[The protection of infant life: from XVIII to XXI century (the input of physicians and scientists of the Research Center of Children Health of the Russian Academy of Medical Sciences)]

The article deals with issues of protection of infant life in the history of the research center of children health of the Russian academy of medical sciences which originates from the Emperor Moscow founding hospital established September 1 1763 according decree of Empress Catherine II. As long as infant mortality persisted at extremely high rate during centuries, the protection of life of children of early age considered as a strategic public purpose in Russia right until middle of XX century. The activity of farsighted and responsible rulers of Russia laid the foundation to public system of mother and child health care 250 years ago. The physicians and researchers of the Moscow founding hospital and such its successors as the Infant Protection Home, the Institute of protection of maternity and infancy and the academic institute of pediatrics made their own input into protection of infant life. Because of all that, children mortality at infant age decreased more than in 30 times. Billions of children lives were saved.

A rollercoaster of policy shifts: global trends and reproductive health policy in The Gambia

Global trends influence strategies for health-care delivery in low- and middle-income countries. A drive towards uniformity in the design and delivery of healthcare interventions, rather than solid local adaptations, has come to dominate global health policies. This study is a participatory longitudinal study of how one country in West Africa, The Gambia, has responded to global health policy trends in maternal and reproductive health, based on the authors' experience working as a public health researcher within The Gambia over two decades. The paper demonstrates that though the health system is built largely upon the principles of a decentralised and governed primary care system, as delineated in the Alma-Ata Declaration, the more recent policies of The Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria and the GAVI Alliance have had a major influence on local policies. Vertically designed health programmes have not been easily integrated with the existing system, and priorities have been shifted according to shifting donor streams. Local absorptive capacity has been undermined and inequalities exacerbated within the system. This paper problematises national actors' lack of ability to manoeuvre within this policy context. The authors' observations of the consequences in the field over time evoke many questions that warrant discussion, especially regarding the tension between local state autonomy and the donor-driven trend towards uniformity and top-down priority setting.

[The House of infant protection in Moscow]

The article deals with short (1918-1922) but exremely important time of reorganization and functioning of the House of infant protection in Moscow established by the initiative of the Department of mother and infant protection. It turned out, because of enthusiasm and professionalism of physicians and in spite of the most severe situation in the country, to organize the departments for healthy infants, to establish clinics for gravely sick little patients, laboratory diagnostic units and children consultation. The House of infant protection became the only practical research center in the Soviet Russia to study physiology and pathology of children of early age and to train physicians and medical nurses specialized in the area of early childhood. The importance of the House of infant protection which was at the origins of the Soviet system of protection of children health, is hard to overestimate. The House was a kind of experiment area to develop the institutions of public system of mother and child protection, to elaborate the Soviet pediatric science and schools of training and advanced training of research and practical specialists in this field of medicine.

[An evaluation of the 1906 issues of the first medical periodical in Izmir, Hifzissihha Periodical]

The purpose of this study is to review the first issues of Hifzissihha Periodical published in 1906 as the first medical periodical of Izmir. We already conducted a similar study on the 1908 issues of the same periodical published as 26 issues between May 8, 1908 and December 24, 1908. This particular study, on the other hand, mainly focuses on the very first issues (from Issue 3 to 21) which were published in 1906. Published as a weekly periodical in Turkish in Arabic alphabet by Doktor Taslizade Edhem Bey, the periodical was formatted in two columns with a 25.5 x 18.5 page size. The articles in the periodical included information about epidemics, mother and child health, healthy nutrition and maintaining a healthy life were written in a plain language. Our study also aims to provide information about the articles, authors, and the date and place of publication of each issue.

Using human rights to improve maternal and neonatal health: history, connections and a proposed practical approach

We describe the historical development of how maternal and neonatal mortality in the developing world came to be seen as a public-health concern, a human rights concern, and ultimately as both, leading to the development of approaches using human rights concepts and methods to advance maternal and neonatal health. We describe the different contributions of the international community, women's health advocates and human rights activists. We briefly present a recent effort, developed by WHO with the Harvard Program on International Health and Human Rights, that applies a human rights framework to reinforce current efforts to reduce maternal and neonatal mortality.

