v17_2006j - Mother and Child: A Multi-Determinant Model for...

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169 Mother and Child: A Multi-Determinant Model for Maternal and Infant Health Outcomes in Urban, Low-Income Communities and the Effectiveness of Prenatal Care and Other Interventions 9 M OTHER AND C HILD : A M ULTI -D ETERMINANT M ODEL FOR M ATERNAL AND I NFANT H EALTH O UTCOMES IN U RBAN , L OW -I NCOME C OMMUNITIES AND THE E FFECTIVENESS OF P RENATAL C ARE AND O THER I NTERVENTIONS Matthew W. Wolfe Research examining the outcomes of prenatal care has largely been restricted to medical interventions. Focusing on low-in- come women in urban communities, this paper ± rst describes a broadened set of expectations of prenatal care and other inter- ventions. It proposes a more holistic framework for analyzing policy choices by examining the numerous determinants that affect maternal and child health outcomes. Then, it examines policy options through these determinants. I NTRODUCTION What we currently have in place is not a health care system but a disease care system. We have created a medical complex that is pretty darn good at diagnosing disease, managing disease, and sometimes curing disease, but not nearly so good at preventing disease—and Matthew W. Wolfe is a joint degree candidate in Law and Public Policy at Duke Uni- versity School of Law and the Terry Sanford Institute, Duke University (matthew. wolfe@duke.edu).
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170 Matthew W. Wolfe sometimes it’s only too good at creating disease. —Dr. Ronald David, Wiener Center for Social Policy at the Kennedy School of Government Pregnancy, in economic terms, provides an opportunity for increased assets to a community as well as a demand for increased support from a community. A developed society responds to this demand and attains the assets primarily through prenatal care, a health-based intervention to assist the mother in carrying and delivering a healthy child. The goal of prenatal care, then, seems to be maximizing the health outcomes, however deF ned, of the mother and child. To put the objective more poetically, our society has committed to assisting the development of new lives. This vision of pregnancy and childbirth is far from a reality in the United States, where infants are more likely to be born with low-birth weight than those born in almost any other developed country (Reichman & Teitler 2005, 151). Every year about 70,000 women, roughly 2 percent of pregnant women, receive no prenatal care (Taylor et al. 2005, 125). Minorities lack prenatal care disproportionately: 66 percent of those who receive no prenatal care are black or Hispanic, even though 65 percent of the pregnant population is white (ibid.). Yet, prenatal care exempliF es the merits of preventative care. To the extent that proper care and education is given to the mother and diagnostics per- formed to anticipate any complications in the pregnancy to ensure greater predictability of labor, delivery, and the infant’s antenatal care, prenatal services are extremely worthwhile from a simple cost-beneF t analysis.
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This note was uploaded on 02/01/2012 for the course POLS 494 taught by Professor Garymoncrief during the Fall '11 term at Boise State.

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v17_2006j - Mother and Child: A Multi-Determinant Model for...

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