Labor and delivery complications among teenage mothers

A broad set of academic literatures shows that childbearing is associated with a variety of negative health outcomes for teenage mothers. Many researchers question whether teenage childbearing is the causal explanation for the negative outcomes (i.e., whether there is a biological effect of teenage childbearing or whether the relationship is due to other factors correlated with health and teenage childbearing). This study investigates the relationship between teenage childbearing and labor and delivery complications using a panel of confidential birth certificate data over the period from 1994 to 2003 from the state of Texas. Findings show that compared to mothers aged 25 to 29 having their first child, teenager mothers appear to have superior health in most--but not all--labor and delivery outcomes.     

A hazard logit model analysis of covariates of childhood mortality in Matlab, Bangladesh.

In a prospective study in Matlab, a rural area in Bangladesh, the relationship between a variety of covariates and childhood mortality was examined. Economic status of household, education of mother, sex of the children, health intervention programmes, age of mother, and live birth order of the children were identified as having a statistically significant impact on child survival when the effect of age was controlled. The effects of sex of the children, health programmes, age of mother, and birth order were found to be dependent on the age of the children, but the effect of mother's education was dependent on sex of the children.     

Estimating the educational consequences of teenage childbearing: Identification,heterogeneous effects and the value of biological relationship information

Understanding the contribution of childbearing to social disadvantages of teenage mothers requires estimates that control for unobservables and generalize to teenage mothers. Sibling-differences and Instrumental Variables (IV) are common approaches to this end. Using the “Add Health” data, which oversampled siblings, and building on IV specifications from a widely-cited study, we compare various estimates of the consequences of teenage childbearing for schooling attainment. These IV-based estimates suggest moderate to large adverse impacts of teenage births (point estimates of −0.7 years of schooling or larger). However, the IV estimates are highly sensitive to choice of instrument and model specification. Estimates based on sibling and twin differences are consistently near zero—e.g., an estimated difference of −0.1 years between a teen mother and her biological full sister who did not have a teen birth—and are estimated with sufficient precision to exclude effects larger than −0.5 years. We review concerns about sibling methods and conclude that, despite their limitations, sibling estimates should be admitted along with other evidence on the consequences of teenage childbearing. Appreciation of the sensitivity of IV estimates and their other limitations would reinforce this conclusion.     

Maternal adverse childhood experiences,child mental health,and the mediating effect of maternal depression: A cross-sectional,population-based study in rural,southwestern Uganda

Objectives

This study aimed to examine the intergenerational effects of maternal adverse childhood experiences (ACEs) and child mental health outcomes in rural Uganda, as well as the potentially mediating role of maternal depression in this pathway. Additionally, we sought to test the extent to which maternal social group membership attenuated the mediating effect of maternal depression on child mental health.

Methods

Data come from a population-based cohort of families living in the Nyakabare Parish, a rural district in southwestern Uganda. Between 2016 and 2018, mothers completed surveys about childhood adversity, depressive symptoms, social group membership, and their children's mental health. Survey data were analyzed using causal mediation and moderated-mediation analysis.

Results

Among 218 mother–child pairs, 61 mothers (28%) and 47 children (22%) showed symptoms meeting cutoffs for clinically significant psychological distress. In multivariable linear regression models, maternal ACEs had a statistically significant association with severity of child conduct problems, peer problems, and total child difficulty scores. Maternal depression mediated the relationship between maternal ACEs and conduct problems, peer problems, and total difficulty, but this mediating effect was not moderated by maternal group membership.

Conclusions

Maternal depression may act as a potential mechanism linking maternal childhood adversity with poor child mental health in the next generation. Within a context of elevated rates of psychiatric morbidity, high prevalence of childhood adversity, and limited healthcare and economic infrastructures across Uganda, these results emphasize the prioritization of social services and mental health resources for rural Ugandan families.     

