The War on Women’s Health, Part 2 – Family Planning
The War on Women's Health
Part 2: Family Planning
It's all about keeping mothers well and making healthly babies.
By Truthmonk October 29, 2012
The CDC called family planning one of the ten greatest achievements in public health in the 20th century.1 Family planning is about deciding how many children couples want to have and when they want to have them.
Family planning has allowed the United States to achieve desired birth spacing and smaller family size. The success of family planning has been instrumental in the decline of infant, child, and maternal deaths as well as improving the overall health of infants, children, and women.2
Reproductive events in a woman's life
The typically American woman spends about five years pregnant, recovering from being pregnant, or trying to get pregnant. However, she'll spend most of her reproductive life, almost 40-years or 87%, trying to avoid getting pregnant. In the end she'll have two children.3
Without family planning and modern contraceptives, the average woman would have 12 to 15 pregnancies in her lifetime.4
American Family Size
The colonial family from the founding of the Plymouth colony in 1620 to the Revolutionary War in 1775 had on average at least seven children and sometimes as many as nine or 10.5
But with the start of the Industrial Revolution, the American family size started to drop.6 The interrelationships between the social, economic, and political arenas caused fundamental changes to occur. One change was the increased opportunities for upward social and economic mobility brought about by the construction of industrial mills, primarily iron and textiles.
Peale family Portrait by Charles Willson Peale in 1771-1773. Some of Charles Peale 17 children. All this economic growth "led to increases in the quality and quantity of available consumer products and services, expected consumption standards rose, and individuals were required to spend more money simply to maintain the new normal standard of living."
Adults sought to take advantage of these opportunities for themselves and their families. However, the urban locations of the mills, required them to move from the farms to the cities. Moving to the cities meant they had to give up self-sufficiency in exchange for the necessity of paying cash for housing, food, clothing, and other essentials.
Another change was the downward adjustment in the parental benefits of having children. This came from two directions. First the benefits of having a large number of children while economical on the farm had little purpose in the cities, especially after “the passage of laws restricting child labor and mandating compulsory education.” Second children in the cities cost money. The cost of supporting each additional child at a new normal level became increasingly apparent.
Larger Graph
Herdandez tidily summed up the situation said, “In addition, the newly available goods and services competed with children for parental time and money. Since each additional child in a family requires additional financial support and makes greater demands on parental time and attention, the birth of each child reduces the time and money parents can devote to their own work or career as well as to recreation and to older children.”
Parents met this challenge "at least in part by limiting their fertility," i.e. family planning.
Short birth intervals has medical risks for mother and fetus
Short birth intervals not only plays a significant role in determining the weight and health of the newborn baby, but has ramifications for the mother and fetus as well.
A short list of maternal risk include infection, premature rupture of the amnion and chorion membranes, third-trimester bleeding, and postpartum hemorrhage;7 placental abruption, placenta previa, and uterine rupture;8 and even maternal morbidity, and death.9
Some maternal medical conditions that can emerge during the pregnancy are anemia7 and macro- and micro-nutrient nutrient depletion.9
These conditions can affect the developing fetus causing low birthweight and small size for gestational age;8 retarded fetal growth;9 preterm births, miscarriages and stillbirths.10
Short birth interval leads to low birthweight infants
In the last three decades, advances in medical technology and neonatal intensive care have significantly improved the survival rates of infants born preterm. Yet, these very small premature babies, those under three pounds, are at high risk for delayed growth and lasting developmental problems.
A neonatal intensive care nurse holds a very small premature baby weighing less than 3 pounds.
Photo from CarmenWiki, The Ohio State University
The spacing between births, called the birth interval, plays a significant role in determining the weight of the newborn baby, thus the health of the baby.11Normal, healthy babies weigh at least 2,500 grams or 5 pounds 8 ounces. Babies weighing less at birth are classified as follows: low birthweight (LBW) infants (less than 2,500 grams or 5 pounds 8 ounces), moderately low birthweight (MLBW) infants (1,500-2,499 grams, or 3 pounds 4 ounces to 5 pounds 8 ounces), and very low birthweight (VLBW) infants (less than 1,500 grams, or 3 pounds 4 ounces).
The correlation between subnormal birthweight risk and birth interval is direct as shown in the graph. There is a substantial increase risk of low birth weight when babies are born less than 18 months after a previous live birth. The risk for low birth weight increases after 48 months. The best birth interval is between 24 to 47 months, i.e. the birth interval associated with the lowest risk for having a low birth weight baby.
