Special Issue "Social, Structural, and Policy Determinants of Maternal and Child Health and Health Inequities"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Children's Health".

Deadline for manuscript submissions: 28 February 2021.

Special Issue Editors

Dr. Maeve Wallace
Website
Guest Editor
Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA 70112, USA
Interests: maternal and child health; health equity; social determinants
Dr. Rachel Hardeman
Website
Guest Editor
Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St SE, MMC 729 Mayo, Minneapolis, MN 55455, USA
Interests: maternal and child health; sexual and reproductive health; health equity; structural racism; population health; medical education
Dr. Whitney Rice
Website
Assistant Guest Editor
Department of Behavioral Sciences and Health Education, Emory University, 1518 Clifton Road, GCR 538, Atlanta, GA 30322, USA
Interests: HIV/AIDS prevention; health policy; maternal and child health; health services research; reproductive health; women’s health
Ms. Brigette Davis
Website
Assistant Guest Editor
Department of Social & Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
Interests: structural determinants of health inequities; racism; trauma; community health and resilience; maternal and child health
Dr. Dara Mendez
Website
Assistant Guest Editor
Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, 30 DeSoto Street, 5130 Parran Hall Pittsburgh, Pittsburgh, PA 15261, USA
Interests: pregnancy; birth; women's health

Special Issue Information

Dear Colleagues,

The health of women and children reflects the health of a nation. Yet, in countries across the globe—including the US—reproduction represents a potentially dangerous experience: maternal and infant mortality rates remain unacceptably high, maternal morbidity and other adverse maternal and child health outcomes continue to occur. The persistence of these health challenges, despite increased health care spending, improved access to care, and decades of public health and clinical research, suggests the need to explore more deeply rooted fundamental causes. These are features of the places where women are born, live, work, and play; the policies that shape those places as protective or harmful to health; and the very structure and functioning of a society that dictates the distribution of power and resources across the population.

Moreover, the persistence of vast inequities in maternal and child health outcomes reflects an ongoing failure to confront the reality of life in a stratified society, one where governance, policy, cultural, and societal norms and values are fundamentally shaped by structural racism, class, and gender oppression. Research is needed in order to illuminate how maternal and child population health inequities are a reflection of these conditions and how best to eliminate them.

This Special Issue seeks manuscripts that identify social, structural, and/or policy determinants of maternal and child health and health inequities. We welcome the submission of manuscripts that explore how maternal and child health outcomes and inequities are part of and inseparable from the contexts in which they occur. We encourage work that moves beyond documenting associations towards demonstrations of how policy can remediate harmful contexts to advance health equity. We especially welcome interdisciplinary work, mixed methodologies, and research that identifies interventions aiming to dismantle the systems that perpetuate racial, socioeconomic, geographic, and other health inequities in maternal and child health.

Dr. Maeve Wallace
Dr. Rachel Hardeman
Dr. Whitney Rice
Dr. Dara Mendez
Ms. Brigette Davis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • maternal and child health
  • health equity
  • social determinants of health
  • health policy
  • maternal mortality
  • infant mortality

Published Papers (5 papers)

