 Maternal Health. At the beginning of the twentieth century, for every one thousand live births, six to nine women died of pregnancy-related complications. Sepsis was the leading cause of maternal death, with half of the cases following delivery (often performed without following the principles of asepsis), and half associated with illegally induced abortion. Hemorrhage and preeclampsia (convulsions) were other leading causes of mortality. In response to the high maternal and infant mortality rates, and to women's suffrage, Congress passed the Maternity and Infancy Act
Table 1
A Chronology of Maternal and Child Health Services in the United States
SOURCE: Courtesy of author.
1909 First White House Conference on Care of Dependent Children
1912 Children's Bureau created
1921 Maternity and Infancy Act (Sheppard-Towner Act) enacted
1929 Sheppard-Towner Act overturned
1930 American Academy of Pediatrics founded
1935 Title V legislation enacted as part of Social Security Act
1935 Crippled Children's Services (CCS) created
1943 Emergency Maternity and Infant Care enacted (P78-156)
1951 American College of Obstetricians and Gynecologists founded
1965 Medicaid (Title XIX) enacted
1965 Head Start Program started
1965 Community and Migrant Health Center Program created
1972 Special Supplemental Food Program for Women, Infants, & Children created
1973 Roe v. Wade legalizes abortion before fetal viability
1973 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) created
1976 Supplemental Security Income Program for children with disabilities enacted
1979 Pregnancy-Related Mortality Surveillance System established
1981 Title V MCH Services Block Grant to states created
1984 Emergency Medical Services for Children enacted
1989 OBRA 89 expands coverage of prenatal care for low-income women
1991 Healthy Start Program started
1994 Early Head Start Program started
1996 Temporary Assistance for Needy Families (TANF) program created
1997 State Children's Health Insurance Program created
(also known as the Sheppard-Towner Act) in 1921. The Fetal, Newborn, and Maternal Mortality and Morbidity Report of the 1933 White House Conference on Child Health Protection called attention to the link between poor aseptic practice, excessive and inappropriate obstetrical interventions (induction of labor, use of forceps, episiotomy, and cesarean deliveries), and high maternal mortality. During the 1930s and 1940s, hospital and state maternal mortality review committees were established. At the same time, a shift from home to hospital deliveries was occurring. The proportion of infants born in hospitals increased from 55 percent in 1938 to 90 percent in 1948, which was accompanied by a 71 percent decrease in maternal mortality. Medical advances (including the use of antibiotics, the use of oxytocin to induce labor, safe blood transfusions, and better management of hypertensive disorders) accelerated the declines in maternal mortality. Liberalization of state abortion laws, beginning in the 1960s, contributed to an 89 percent decline in deaths from septic illegal abortions between 1950 and 1973. In 1979, the Centers for Disease Control and Prevention partnered with the American College of Obstetricians and Gynecologists in developing the Pregnancy-Related Mortality Surveillance System, and implementing maternal mortality review boards across the country. At the end of the twentieth century, for every 100,000 live births, only seven to eight women died of pregnancy-related complications—a 99 percent reduction of the rate at the beginning of the century
Related Resources: home care services, home health care, home security, security surveillance
|