Low birthweight has medical risks for infant and children
“ The smaller an infant is at birth, the greater the risk of health and developmental complications.”12
As advances in medical technology have for low birthweight (LBW) infants greatly increased their survival odds, there remains troubling medical outcomes for them.
Surviving LBW infants are three times more likely to have neurodevelopmental handicaps and twice as likely to have a serious congenital anomaly.11
Studies have shown LBW children have "significantly greater risk for developing respiratory symptoms, including wheezing, coughing and pulmonary infections"13 and "that these respiratory problems may persist well beyond their infancy and childhood and into adulthood."14
LBW children are "at higher risk for psychiatric disturbances from childhood through high school" including delinquent & aggressive behavior in boys15 and anxiety & depression in girls.16 The incidence of ADHD is higher for LBW children.15
The additional familial stress puts them at higher risk for abuse and neglect.17
They have an increased risk of developing serious or prolonged illnesses throughout their lives. A host of medical complications developing in later life such as cardiovascular diseases, high blood pressure, type II diabetes (adult onset diabetes)18, and asthma19 are associated with low birthweight.
Low birthweight leads to higher risk of infant death
Obviously the worse medical risk for an infant is death. The risk of dying at less than 1 year of age sharply increases with declining birth weight.12 In the first year of life the risk of dying for very low birth-weight babies is 105 times higher than for normal birth weight babies. Even for moderately low birth-weight babies there is a 6 times higher risk of death during the first year.
Dr. Maureen Hack, the Director of the High Risk Follow-Up Program in the Department of Pediatrics and Department of Obstetrics and Gynecology at Case Western Reserve University, tidily summed up: NEUROLOGICAL ABNORMALITIES: • Cerebral palsy, blindness, deafness and other neuromotor dysfunction are potential risks of low birth weight. • Though the mean IQ score of low birth weight children falls within the average range, there are higher rates of deficient and subnormal intelligence. HEALTH PROBLEMS: • Higher rates of health problems result in more medical and surgical procedures, frequent rehospitalizations after surgery, and limitations to the activities of daily life. • The rates of conduct disorder, hyperactivity and attentional weakness increase with decreasing birth weight and are associated with brain injury due to low birth weight. FAMILY ISSUES: • Low birth weight has significant negative effects on families, including financial impact, increased caretaker burden, and general family burden. • Parents of low birth weight children exhibit higher levels of parental protection at school age than normal birth weight children. SOCIAL EFFECTS: • Mental or emotional delay can limit a child’s ability to participate in physical activities and to play or socialize with others. • Health problems contribute to an increased number of days spent in bed, restricting children’s activity, decreasing their school attendance, and limiting their social interactions. • Learning problems at school place LBW children at greater risk for grade repetition or placement in special education programs. • LBW teens are involved in fewer risky behaviors in adolescence, including lower rates of alcohol and marijuana use, less contact with police, and lower rates of pregnancy than normal birth weight teens. GROWTH AND DEVELOPMENT: • Growth attainment is generally lower than normal birth weight peers. • Compared to their peers, children born with low birth weight are more likely to experience functional limitations. Hack, Maureen | Focus on Research at Case Western Reserve University | Policy Brief | Schubert Center for Child Studies (Case Western Reserve University) | Policy Brief 6 | October 2007.
Next: The War on Women's Health, Part 3 - Maternal Fetal Medicine
Family Life in 17th- and 18th-Century America (Family Life through History) Colonial America comes alive in this depiction of the daily lives of families—mothers, fathers, children, and grandparents. The Volo's examine the role of the family in society and typical family life in 17th- and 18th-century America. Through narrative chapters, aspects of family life are discussed in depth such as maintaining the household, work, entertainment, death and dying, ceremonies and holidays, customs and rites of passage, parenting, education, and widowhood. Readers will gain an in-depth understanding of the world in which these families lived and how that world affected their lives. Also included are sources for further information and a timeline of historic events.
The book focuses on the day-to-day lives and roles of families throughout history. The roles of all family members are defined and information on daily family life, the role of the family in society, and the ever-changing definition of family are discussed.
America's Children: Resources from Family, Government, and the Economy (Population of the United States in the 1980s: A Census Monograph) Chapter 2 (The family-size revolution: From many to few siblings) reports the dramatic decline in the number of children in families, the change in sibling relationships, and the corresponding competition for limited family resources between the siblings.