Family-building patterns and childhood mortality: a family-level analysis

It has been suggested that altering the pace of reproduction would improve the health of women and children. For formulating intervention policies, it is important to know whether on its own such a strategy is likely to lead to risk reduction. This paper analyses mortality risk in sibships to explore the relationship between family formation factors and other household characteristics that identify women whose families are at higher risk. The analysis allows for the fact that reproductive behaviour may be modified by the family's prior experience of child death, using simultaneous equations methods to purge the model of the 'feedback' effects of death on the endogenous variable, childbearing pace. The strong relationship between reproductive pace and average risk in a family appears to be due to the association of both with other differences between households. Other aspects of family formation patterns are good indicators of which families are likely to experience excess risks to their children. These factors are associated with maternal education, but measure characteristics of the family or mother that educational attainment does not fully capture. They indicate that high-risk mothers are likely to have less control over many aspects of their lives. The pace of family building does not lead to excess average family risk, but may result, at least in part, from the concentration of risk in families with other characteristic patterns of family formation and few resources. The paper argues for a broader conception of household influences on child health and the health-related behaviour of parents.     

The “Long-arm” of chronic conditions in childhood: Evidence from Canada using linked survey-administrative data

The objective of this study was to investigate the relationship between health conditions in childhood (ages 4–11), and health and socioeconomic outcomes in adulthood (ages 21–33). This study takes advantage of a new linkage between the National Longitudinal Survey of Children and Youth (NLSCY) and administrative tax data from the T1 Family File (T1FF) from Statistics Canada. The NLSCY includes rich longitudinal information on child development, while the T1FF includes administrative tax information on each child in adulthood (e.g., income, social assistance). The primary measures of child health relate to the diagnosis of a chronic condition, affecting the child’s physical or mental/developmental health. The results suggest that mental/developmental health conditions in childhood more negatively influence adult health and socioeconomic conditions, compared to physical health conditions. Interaction models reveal modest heterogenous effects; for example, there is some evidence of a cushioning effect from higher household income in childhood, as well as an exacerbating negative effect from lower birth weight for mental/developmental health conditions. Using a covariate decomposition approach to explore underlying pathways, the results reveal that associations between health in early life and outcomes in adulthood are partially explained by differences in cognitive skills (i.e., mathematics test scores) in adolescence (ages 16–17). Results may encourage policy investments to mitigate the occurrence of health conditions in childhood and to ensure timely access to educational supports and health services for children with chronic conditions.     

Children in an ageing society

This paper explores the implications of demographic aging for children and pediatric practice in the Western society. It focuses on the social class differences in childbearing patterns, specific issues related to disability, and distribution of resources between age groups. Women in the Western world are now having children at an older age than at any time in the past 50 years. Voluntary childlessness or deliberate delay in childbearing is common among highly educated women. This changing pattern in childbearing may increase and polarize health and wealth inequalities. With advancements in neonatal and pediatric care which prolong life expectancy and survival of disabled children, it is projected that there will be an increasing number of very old parents caring for severely disabled offspring. Meanwhile, there are also many children who are carrying considerable burdens of caring for their disabled parents. The community burden of disability will continue to rise. The needs of the elderly population may drain resources from child health services. Despite this demographic pattern, care for the children is still important. Health care authorities must not become contented with the existing pediatric care services just because demographic changes require that the nation should invest more in care of the older population.     

The effect of the nurturant bonding system on child security of attachment and dependency

