TY - JOUR
T1 - Integrated perinatal health framework
T2 - A multiple determinants model with a life span approach
AU - Misra, Dawn P.
AU - Guyer, Bernard
AU - Allston, Adam
N1 - Funding Information:
Financial support was provided by the Maternal and Child Health Bureau (MCHB) (cooperative agreement U93 MC 00101), Health Resources and Services Administration, U.S. Department of Health and Human Services. We acknowledge especially the contributions of Ann Koontz at the MCHB. Holly Grason, director of the Johns Hopkins University (JHU) Women’s and Children’s Health Policy Center (WCHPC), was particularly instrumental in the development and writing of this paper. The input of many colleagues from the JHU WCHPC (Cynthia Minkovitz, Donna Strobino, Patricia O’Campo, Wanda Nicholson, and Carol Weisman), as well as experts from across the country (WCHPC state cluster group and other special members), also contributed to the development of the thinking in the paper. We also acknowledge the constructive suggestions made by the three anonymous reviewers for the journal.
PY - 2003/7
Y1 - 2003/7
N2 - Rationale: Despite great strides in improving prenatal care utilization among American women, key perinatal indicators have remained stagnant or worsened in the past decade, and the United States continues to rank near the bottom compared to other developed countries. A new approach is needed if we are to achieve improvements in perinatal health. Objective: To propose a new framework that integrates a "life span" approach with a multiple determinants model. Method: We recognize that (1) powerful influences on outcome occur long before pregnancy begins; (2) pregnancy outcome is shaped by social, psychological, behavioral, environmental, and biological forces; and (3) the demography of pregnancy has changed dramatically in the last few decades with more women delaying their first birth. Approaches that simultaneously consider the entire life span as well as multiple determinants may need to be adopted. We propose a framework that integrates these approaches and is supported by the research literature. The life span perspective focuses attention toward the preconceptional and interconceptional periods as targets for intervention in improving perinatal health. The multiple determinants model distinguishes among concepts of disease, health and functioning, and well-being for both women and their offspring. Conclusion: Our intent is to influence how policymakers, public health professionals, clinicians, and researchers approach perinatal health.
AB - Rationale: Despite great strides in improving prenatal care utilization among American women, key perinatal indicators have remained stagnant or worsened in the past decade, and the United States continues to rank near the bottom compared to other developed countries. A new approach is needed if we are to achieve improvements in perinatal health. Objective: To propose a new framework that integrates a "life span" approach with a multiple determinants model. Method: We recognize that (1) powerful influences on outcome occur long before pregnancy begins; (2) pregnancy outcome is shaped by social, psychological, behavioral, environmental, and biological forces; and (3) the demography of pregnancy has changed dramatically in the last few decades with more women delaying their first birth. Approaches that simultaneously consider the entire life span as well as multiple determinants may need to be adopted. We propose a framework that integrates these approaches and is supported by the research literature. The life span perspective focuses attention toward the preconceptional and interconceptional periods as targets for intervention in improving perinatal health. The multiple determinants model distinguishes among concepts of disease, health and functioning, and well-being for both women and their offspring. Conclusion: Our intent is to influence how policymakers, public health professionals, clinicians, and researchers approach perinatal health.
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U2 - 10.1016/S0749-3797(03)00090-4
DO - 10.1016/S0749-3797(03)00090-4
M3 - Review article
C2 - 12818312
AN - SCOPUS:0038347140
SN - 0749-3797
VL - 25
SP - 65
EP - 75
JO - American journal of preventive medicine
JF - American journal of preventive medicine
IS - 1
ER -