Healthy People 2000 Consortium Meeting November 7, 1997

Summary of Breakout Group Discussion Concerning Priority Area 14: Maternal and Infant Health

A number of issues were discussed at the meeting, including the overall structure of the Healthy People 2010 framework, the framework's provisions for special populations, and the specific objectives included in the Maternal and Infant Health Chapter. Following is the summary of the discussions.

I. Structure of Healthy People 2010

One of the major structural issues for this work group was the question of whether to include child health objectives in the maternal and infant health section of the document. In the original Healthy People 2000 objectives, no section specifically addressed objectives for child health; therefore, in the Healthy People 2010 framework, child health has been added to the maternal and infant health focus area. It was suggested that this addition will diminish the focus on the maternal and infant health area, as well as making it difficult to cover all important aspects of child health. Other suggestions regarding the scope of the maternal and infant health section included the following:

• Adding a focus on adolescents, specifically on adolescent pregnancy
• Adding a focus on infant morbidity
• Introducing bivariate data to the objectives

It was also noted that, in reorganizing the objectives for Healthy People 2010, changing the identifying numbers of the objectives from those used in Healthy People 2000 may make the document more difficult for health officials to use. It was also suggested that, to make the final document more user-friendly, it should include a system of cross-referencing by key words to help users to find all objectives of interest, since so many elements of maternal and infant health are also related to objectives presented in other focus areas.

The discussion then turned to the issue of the development of a special focus area on special populations, currently defined by low income, race/ethnicity, age, gender, and people with disabilities. Some participants questioned the development of a special section for objectives for these populations, as it may imply a loss of focus on these populations in the general objectives, or a decrease in emphasis on developing sources of information on these groups for all objectives.

Finally, the group discussed the overall structure of the framework, noting that, in the current scheme, it is not clear how the first two focus areas (mental and physical impairment and disability, and chronic disease) relate to the four enabling goals. To help to address this problem and that of the place of special populations in the framework, it was suggested that the concerns of special populations be shown as overarching and apply to all focus areas.

II. Maternal and Infant Health Objectives

The discussion then turned to the specific objectives within the Maternal and Infant Health chapter. In general, the group urged that no objectives be removed or added without strenuous deliberations, as all the current objects are of prime importance to the health of this population. The group's comments on the specific objectives discussed are summarized below.

Objective 14.6	Increasing the proportion of women achieving the minimum weight gain during pregnancy. Although this was acknowledged to be an important objective, a method is needed to measure the objective and to find sources of supporting data.
Objective 14.7	Reducing the rate of severe complications of pregnancy. It was suggested that the target for this objective be reduced to 10 per 100 deliveries, from the current target of 15 per 100. It was also suggested that this objective be operationalized using some measure other than hospitalizations.
Objective 14.8	Reducing the rate of cesarean delivery. It was suggested that the target for primary cesarean be reduced to 10 per 100 deliveries and for repeat cesarean to 35 per 100.
Objective 14.9	Increasing the proportion of mothers who breastfeed. The group was urged to keep this objective, but a few caveats were noted. First, a consistent definition of "breastfeeding" is needed. Second, some Participants expressed concern over the use of data from Ross Laboratories to measure progress toward this objective; suggestions for other sources of national data on this objective would be welcome. Finally, it was suggested that an objective be developed for the rate of breastfeeding at one year (in addition to current objectives for the early postpartum period and age 5 to 6 months).
Objective 14.11	Increasing the proportion of pregnant women who receive first-trimester prenatal care. It was suggested that objectives be added that address access to prenatal care throughout pregnancy, and that the objective somehow reflect the quality of care received.
Objective 14.12	Increasing the proportion of primary care providers who provide age-appropriate preconception care and counseling. It was noted that no source of data exists for this objective for the years 1990-1995.
Objective 14.13	Increasing the proportion of women who are offered prenatal screening and counseling on fetal abnormalities. This objective spurred a discussion of the need for increased awareness among the genetics community of the Healthy People 2010 objectives and the general need for increased prevention and early identification of genetic diseases and their effect on the overall health of the community. It was also suggested that the wording of this objective, emphasizing that women should be offered screening, be kept intact, and not changed to imply that all women be required to receive screening.
Objective 14.14	Increasing the proportion of pregnant women and infants receiving risk-appropriate care. As data have never been available for this objective, it was suggested that it may be dropped.
Objective 14.15	Increasing the proportion of newborns screened for genetic disorders and the proportion testing positive who receive appropriate treatment. This objective is closely related to Objective 14.13. Again, the importance of early identification of children with special health care needs was emphasized. The group was urged to incorporate the needs of this population into the maternal and infant health focus area and to coordinate closely with the work group on Mental and Physical Impairment and Disability. However, sources of data are needed for this objective.
Objective 14.16	Increasing the proportion of infants receiving recommended primary care services. Data have never been available for this objective.
Objective 14.17	Reducing the incidence of neural tube defects. It was noted that this objective was added in 1995, although data are only available from 1990.

Finally, several suggestions were made regarding additions to the objectives. These included the following:

• To the set of Health Status Objectives (objectives 14.1 through 14.4), including additional morbidity objectives
• To the set of Services and Protection Objectives (objectives 14.11 through 14.16), adding objectives regarding prenatal education
• To the set of Risk Reduction Objectives (objectives 14.5 through 14.10), adding an objective regarding the proportion of mothers who breastfeed at one year, adding a definition of breastfeeding, and modifying the objectives regarding cesarean deliveries as noted above
• Adding adolescent mothers and mothers age 35 and above to the definition of special populations.

Participants

Stella Yu, Facilitator, Health Resources and Services Administration
Patti Brumbaugh, National Association of Childbearing Centers
Charlotte Dickinson, Centers for Disease Control and Prevention
Connie Granoff, Centers for Disease Control and Prevention
James W. Hanson, University of Iowa, College of Medicine
Barbara Heiser, National Alliance for Breastfeeding Advocacy
Alice Hill, National Association of Neonatal Nurses
Teresa Marchese, American College of Nurse-Midwives
Christine Murphy
Joann Petrini, March of Dimes
Nancy Schweers, International Lactation Consultant Association
Tina Weitkamp


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