This paper uses a biopsychosocial theory of human bonding to explore the intergenerational transmission of bonding traits. More specifically, it examines how the nurturant bonding system of the mother affects the succorant bonding system of the young child. In the first section of the paper, we take the bonding framework proposed by Miller and Rodgers (2001) and elaborate its implications for mother-child dyads. Next, we describe the collection of data from 78 mothers prior to their pregnancy with an index child and again when that child is between the ages of two and four and a half. These data allow the creation of a number of mother and child variables that are derived from the bonding framework. Using these variables, we construct a temporally organized, structural equation model of maternal effects on the child, with the two main outcome variables being child security of attachment and child dependency. We then test the model using LISREL. Although the results are tentative and require further confirmatory research, they lend support to three broad hypotheses derived from the bonding framework. In particular, the results support the construct of a motivational substrate that affects both maternal childbearing and her child-rearing behaviors. They also indicate the importance of child temperament in the formation of the succorant bond. Finally, they demonstrate that the preconception nurturant characteristics of the mother have multiple effects on the two main outcome variables, child security of attachment and dependency. Two submodels based on predictors of these two outcomes reveal a number of pathways along which these effects take place. We conclude with a brief discussion of the lessons learned that might strengthen future studies of mother-child bonding and, more generally, the intergenerational transmission of bonding traits.     

Efficacy of light therapy for perinatal depression: a review

ABSTRACT: Perinatal depression is an important public health problem affecting 10-20% of childbearing women. Perinatal depression is associated with significant morbidity, and has enormous consequences for the well-being of the mother and child. Treatment of depression during the perinatal period poses a complex problem for both mother and clinician, as antidepressant treatment strategies must consider the welfare of both mother and child during pregnancy and lactation. Bright light therapy may be an attractive treatment for perinatal depression because it is low cost, home-based, and has a much lower side effect profile than pharmacotherapy. The antidepressant effects of bright light are well established, and there are several rationales for expecting that bright light might also be efficacious for perinatal depression. This review describes these rationales, summarizes the available evidence on the efficacy of bright light therapy for perinatal depression, and discusses future directions for investigation of bright light therapy as a treatment for perinatal depression.     

Gestational Age at Birth and ‘Body-Mind’ Health at 5 Years of Age: A Population Based Cohort Study

Numerous studies have identified the effects of prematurity on the neonate’s physical health, however few studies have explored the effects of prematurity on both the physical and mental health of the child as they develop. Secondary analysis of data from the Millennium Cohort Study, a longitudinal study of infants (n = 18 818, born 2000–2002 in the United Kingdom) was performed. Effects of gestational age at birth on health outcomes at 5 years were measured using parental rating of their children’s general health and severity of behavior problems. The association between parent’s general health ratings and behavior problem ratings was low: 86% of those reporting serious behavior problems (5% of the sample, n = 764) rated their child as being in excellent, very good, or good health. Still, a gradient of increasing risk of poorer outcome with decreasing gestational age was observed for a composite health measure (poor/fair health and/or serious behavior problems), suggesting an association with prematurity for this composite assessment of health status. The greatest contribution to the childhood composite health measure at 5 years was for children born at 32–36 weeks gestation: population attributable fractions for having poor outcomes was 3.4% (Bonferroni-adjusted 95% confidence interval 1.1%–6.2%), compared to 1% (0.2–2.3) for birth at less than 32 weeks. Results suggest that preterm children, by school entry, are not only at high risk of physical health problems, but also of behavioral health problems. The recognition of, and response to comprehensive health and well-being outcomes related to prematurity are important in order to correctly plan and deliver adequate paediatric health services and policies.     

Paternal investment and status-related child outcomes: timing of father's death affects offspring success

Recent work in human behavioural ecology has suggested that analyses focusing on early childhood may underestimate the importance of paternal investment to child outcomes since such investment may not become crucial until adolescence or beyond. This may be especially important in societies with a heritable component to status, as later investment by fathers may be more strongly related to a child's adult status than early forms of parental investment that affect child survival and child health. In such circumstances, the death or absence of a father may have profoundly negative effects on the adult outcomes of his children that cannot be easily compensated for by the investment of mothers or other relatives. This proposition is tested using a multigenerational dataset from Bangalore, India, containing information on paternal mortality as well as several child outcomes dependent on parental investment during adolescence and young adulthood. The paper examines the effects of paternal death, and the timing of paternal death, on a child's education, adult income, age at marriage and the amount spent on his or her marriage, along with similar characteristics of spouses. Results indicate that a father's death has a negative impact on child outcomes, and that, in contrast to some findings in the literature on father absence, the effects of paternal death are strongest for children who lose their father in late childhood or adolescence.     