Child health in Latin America: historiographic perspectives and challenges

Patterns of child health and well-being in Latin America's past--have been assumed to be delayed and derivative of European and North Americanexperiences. Through an examination of recent historiography, this essay traces a more complex reality: interest in infant and child health in Latin America arose from a range of domestic and regional prerogatives. This attention was rooted in preColumbian cultures, then relegated to the private sphere during the colonial period, except for young public wards. Starting in the 19th century, professionals, reformers, and policy-makers throughout the region regarded child health as a matter central to building modern societies. Burgeoning initiatives were also linked to international priorities and developments, not through one-way diffusion but via ongoing interaction of ideas and experts. Despite pioneering approaches to children's rights and health in Latin America, commitment to child well-being has remained uneven, constrained in many settings by problematic political and economic conditions uch.

[Pregnancy in diabetic women--past and today]

The discovery of insulin in 1921 and introducing insulin into a clinical practice gave an unique opportunity to treat people suffering from a type 1 diabetes successfully. Prior to this success, pregnancy in diabetic women was extremely rare and most of cases resulted in stillbirth and fatal outcome for mother. After the introduction of insulin into therapy of pregnant women with diabetes, a permanent improvement in neonatal and maternal outcome has been noted. However, a diabetic pregnancy still constitutes a high risk pregnancy, requiring a targeted, highly specialized control of women and fetus. This review presents problems concerning diagnose, treatment and outcome of diabetic pregnancy throughout the XXth century.

A Passion for Nursing

As epidural and cesarean rates climb, a nurse leader provides a model for effective advocacy for normal birth and supportive care for women and their infants. Dr. Sharron Smith Humenick had a passion and devoted her life to providing women with adequate support for natural, empowering birth and successful breastfeeding. Lessons from her life's work can inspire nurses in our specialty to be tireless and passionate advocates in practice, education, and public policy for supportive nursing care. Dr. Humenick died on September 9, 2006.

The history of preconception care: evolving guidelines and standards

This article explores the history of the preconception movement in the United States and the current status of professional practice guidelines and standards. Professionals with varying backgrounds (nurses, nurse practitioners, family practice physicians, pediatricians, nurse midwives, obstetricians/gynecologists) are in a position to provide preconception health services; standards and guidelines for numerous professional organizations, therefore, are explored. The professional nursing organization with the most highly developed preconception health standards is the American Academy of Nurse Midwives (ACNM); for physicians, it is the American College of Obstetricians and Gynecologists (ACOG). These guidelines and standards are discussed in detail.

Myron Wegman: early days, lasting influence

Dr. Myron Wegman's long life (1908-2004) and career connected him with the most important and formative period of child health in American history. His work paralleled momentous changes in federal child health policy and in the fields of pediatrics and public health. He began professional life at a moment that gave him entrée into the forefront of that history, and he was part of it at every level, from the most rural local settings to the international stage. Despite his high profile, little has been written about his early career in Maryland or how that period shaped him as a leader in maternal and child health (MCH). This article describes Wegman's work in rural Maryland and his initiation into academic public health at Johns Hopkins University. We suggest that Wegman's time in Maryland was formative, both for himself and for the MCH field. His work during this time influenced his own thinking and subsequent work in MCH education, his understanding of the healthy development of children, and his emergence as a social conscience for the field. This apparently modest start to his career gains import because his achievements rose above the individual level: his life and his ideals became part of our current approach to maternal and child health science and social philosophy. This article is based on life history interviews and less formal discussions conducted with Wegman by the authors, his own colloquia and lectures on child health history presented at Johns Hopkins from 1991 through 1998, his manuscripts, and the written and oral accounts of his contemporaries.