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Research

Open AccessArticle
Severe Housing Insecurity during Pregnancy: Association with Adverse Birth and Infant Outcomes
Int. J. Environ. Res. Public Health 2020, 17(22), 8659; https://doi.org/10.3390/ijerph17228659 - 21 Nov 2020
Abstract
Introduction: Housing insecurity is increasingly commonplace among disadvantaged women and children. We measured the individual- and population-level impact of severe housing insecurity during pregnancy on adverse birth and infant outcomes. Methods: We analyzed data from 3428 mother–infant dyads enrolled in the Fragile Families [...] Read more.
Introduction: Housing insecurity is increasingly commonplace among disadvantaged women and children. We measured the individual- and population-level impact of severe housing insecurity during pregnancy on adverse birth and infant outcomes. Methods: We analyzed data from 3428 mother–infant dyads enrolled in the Fragile Families and Child Wellbeing Study, a prospective cohort study representing births in 20 large U.S. cities from 1998 to 2000. Severe housing insecurity was defined as threatened eviction or homelessness during pregnancy. Outcomes included low birth weight and/or preterm birth, admission to a neonatal intensive care unit (NICU) or stepdown facility, extended hospitalization after delivery, and infant health and temperament. We estimated exposure–outcome associations with risk ratios adjusted for pre-pregnancy maternal sociodemographic and heath factors and calculated a population attributable fraction (PAF) of outcomes attributable to severe housing insecurity. Results: We found statistically significant associations between severe housing insecurity during pregnancy and low birth weight and/or preterm birth (risk ratio (RR] 1.73, 95% confidence interval (CI) 1.28, 2.32), NICU or stepdown stay (RR 1.64, CI 1.17, 2.31), and extended hospitalization (RR 1.66, CI 1.28, 2.16). Associations between housing insecurity and infant fair or poor health (RR 2.62, CI 0.91, 7.48) and poor temperament (RR 1.52, CI 0.98, 2.34) were not statistically significant. PAF estimates ranged from 0.9–2.7%, suggesting that up to three percent of adverse birth and infant outcomes could be avoided by eliminating severe housing insecurity among low-income, pregnant women in US cities. Conclusions: Results suggest that housing insecurity during pregnancy shapes neonatal and infant health in disadvantaged urban families. Full article
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Open AccessArticle
Unmet Healthcare Needs of Children in Vulnerable Families in South Korea: Finding from the Community Child Center Child Panel Survey
Int. J. Environ. Res. Public Health 2020, 17(21), 8241; https://doi.org/10.3390/ijerph17218241 - 07 Nov 2020
Abstract
Presented in this paper is a study that examined the status of unmet healthcare needs of children in vulnerable families and identified factors affecting such unmet needs. The Community Child Center (CCC) Child Panel Survey data in Korea were used. A multiple stepwise [...] Read more.
Presented in this paper is a study that examined the status of unmet healthcare needs of children in vulnerable families and identified factors affecting such unmet needs. The Community Child Center (CCC) Child Panel Survey data in Korea were used. A multiple stepwise logistic regression analysis was performed to examine factors influencing unmet healthcare needs of children. Influencing factors comprised predisposing, enabling, and need factors based on the Andersen Behavioral Model of Health Services Utilization. A total of 340 sixth-graders from vulnerable families participated, and 96 (28.2%) children had unmet healthcare needs. Factors included absence of an after-school caregiver (OR = 1.95, 95% CI [1.16, 3.27]), perceived physical symptoms (OR = 1.33, 95% CI [1.02, 1.73]), parental indifference (OR = 1.33, 95% CI [1.002, 1.77]), duration of daily stay at CCCs (OR = 1.32, 95% CI [1.01, 1.71]), and satisfaction with CCC teachers (OR = 0.65, 95% CI [0.49, 0.85]). The relationship with parents and CCC teachers had the strongest influence on unmet healthcare needs of children. In order to reduce the unmet healthcare needs of children in vulnerable families, existing support structures should be expanded to offer financial and administrative support for children’s parents and CCC teachers. Full article
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Open AccessArticle
Racial Differences in the Biochemical Effects of Stress in Pregnancy
Int. J. Environ. Res. Public Health 2020, 17(19), 6941; https://doi.org/10.3390/ijerph17196941 - 23 Sep 2020
Abstract
Prenatal stress has been linked to preterm birth via inflammatory dysregulation. We conducted a cross-sectional study on female participants who delivered live, singleton infants at University of Pittsburgh Medical Center Magee Women’s Hospital. Participants (n = 200) were stratified by cumulative risk [...] Read more.