Effects of parental public health insurance eligibility on parent and child health outcomes

Many states expanded their Medicaid programs to low-income adults under the Affordable Care Act (ACA). These expansions increased Medicaid coverage among low-income parents and their children. Whether these improvements in coverage and healthcare use lead to better health outcomes for parents and their children remains unanswered. We used longitudinal data on a large, nationally representative cohort of elementary-aged children from low-income households from 2010 to 2016. Using a difference-in-differences approach in state Medicaid policy decisions, we estimated the effect of the ACA Medicaid expansions on parent and child health. We found that parents’ self-reported health status improved significantly post-expansion in states that expanded Medicaid through the ACA by 4 percentage points (p < 0.05), a 4.7% improvement. We found no significant changes in children’s use of routine doctor visits or parents’ assessment of their children’s health status. We observed modest decreases in children’s body mass index (BMI) of about 2% (p < 0.05), especially for girls.     

Maternal age at last birth in Egypt

To assess the effects of women's education, residence, and marital experience on their age at the birth of their last child, a proportional hazards regression model was applied to 1980 Egyptian Fertility Survey (EFS) data. The detailed data include the date of birth of each child for every women interviewed, and the woman's date of birth and age at interview. Age at last birth was examined by regression analysis on birth history and socioeconomic information. 4 hypotheses were tested: women who are well educated have a greater probability of ending childbearing earlier than women with less education; women in rural areas have a higher probability of having their last child at older ages than urban women; marital disruption without remarriage lowers the probability of older maternal age at last birth; and marital disruption with remarriage increases the probability that a woman stops reproducing at an older age. The overall chi-square indicates a significant regression. All coefficients were significant, except the coefficient for women with intact 1st marriages. Women with more education had a greater probability of ending childbearing earlier than women with less education. Rural women tended to have their last children at ages significantly older than overall age at last birth. Current residence in urban areas had the opposite effect. The coefficient for those with intact 1st marriages was insignificant, meaning that the mean age at last birth for this group of women was not much different from the overall mean. Remarried women tended to end childbearing at ages significantly older than the overall average age at last birth, suggesting that these women tended to have children by their new husbands. Those with dissolved 1st marriages who had not remarried had a higher probability of ending childbearing earlier than did older women. Marriage age and final parity had highly significant negative coefficients; as marriage age and number of children born increased, so did the "survival" time or the age at last birth. Results from the hazards model indicate that the effects were as anticipated. The median age at last birth for the total sample of women aged 45-49 was 45-49 years. The median age at last birth was about 2 years older for rural compared to urban women. Illiterate women had the oldest median age at last birth of the education groups. There was little differences between median ages at last birth for women with intact 1st marriages and those whose 1st unions were dissolved and who had remarried. The median age at last birth increased with final parity.     

Valuing mother and child health: The intrauterine environment

The paper estimates the value a mother assigns to own health relative to child health. Estimation of relative health valuation requires the decomposition of a child health improvement into its direct effect on the child's health and its indirect effect, through improvements in maternal health. Failure to distinguish the impact of the direct and indirect effects can lead to biased estimates. We consider the intrauterine environment of a pregnant mother and her unborn child, where maternal health inputs are choice variables and her health affects child health. The empirical estimates suggest that mothers value child health up to six times higher than own health, and that the relative value depends on maternal consumption patterns and household characteristics.     

The socioeconomic gradient in child health and noncognitive skills: Evidence from the Czech Republic

We investigate the presence of a socioeconomic status (SES) gradient in children’s health and noncognitive skill development, and its evolution with child age using cohort data from the Czech Republic. We show that family SES are positively associated with better child health. These effects start to emerge at age 3 and are persistent for all subsequent ages. We find a modest strengthening of the gradient as the children grow older. Similarly, at the lowest distribution of average family income, children lag in their noncognitive skills. We find evidence that children enter school with substantial differences in noncognitive skill endowments based on family SES. This correlation persists when controlling for poor health at birth, the roles of specific and chronic health problems, housing conditions, and partner characteristics. Maternal health status explains some of the association between family income and child noncognitive skills. We account for the endogeniety of SES and non-linearities in measures.     

