depends quality of medical care of children population. The study was carried out to analyze opinions of pediatricians about issues of implementation of rights of patients. The results are presented concerning sociological survey of 261 pediatricians of the Samarskaia oblast. The study established inadequate awareness of respondents about ethical legal issues of medicine and rate of application of knowledge about legal acts in practical activity. The awareness was higher among pediatricians of younger age with duration of professional work lesser than 10 years. This phenomenon is explained by inclusion of courses of biomedical ethics and medical law in educational programs of medical educational institutions during last decade. The direct dependence is established between awareness of pediatricians about issues of bioethics and the level of their qualification. The most of the respondents consider that the have sufficient level of knowledge about rights of children-patients and their parents related to reservation of medical secrecy, consent or refuse of parents to medical intervention and receiving full information about child's health. The overwhelming majority of pediatricians, independently of professional category and duration of service, provided this right implementing modern informational and collegiate model of interaction with parents of ill child and informed that always obtained their consent about medical care. However, such rights of children were limited by framework of child's health and ability for apprehending information about one's health and prospective medical intervention. All respondents participated in survey insisted that they never disclosed medical secrecy. The development of legal literacy of pediatricians by promoting activities of organizational methodical departments of medical organizations and self-contained studying of normative legal acts.

Family legal status and health: Measurement dilemmas in studies of Mexican-origin children

Family legal status is a potentially important source of variation in the health of Mexican-origin children. However, a comprehensive understanding of its role has been elusive due to data limitations and inconsistent measurement procedures. Using restricted data from the 2011-2012 California Health Interview Survey, we investigate the implications of measurement strategies for estimating the share of children in undocumented families and inferences about how legal status affects children's health. The results show that inferences are sensitive to how this "fundamental cause" is operationalized under various combinatorial approaches used in previous studies. We recommend alternative procedures with greater capacity to reveal how the statuses of both parents affect children's well-being. The results suggest that the legal statuses of both parents matter, but the status of mothers is especially important for assessments of child health. The investigation concludes with a discussion of possible explanations for these findings.

Law and pediatric HIV testing: realizing the right to health in Kenya

Realization of the right to health occurs along a continuum including national ratification of international treaties such as the Convention on the Rights of the Child, passage of domestic laws and policies that may specify modes of implementation and enforcement such as Kenya's Constitution and HIV and AIDS Prevention and Control Act, and actual implementation of domestic laws and policies such as through the regulation and delivery of health services. The stages heuristic theoretical framework describes the public policy continuum as consisting of marked stages: agenda setting, policy formulation, policy implementation, and evaluation. This case study illustrates the continuum in Kenya with regard to pediatric HIV testing. Kenya has made progress applying law, policy, and science to reduce vertical transmission of HIV and increase HIV testing of infants, although several challenges remain. Progress in policy implementation may reduce mother-to-child transmission and increase pediatric HIV testing.

Climate change, children's rights, and the pursuit of intergenerational climate justice

Frequently forgotten in the global discussions and agreements on climate change are children and young people, who both disproportionately suffer the consequences of a rapidly changing climate, yet also offer innovative solutions to reduce greenhouse gas emissions (climate change mitigation) and adapt to climate change. Existing evidence is presented of the disproportionately harmful impact of climate-induced changes in precipitation and extreme weather events on today's children, especially in the Global South. This paper examines the existing global climate change agreements under the UN Framework Convention on Climate Change for evidence of attention to children and intergenerational climate justice, and suggests the almost universally ratified Convention on the Rights of the Child be leveraged to advance intergenerational climate justice.