A Population History of North America The book discusses the fine details of many broad trends of North America's population history from pre-Columbian times to the present.
Sources
1 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC | Ten Great Public Health Achievements — United States, 1900–1999 | MMWR | Volume 48, Number 12, Pages 241 – 243 | 19990402. 2 Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC | Achievements in Public Health, 1900–1999: Family Planning | MMWR | Voloume 48, Number 47, Pages 1071 –1081 | 19991203. 3 Gold, Rachel Benson; Sonfield, Adam; Richards, Cory L.; Frost, Jennifer J. | Next Steps for America’s Family Planning Program: Leveraging the Potential of Medicaid and Title X in an Evolving Health Care System | Guttmacher Institute, New York, NY, USA | 2009. 4 Ø | Fact Sheet On Benefits of Family Planning | Bixby Center for Reproductive Health Research & Policy (University of California, San Francisco) | Version 3 | June 2006. 5 Volo, James M.; Volo, Dorothy Denneen | Family Life in 17th- and 18th-Century America (Family Life through History) | Greenwood (2005) | Page 45. 6 Herdandez, Donald J. | America's Children: Resources from Family, Government and the Economy | Russell Sage Foundation (New York, New York, USA) | 1993 | Pages 36 – 38. 7 CATALYST Consortium | Systematic Literature Review and Meta-Analyses on Birth Spacing: How Birth Spacing Relates to Infant and Child Mortality, Maternal and Perinatal Health, and Maternal and Child Nutrition Outcomes | U.S. Agency for International Development | April 29, 2005. 8 Mayo Clinic staff | Family planning: Get the facts about pregnancy spacing | Mayo Clinic | May 27, 2011 | Accessed 20060226 @ http://www.mayoclinic.com/health/family-planning/MY01691. 9 King, Janet C. | The Risk of Maternal Nutritional Depletion and Poor Outcomes Increases in Early or Closely Spaced Pregnancies| Journal of Nutrition | Volume 133, Number 5, Pages :1732S-1736S | May 2003. 10 USAID | Family Planning, Birth Spacing (Webpage) | U.S. Agency for International Development | Updated June 02, 2009 | Accessed 20060226 @ http://www.usaid.gov/our_work/global_health/pop/techareas/birthspacing/index.html. 11 Taffel, SM | Trends in low birth weight: United States, 1975-85; Vital Health Statistics | National Center for Health Statistics | Series 21, Number 48 | October 1989. 12 Mathews, T.J.; MacDorman, Marian F. | Infant Mortality Statistics From the 2007 Period Linked Birth/Infant Death Data Set | National Vital Statistics Reports (National Center for Health Statistics; Hyattsville, MD) | Volume 59, Number 6 | 20110629. 13 Ø | Full-Term, Low-Birth-Weight Babies At Significantly Greater Risk For Early Respiratory Symptoms (Webpage) | ScienceDaily's Science News | May 15, 2007 | Reviewed Feb 25, 2012 @ http://www.sciencedaily.com. 14 Ø | Low Birth Weight Linked To Long-Term Respiratory Problems (Webpage) | ScienceDaily's Science News | July 7, 2009 | Reviewed Feb 25, 2012 @ http://www.sciencedaily.com. 15 Ø | Low Birth Weight Children Appear At Higher Risk Of Psychiatric Disturbances (Webpage) | ScienceDaily's Science News | Sep. 1, 2008 | Reviewed Feb 25, 2012 @ http://www.sciencedaily.com. 16 Ø | Low Birth Weight May Predict Depression In Teen Girls (Webpage) | ScienceDaily's Science News |Mar. 5, 2007 | Reviewed Feb 25, 2012 @ http://www.sciencedaily.com. 17 Ø | Small Birthweight And Premature Births Associated With Higher Risk Of Child Abuse (Webpage) | ScienceDaily's Science News | Mar. 14, 2006 | Reviewed Feb 25, 2012 @ http://www.sciencedaily.com. 18 Ø | Low Birth Weight Of A Baby Entails Risks For The Baby's Father (Webpage) | ScienceDaily's Science News | June 30, 2005 | Reviewed Feb 25, 2012 @ http://www.sciencedaily.com. 19 Ø | Impaired Fetal Growth Increases Risk Of Asthma (Webpage) | ScienceDaily's Science News (Oct. 12, 2009 | Reviewed Feb 25, 2012 @ http://www.sciencedaily.com.