Compliance with diphtheria,tetanus, and pertussis immunisation in Bangladesh: factors identifying high risk groups.

OBJECTIVE--To evaluate factors associated with non-compliance with having second vaccination against diphtheria, tetanus, and pertussis in a treatment centre in Dhaka to determine which children were most at risk of not completing immunisation. DESIGN--Cohort study of infants given first dose of the vaccine and followed up six weeks later to ascertain compliance with having second dose. Factors associated with non-compliance were evaluated. SETTING--Dhaka treatment centre of the International Centre for Diarrhoeal Disease Research, Bangladesh. SUBJECTS--136 unimmunised children aged 6 weeks to 23 months who lived within reach of the treatment centre. At time of the six week follow up 16 of the children could not be traced and seven had died. INTERVENTIONS--All children received their first dose of the vaccine. In each case health education workers had informed the mother about the value of immunisation, and she was given clear instructions to bring the child back after four weeks for the second dose. MAIN OUTCOME MEASURE--Rate of non-compliance with advice to return child for second vaccination. RESULTS--46 of 113 children (41%) received the second dose of the vaccine. Factors most closely associated with mothers'' failure to comply with the second dose were lack of education and low income. Children whose mothers knew most about immunisation at first interview were more likely to have their second dose. CONCLUSIONS--Preventive health care services such as immunisation are appropriately offered in treatment centres, but compliance among children varies with socioeconomic status and mother''s education. Further research should be aimed at ways to make health education more effective among uneducated parents.     

Measuring the childbearing motivation of couples referred to the Shiraz Health Center for premarital examinations

Millions of children who were born during the first decade after the Islamic revolution in Iran are now reaching the age of marriage and childbearing. Short spacing between marriage and the birth of the first child has the potential to cause an excessive and costly increase in the growth of population in Iran. Research into the motivations for the birth of first child among newly married couples can create a knowledge base that will enable health centres to help these couples make better decisions about the timing of their first pregnancy. Using a consecutive sampling technique and administering Miller's Childbearing Questionnaire, data were gathered regarding the childbearing motivations and desires of 300 couples who had been referred to the Shiraz Health Center for premarital counselling. The Childbearing Questionnaire, with some minor modifications, was found to be a valid and reliable instrument for measuring the childbearing motivations of newly married couples of Shiraz County, Fars Province, Iran. The utility of these findings for counselling in health centres is discussed. Based on the results, a longitudinal study is being designed that will allow the development of models for predicting the time of first pregnancy after marriage.     

Operations for harelip and cleft palate; the emotional complications in children

Mothers of children who need reconstructive operations for defects present at birth are likely to feel guilty, particularly if the pregnancy was unwanted. The physician treating the child is in a position to reassure the mother and assuage her guilt. To the child, the meaning of a surgical experience depends not on the type or seriousness of the actual operation, but on the type and depth of imaginings which it stimulates. For children between two and four, the anxiety of separation from the mother is greater than that aroused by the anesthetic. A good relationship with the mother will insulate the child against many traumatic events.A surgical operation is an important and stressful experience for a child, activating the great childhood fears of abandonment, of mutilation, and of death. Very frequently, children with harelip and cleft palate, by the time definitive restorative surgery is contemplated, have had emotional experiences that make them more than usually vulnerable to the harmful effects of operation. If the child can discuss the products of his imagination about the operation and have them corrected by someone he trusts, the total response will be more adequate. Talking out and playing out help prevent the development of excessive and harmful emotional reactions.     

