Why do WIC participants fail to pick up their checks? An urban study in the wake of welfare reform. (73/862)

OBJECTIVES: This study explored whether work or immigration concerns affect women's participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). METHODS: The sample included women who had withdrawn from the WIC program and current WIC clients from 1 center in New York City. Logistic regression analyses were used to predict noncollection of checks; demographic characteristics, program participation, and problems with the WIC program were independent variables. RESULTS: Strong predictors of noncollection of checks were job conflicts, transportation or illness problems, and WIC receipt by the woman herself (rather than by her children). CONCLUSIONS: Employment conflicts were related to failure to pick up WIC checks; immigration concerns were not. As a means of enhancing WIC participation, flexibility is recommended in terms of center hours, locations, and staffing and program check distribution policies.  (+info)

The effects of anticipated funding changes on maternal and child health projects: a case study of uncertainty. (74/862)

A questionnaire survey of Title V special projects--Maternal and Infant Care (M&I), Comprehensive Care for Children and Youth (C&Y), Neonatal Intensive Care and Children's Dental Care--indicated that the anticipated change from federal project grants to state formula grants caused anxiety among project directors, low morale and high turnover in project staff, difficulty in filling staff positions, and anticipation of service reductions. These effects were much more prevalent and severe in projects which could realistically be expected to suffer budget cuts as a result of the shift in funding method. Despite the widespread anxiety, low morale and adverse effects reported by program directors, there was no reduction in the number of patients served, the scope of services offered, or the number of staff employed.  (+info)

A partnership to reduce African American infant mortality in Genesee County, Michigan. (75/862)

A partnership in Genesee County, Michigan, has been working to reduce African American infant mortality. A plan was developed utilizing "bench" science and community residents' "trench" knowledge. Its theoretical foundation is ecological, grounded in a philosophy of public health as social justice, and based on the understanding that cultural beliefs and practices can be both protective and harmful. Partners agree that no single intervention will eliminate racial disparities and that interventions must precede, include, and follow the period of pregnancy. Core themes for the work include: reducing racism, enhancing the medical care and social services systems, and fostering community mobilization. Strategies include community dialogue and raising awareness, education and training, outreach and advocacy, and mentoring and support. The evaluation has several components: scrutinizing the effect of partnership activities on direct measures of infant health; analyzing changes in knowledge, attitudes, behaviors and other mediating variables thought to influence maternal and infant health; and effecting changes in personal and organizational policy and practice.  (+info)

Maternal psychosocial well-being in Eritrea: application of participatory methods and tools of investigation and analysis in complex emergency settings. (76/862)

OBJECTIVE: To establish the context in which maternal psychosocial well-being is understood in war-affected settings in Eritrea. METHOD: Pretested and validated participatory methods and tools of investigation and analysis were employed to allow participants to engage in processes of qualitative data collection, on-site analysis, and interpretation. FINDINGS: Maternal psychosocial well-being in Eritrea is maintained primarily by traditional systems of social support that are mostly outside the domain of statutory primary care. Traditional birth attendants provide a vital link between the two. Formal training and regular supplies of sterile delivery kits appear to be worthwhile options for health policy and practice in the face of the post-conflict challenges of ruined infrastructure and an overstretched and/or ill-mannered workforce in the maternity health service. CONCLUSION: Methodological advances in health research and the dearth of data on maternal psychosocial well-being in complex emergency settings call for scholars and practitioners to collaborate in creative searches for sound evidence on which to base maternity, mental health and social care policy and practice. Participatory methods facilitate the meaningful engagement of key stakeholders and enhance data quality, reliability and usability.  (+info)

Which health services reduce maternal mortality? Evidence from ratings of maternal health services. (77/862)

We report cross-national regressions for maternal mortality in 49 developing countries, using indices of the adequacy of maternal health services derived from ratings by at least 10 experts per country. As in previous such regressions, a socioeconomic factor - in this case per capita income - has a significant effect, but having a trained attendant at delivery does not. Instead, the ratings index for access to services has a consistent, significant effect regardless of which estimates of maternal mortality ratios are predicted. Further analysis suggests that access to treatment for pregnancy complications and to services that help avoid pregnancy and birth are most closely related to lower mortality. Service ratings are interdependent, however, so that focusing only on individual services may not be productive.  (+info)

Family physicians make a substantial contribution to maternity care: the case of the state of Maine. (78/862)

Family physicians provided nearly 20 percent of labor and delivery care in Maine in the year 2000. A substantial proportion of this care was provided to women insured by Medicaid and those delivering in smaller, rural hospitals and residency-affiliated hospitals. As family medicine explores its future scope, research identifying regional variations in the maternity care workforce may clarify the need for maternity care training in residency and labor and delivery services in practice.  (+info)

One state's response to the malpractice insurance crisis: North Carolina's Rural Obstetrical Care Incentive Program. (79/862)

In the period 1985-89, there was a severe drop in obstetrical services in rural areas of North Carolina, partly because of rising malpractice insurance rates. The State government responded with the Rural Obstetrical Care Incentive (ROCI) Program that provides a malpractice insurance subsidy of up to $6,500 per participating physician per year. Enacted into law in 1988, the ROCI Program was expanded in 1991, making certified nurse midwives eligible to receive subsidies of up to $3,000 per year. To participate, practitioners must provide obstetrical care to all women, regardless of their ability to pay for services. Total funding for the program has increased from $240,000 to $840,000, in spite of extreme budgetary constraints faced by the State. The program and how its implementation has maintained or increased access to obstetrical care in participating counties are described on the basis of site visits to local health departments in participating counties and data from the North Carolina Division of Maternal and Child Health. The program is of significance to policy makers nationwide as both a response to rising malpractice insurance rates and reduced access to obstetrical care in rural areas, and as an innovative, nontraditional State program in which the locus of decision making is at the county level.  (+info)

Maternal mortality and access to obstetric services in West Africa. (80/862)

OBJECTIVES: Process evaluation has become the mainstay of safe motherhood evaluation in developing countries, yet the extent to which indicators measuring access to obstetric services at the population level reflect levels of maternal mortality is uncertain. In this study we examine the association between population indicators of access to obstetric care and levels of maternal mortality in urban and rural West Africa. METHODS: In this ecological study we used data on maternal mortality and access to obstetric services from two population-based studies conducted in 16 sites in eight West African countries: the Maternal Mortality and Obstetric Care in West Africa (MAMOCWA) study in rural Senegal, Guinea-Bissau and The Gambia and the Morbidite Maternelle en Afrique de l'Ouest (MOMA) study in urban Burkina Faso, Cote d'Ivoire, Mali, Mauritanie, Niger and Senegal. RESULTS: In rural areas, maternal mortality, excluding early pregnancy deaths, was 601 per 100,000 live births, compared with 241 per 100,000 for urban areas [RR = 2.49 (CI 1.77-3.59)]. In urban areas, the vast majority of births took place in a health facility (83%) or with a skilled provider (69%), while 80% of the rural women gave birth at home without any skilled care. There was a relatively close link between levels of maternal mortality and the percentage of births with a skilled attendant (r = -0.65), in hospital (r = -0.54) or with a Caesarean section (r = -0.59), with marked clustering in urban and rural areas. Within urban or rural areas, none of the process indicators were associated with maternal mortality. CONCLUSION: Despite the limitations of this ecological study, there can be little doubt that the huge rural-urban differences in maternal mortality are due, at least in part, to differential access to high quality maternity care. Whether any of the indicators examined here will by themselves be good enough as a proxy for maternal mortality is doubtful however, as more than half of the variation in mortality remained unexplained by any one of them.  (+info)