A social component in the negative effect of sons on maternal longevity in pre-industrial humans

Due to their effect on maternal testosterone levels, sons are said to have reduced maternal longevity in pre-industrial humans. This analysis, using information from a Flemish agricultural village in the 18th-20th centuries, confirms the presence of a negative effect of sons on maternal longevity. However, the effect is mainly observed for mothers belonging to the least privileged social group and for sons surviving their fifth birthday. Both findings make the above-mentioned biological explanation relative. However, a plausible alternative, social interpretation is male-dominated intra-household resource competition. It is reasonable to assume that only sons above a certain age are able to claim a serious amount of resources and that competition is strongest within the least privileged social group.

The inequality of maternal health care in urban sub-Saharan Africa in the 1990s

Numerous studies document the disadvantage in child health of the urban poor in African cities. This study uses Demographic and Health Survey data from 23 countries in sub-Saharan Africa to examine whether the urban poor experience comparable disadvantages in maternal health care. The results show that, although on average the urban poor receive better antenatal and delivery care than rural residents, the care of the urban poor is worse than that of the urban non-poor. This suggests that the urban bias in the allocation of health services in Africa does not benefit the urban poor as much as the non-poor. Multilevel analyses reveal significant variations in maternal health in urban areas across countries of sub-Saharan Africa. The dis-advantage of the urban poor is more pronounced in countries where maternal health care is relatively good. In these countries the urban poor tend to be even worse off than rural residents, suggesting that the urban poor have benefited least from improvements in maternal health care.

Our legacy for leadership in MCH

The history of Maternal and Child Health (MCH) in the United States provides some important lessons for us today. Emerging from the child labor abolition and progressive reform movements of the late 1800s, the basis of MCH in the United States can be traced to fundamental concerns regarding how our society should protect children from a host of threats, including abuse, the adverse practices of childhood labor, disease, and the ill effects of unclean milk and water, poor sanitation, and an unsafe environment. These and additional concerns about how to assure that children and families have access to adequate healthcare and to health and social systems that understand the special developmental needs of children persist to this day. A review of the history of MCH fosters an appreciation of the many accomplishments made by early MCH leaders during some very difficult times in this country. Today, with the advent of war and an unclear economic forecast, to say nothing of continuing health care reforms and the reinvention of the roles and purposes of public health, it may offer modest comfort to know that our predecessors faced grim circumstances too and prevailed. As MCH continues to evolve in response to the major social events of the times, there is an ongoing need to revisit and reflect upon the role and purpose of MCH in the society. Our inherited legacy of leadership in MCH both inspires and challenges us as we strive to responsibly advocate, align constituencies, build and use data capacities for need assessment and evaluation, question our premises, identify and courageously confront pressing health and social issues, and continue our efforts to formulate and articulate a vision for the future of MCH.

Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries

This paper investigates whether children later reported as having been unwanted or mistimed at conception will, when compared with children reported as wanted, show adverse effects when the following criteria are applied: receipt of antenatal care before the sixth month of gestation, supervised delivery, full vaccination of the child, and child growth (stunting). The study uses data from five recent Demographic and Health Survey enquiries in Bolivia, Egypt, Kenya, Peru, and the Philippines. In Peru, children unwanted at conception were found to have significantly worse outcomes than other children, but in the other countries, a systematic effect was found only for receipt of antenatal care. Weak measurement of the complex concept of wantedness may have contributed to these results. Birth order of the child, with which wantedness is inextricably linked, has more powerful and pervasive effects, with first-born and second-born children being much less likely to show adverse effects.