The public health implications of maternal care trade-offs

The socioeconomic and ethnic characteristics of parents are some of the most important correlates of adverse health outcomes in childhood. However, the relationships between ethnic, economic, and behavioral factors and the health outcomes responsible for this pervasive finding have not been specified in child health epidemiology. The general objective of this paper is to propose a theoretical approach to the study of maternal behaviors and child health in diverse ethnic and socioeconomic environments. The specific aims are: (a) to describe a causal pathway between the utility that women obtain through work outside the home and through child care and disease hazard rates in childhood using an optimization model; (b) to specify the influence of ethnic and socioeconomic factors on model constraints; (c) to use the model as a tool to learn about how different combinations of maternal wage labor and child care time might influence child health outcomes in diverse social contexts; (d) to identify parameters that will require measurement in future research; (e) to discuss research strategies that will enable us to obtain these measurements; and (f) to discuss the implications of the model for biostatistical modeling and public health intervention. Optimization models are powerful heuristic tools for understanding how ethnic, environmental, family, and personal characteristics can place important constraints on both the quality and quantity of care that women can provide to their children. They provide a quantitative appreciation for the difficult trade-offs that most women face between working in order to purchase basic goods that children cannot do without (e.g., food, clothing, shelter, health insurance), and increasing offspring well-being through child care (e.g., training in social skills, affection, protection from environmental hazards, help with homework). The research was funded by a Faculty Scholars Award from the William T. Grant Foundation to A. Magdalena Hurtado. A. Magdalena Hurtado, Ph.D., is an associate professor in the Department of Anthropology, University of New Mexico. Her research interests include the origins of the sexual division of labor, epidemiology of indigenous peoples, disease susceptibility, the development and intergenerational transmission of antigens and immune defense, immune function and allergic sensitization, and trauma. She also works on public health interventions, biological capital and poverty, and land tenure and human rights in native communities of South America. Carol Lambourne, M.Sc., is a doctoral candidate in the Department of Anthropology, University of New Mexico. Her research interests are evolutionary models of child and adolescent development, life history theory, family composition and investment patterns, pubertal timing and psychosexual maturation, juvenile stress, and infanticide. Kim Hill, Ph.D., is a professor in the Department of Anthropology, University of New Mexico. His research interests are modern hunter-gatherers, including extensive fieldwork in lowland South America. Current topics of interest include human evolution, economic strategies, life history theory, the evolution of cooperation, and the emergence of social norms enforced by punishment. He is also involved in economic development, health and education projects with lowland South American native populations. Karen Kessler received her M.S. in Anthropology from the University of New Mexico in 1996. Her research interests are the application of mathematical modeling to the prevention of diabetes and other causes of morbidity and mortality in historical populations.     

Strongyloides stercoralis: a field-based survey of mothers and their preschool children using ELISA, Baermann and Koga plate methods reveals low endemicity in western Uganda

To ascertain the current status of strongyloidiasis in mothers and their preschool children, a field-based survey was conducted in western Uganda using a combination of diagnostic methods: ELISA, Baermann concentration and Koga agar plate. The prevalence of other soil-transmitted helminthiasis and intestinal schistosomiasis were also determined. In total, 158 mothers and 143 children were examined from five villages within Kabale, Hoima and Masindi districts. In mothers and children, the general prevalence of strongyloidiasis inferred by ELISA was approximately 4% and approximately 2%, respectively. Using the Baermann concentration method, two parasitologically proven cases were encountered in an unrelated mother and child, both of whom were sero-negative for strongyloidiasis. No infections were detected by Koga agar plate method. The general level of awareness of strongyloidiasis was very poor ( < 5%) in comparison to schistosomiasis (51%) and ascariasis (36%). Strongyloidiasis is presently at insufficient levels to justify inclusion within a community treatment programme targeting maternal and child health. Better epidemiological screening is needed, however, especially identifying infections in HIV-positive women of childbearing age. In the rural clinic setting, further use of the Baermann concentration method would appear to be the most immediate and pragmatic option for disease diagnosis.