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vaccines that have been recommended for universal administration for at least 5 years. • Increase the proportion of noninstitutionalized adults who are vaccinated annually against influenza and ever vaccinated against pneumococcal disease. Access to Health Care Strong predictors of access to quality health care include having health insurance, a higher income level, and a regular primary care provider or other source of ongoing health care. Use of clinical preventive services, such as early prenatal care, can serve as indicators of access to quality health care services. The objectives selected to measure progress in this area are: • Increase the proportion of persons with health insurance. • Increase the proportion of persons who have a specific source of ongoing care. • Increase the proportion of pregnant women who begin prenatal care in the first trimester of pregnancy. Department of Health and Human Services. (2000). Leading health indicators. Healthy People 2010. Washington, D.C.: DHHS. per 100,000 live births. It is still that high in developing countries. In the United States at present, the maternal mortality rate has declined to a low of 6.5 per 100,000 live births (NCHS, 2005) (Fig. 1.3). This dramatic decrease can be attributed to improved preconceptual, prenatal, labor and birth, and postpartum care, such as the following: • Greater detection of disorders such as ectopic pregnancy or placenta previa and prevention of related complications through the use of ultrasound • Increased control of complications associated with hypertension of pregnancy • Decreased use of anesthesia with childbirth For most of the 20th century, uterine hemorrhage and infection were the leading causes of death during pregnancy and childbirth. This has changed because of the increased ability to prevent or control hemorrhage and infection, and now hypertensive disorders are the leading causes of death in childbirth. Pregnancy-induced hypertension adds to preexisting hypertensive disorders, especially in older women. Nurses who are alert to the signs and symptoms of hypertension are invaluable guardians of the health of pregnant and postpartum women. Infant Mortality Rate The infant mortality rate of a country is an index of its general health, because it measures the quality of pregnancy care, nutrition, and sanitation as well as infant health. This rate is the traditional standard used to compare the state of national health care with that of previous years or of other countries. Thanks to health care advances and improvements in child care, the infant mortality rate in the United States has been steadily declining in recent years; it has reached a record low of 6.9 per 1,000 population (NCHS, 2005). Unfortunately, infant mortality is not equal for all people. African-American infants, for example, have a mortality rate of almost 15% (NCHS, 2005). This difference in AfricanAmerican and white infant deaths is thought to be related to the higher proportion of births to young African-American 12 UNIT 1 Maternal and Child Health Nursing Practice TABLE 1.3 Trends in Maternal and Child Health Care and Implications for Nurses Trend Implications for Nursing Families are smaller than in previous decades. Single parents are increasing in number. An increasing number of women work outside the home. Families are more mobile than previously; there is an increase in the number of homeless women and children. Abuse is more common than ever before. Families are more health-conscious than previously. Health care must respect cost containment. Fewer family members are present as support in a time of crisis. Nurses must fulfill this role more than ever before. A single parent may have fewer financial resources; this is more likely if the parent is a woman. Nurses need to inform parents of care options and to provide a backup opinion when needed. Health care must be scheduled at times a working parent can bring a child for care. Problems of latch-key children and the selection of child care centers need to be discussed. Good interviewing is necessary with mobile families so a health database can be established; education for health monitoring is important. Screening for child or intimate partner abuse should be included in family contacts. Be aware of the legal responsibilities for reporting abuse. Families are ripe for health education; providing this can be a major nursing role. Comprehensive care is necessary in primary care settings because referral to specialists may no longer be an option. BOX 1.6 Statistical Terms Used to Report Maternal and Child Health Birth rate: The number of births per 1,000 population. Fertility rate: The number of pregnancies per 1,000 women of childbearing age. Fetal death rate: The number of fetal deaths (over 500 g) per 1,000 live births. Neonatal death rate: The number of deaths per 1,000 live births occurring at birth or in the first 28 days of life. Perinatal death rate: The number of deaths of fetuses more than 500 g and in the first 28 days of life per 1,000 live births. Maternal mortality rate: The number of maternal deaths per 100,000 live births that occur as a direct result of the reproductive process. Infant mortality rate: The number of deaths per 1,000 live births occurring at birth or in the first 12 months of life. Childhood mortality rate: The number of deaths per 1,000 population in children, 1 to 14
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