Did mothers begin with an advantage? A study of childbirth and maternal health in England and Wales, 1778-1929

This paper contributes to two ongoing debates among demographers. One deals with the immediate and deferred health effects of childbearing in the past, and the other with competing explanations--the frailty and insult accumulation hypotheses--for differences in individual health later in life. The study population consists of working women who lived at four locales in England and Wales in parts of the period 1778-1929 and who were under observation for incapacitating sickness during and after their childbearing years. Mothers within the study population are contrasted with a comparison group made up principally of non-mothers. The mothers began their reproductive careers with an advantage in health that was especially evident in the duration of sickness episodes. Even though individual births were less hazardous than individual sicknesses at the same ages, the cumulative effect of childbearing appears to have eroded the mothers' advantage. By ages 50-74 the mothers resembled the comparison group in health.

Mothers' health and babies' weights: the biology of poverty at the Melbourne Lying-in Hospital, 1857-83

Birth weight remains a major focus of medical research into the relationship between pre-natal growth and life course health, and historians have used mean birth weight to assess women's standard of living. However, there are intrinsic difficulties in inferring maternal health and nutritional status from birth weight, and some of the known data sets produce puzzling results. One rich data set comes from the Melbourne Lying-in Hospital, 1857-83, and the article discusses the complex institutional, social, and economic causes that may underlie its apparently counter-intuitive anthropometric results. This data set reveals the biological effects differential social conditions can inflict, even within an otherwise affluent society.

Dorothy Reed and Hodgkin's disease: a reflection after a century

It has now been 100 years since Dorothy Reed, at the age of 28, wrote her paper on Hodgkin's disease. Her biography reveals the difficult lives of women entering the hitherto male-dominated field of medicine, let alone medical research. Her historic paper on Hodgkin's disease is remarkable for its brilliant observations and concise scientific reasoning. Nevertheless, she was told that as a woman she could not hope for a career as an academic pathologist. After marriage to Charles Elwood Mendenhall, Professor of Physics at the University of Wisconsin and after giving birth to four children, the second part of her career began. Motivated by the loss of her firstborn, she began a study of infant mortality, an interest that lasted throughout her career. In 1926, Mendenhall undertook a survey comparing infant and maternal mortality rates in Denmark and the United States. This influential study concluded that American mortality rates were higher because of unnecessary interference in the natural process of childbirth and recommended the education of midwives follow the Danish model. In 1937, her efforts were rewarded when Madison, WI received recognition for having the lowest infant mortality of any city in the United States. Reading Reed's paper on Hodgkin's disease, we see that her observations go far beyond a description of a specific cell. Her presentation of macroscopic and microscopic features is remarkable for the distinction between "young" and "old" growths: Reed saw Hodgkin's disease as a process, rather than the spreading of a cancer. She was the first to note that those most commonly affected are boys or young adults, especially those whose general health before the disease had been excellent. She was also the first to note anergy to tuberculin. Dorothy Reed defined Hodgkin's disease in relation to tuberculosis, described its pathologic features, and offered comments on its pathogenesis, epidemiology, and immunology that still deserve to be discussed.

[The medicalizing of mothers and children in Colonial Vietnam, 1860-1939]

Almost nothing has been written about the history of maternal and child care in South East Asia. The issue however has a great amount of interest. For instance, French Indochina under colonial rule (1860-1954) experienced significant advancements in both areas. Writing their history helps to better understand the international dissemination of medical intervention towards pregnant women and their children and some of the movement's national characteristics. Maternal and child care rapidly became the only area within the health policy Indochina received before and after the establishment of an official health program (1905). Its rise also occurred during a period of great scientific change which necessarily had influence on its trends and applications. Certainly, the French Republic wanted to exploit its new territory. Consequently, the colonial government in Hanoi would concentrate on infant morbidity and mortality. Nevertheless, within a few years and especially between the two world wars, the administrators would even provide social welfare, particularly to babies and grown children. Maternal and child care were priorities for the Vietnamese territories. However the colonial health system took local pathological, sociocultural, and economic contexts and peninsular medical traditions into account. The system was based everywhere on maternity wards and indigenous midwives to achieve colonial goals about fighting mortality and educating populations in hygiene. The data indicates that France's moves towards offering health care to Indochinese people improved morbidity and rates and accelerated medical acculturation.