ductive health, although menopause has become a
topic of public discussion and reproductive cancers
are receiving new attention.
Maternal Health and Child Health
Common sense as well as scientific evidence tells
us that the health of women and the health of their
children are closely related. Persistent infant health
problems such as low birth weight and prematurity
have been linked to maternal conditions that precede
pregnancy, and may even be traced through previous
generations in a woman’s family. A woman in poor
health who wants to become pregnant is more likely
to experience infertility. Once she does become preg-
nant, she is less likely to have a healthy infant and less
able to marshal the consistent energy and resources
needed to promote childhood health. Women and
their children share the same social and economic en-
vironments; poverty, inadequate housing, and unsafe
neighborhoods create multiple stresses and potential-
ly harmful exposures for women, children, and all
family members.
In the late twentieth century there was an increase
in public awareness and concern about infant health
problems stemming from pregnant women’s use of
substances, including tobacco, alcohol, and illicit
drugs, and from sexually transmitted diseases, includ-
ing HIV and AIDS. Domestic violence is also under-
stood as a public health problem affecting pregnant
women and mothers. These behaviors and risks may
be found throughout the entire population, but the
consequences are often worse for disadvantaged
women who have less access to health care and other
support services.
Government programs that subsidize health care
for children sometimes support women only while
they are pregnant or recovering from childbirth.
Gender discrimination or lack of support for women,
as well as economic and racial inequities, is harmful
to the health of families. Knowledge and understand-
ing of the reciprocal needs of women, men, and chil-
dren are needed to promote the physical and mental
health of families and larger communities.
The developing fetus is most vulnerable to many
influences soon after conception when women are
often unaware of their pregnancies, especially in the
case of an unintended pregnancy. Nearly half (49%)
of pregnancies to women in the U.S. are not the result
of conscious planning at the time of conception.
Thus, healthy fetal development in the first trimester
requires health screening and education among sexu-
ally active women before they become pregnant. Pre-
conceptional health care is a model that provides
guidelines for examination, counseling, and treat-
ment of women who may be thinking about getting
pregnant. Universal recommendations for all women
of childbearing age are likely to reach more potential
mothers and may have long-term benefits for the
women themselves, regardless of their decisions
about childbearing. Examples of such recommenda-
tions include smoking cessation, HIV antibody test-
ing, and consumption of vitamins containing folic
acid for prevention of birth defects. Utilization of
family planning services and routine preventive
health care will help women plan the timing of want-
ed pregnancies and maintain their own health, thus
helping them to improve the health of their children.
Prenatal care provides an important opportunity
to address the unmet health needs of pregnant
women. Although interventions during pregnancy
are too late to promote optimal reproductive out-
comes for many women, surveillance and care during
pregnancy are important for the medical and psycho-
logical well-being of both mothers and children. Nu-
tritional, educational, and psychosocial services for
women and families are available in comprehensive
prenatal care settings. An important role of prenatal
care is to engage women in ongoing relationships
with health-care providers, so they will have continu-
ing contact with caring professionals after childbirth
and during the interval before subsequent pregnan-
cies.
The postpartum period is an important time for
establishing positive family relationships, particularly
because the social demands on new mothers are sig-
nificant. In addition to routine preventive care, devel-
opmental screening, and treatment of any special
needs in childhood, the best way to promote chil-
dren’s health is to ensure healthy mothers and well-
functioning families. Physical health is basic to child-
rearing responsibilities, but psychological and other
supports beyond the medical realm are also essential.
Women shoulder the major burden of childcare in
most families, a stressful job under the best of circum-
stances. Taking care of children with special health
care needs is even more challenging, requiring guid-
ance and respites for parents as well as supportive ser-
vices to guarantee the best possible futures for the
children.
Because motherhood has been perceived by soci-
ety as central to women’s identities, there is often a
gap in access to and utilization of health services after
women complete their childbearing years. Women
live longer than men, but suffer from a higher rate of
chronic diseases later in life. Some of these chronic
conditions are influenced by women’s reproductive
histories, and the continuum of health-care needs is
important throughout the life cycle. As more women
have entered the workforce, they have accumulatedMATERNAL HEALTH 249