Prenatal stress has been linked to preterm birth via inflammatory dysregulation. We conducted a cross-sectional study on female participants who delivered live, singleton infants at University of Pittsburgh Medical Center Magee Women’s Hospital. Participants (n = 200) were stratified by cumulative risk scores using a combination of individual factors (maternal education, diabetes, hypertension, smoking, relationship status, obesity, depression) and neighborhood deprivation scores. We hypothesized that inflammatory cytokines levels differ by risk group and race. Multiplex analyses of IL-6, IL-8, IL-10, IL-13 and TNF-alpha were run. We found that Black birthing people had more risk factors for chronic stress and had lower levels of IL-6 compared to White birthing people. When stratified by risk group and race, low-risk Black birthing people had lower levels of IL-6 compared to low-risk White birthing people, and high-risk Black birthing people had lower levels of IL-8 compared to high-risk White birthing people. Higher area deprivation scores were associated with lower IL-6 levels. Our results suggest that the relationship between chronic stress and inflammatory cytokines is modified by race. We theorize that Black birthing people encounter repetitive stress due to racism and social disadvantage which may result in stress pathway desensitization and a blunted cytokine response to future stressors. Full article
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Open AccessArticle
Association of Summer Heat Waves and the Probability of Preterm Birth in Minnesota: An Exploration of the Intersection of Race and Education
Int. J. Environ. Res. Public Health 2020, 17(17), 6391; https://doi.org/10.3390/ijerph17176391 - 02 Sep 2020
Abstract
Preterm birth (PTB) is common and has negative impacts on infant health. While some maternal risk factors have been identified, including age under 20 or over 40, substance abuse, low BMI, and racism, less is known about the impact of environmental exposures like [...] Read more.
Preterm birth (PTB) is common and has negative impacts on infant health. While some maternal risk factors have been identified, including age under 20 or over 40, substance abuse, low BMI, and racism, less is known about the impact of environmental exposures like high heat. We combined 154,157 records of live births occurring in Minnesota between 2009 and 2015 with hourly weather records collected from the Minneapolis–St. Paul airport. We tested if maternal heat wave exposure (a seven-day period with a mean daily high temp of 37 °C) immediately prior to birth leads to a higher risk of preterm birth. Additional covariates included maternal age, race/ethnicity, educational status, and residence in the seven-county Minneapolis–St. Paul metro area. Pregnant women exposed to a seven-day heat wave of 37 °C or higher experienced a higher relative risk of PTB compared to women who did not experience a heat wave (1.14 risk ratio (RR), 1.0–1.3 95% confidence interval (CI)). The result is robust to controls for a woman’s age, race/ethnicity, educational attainment, place of residence, and year of the birth. Children born to Black women with college degrees who are exposed to heat waves experience a higher relative risk of PTB compared to White women with college degrees in a heat wave (2.97 RR, 1.5–6.1 95% CI). Summer heat waves are associated with higher risk of PTB in late-term pregnancies in Minnesota. Full article
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Open AccessArticle
Cultural Influences on Complementary Feeding Beliefs amongst New Chinese Immigrant Mothers in England: A Mixed Methods Study
Int. J. Environ. Res. Public Health 2020, 17(15), 5468; https://doi.org/10.3390/ijerph17155468 - 29 Jul 2020
Abstract
Adequate nutrition during infancy and early childhood is essential for ensuring the growth, health, and development of children so that they can reach their full potential. There is a current void of data on infant and young child feeding practices (IYCF) in ethnic [...] Read more.
Adequate nutrition during infancy and early childhood is essential for ensuring the growth, health, and development of children so that they can reach their full potential. There is a current void of data on infant and young child feeding practices (IYCF) in ethnic minority communities in the UK; specifically, it is difficult to find accurate Chinese IYCF data in the UK because survey data often includes Chinese in the category of ‘Chinese or other ethnic group’, further contributing to health inequalities. This mixed methods study aimed to explore the cultural influences on IYCF beliefs among new Chinese immigrant mothers. A total of 31 mothers of infants aged 6–23 months were recruited from informal community organizations. All 31 mothers were born in Mainland China, the mean length of their stay after immigrating to the UK was 10 years (range = 1–21 years), and their mean age was 29 ± 3.40 years. When using the Infant Feeding Style Questionnaire (IFSQ) to investigate IYCF beliefs, the highest score was obtained for responsive attention, with a value of 4.28 ± 0.92, indicating that parents were very attentive to child hunger and satiety cues; lower scores were obtained for indulgence soothing (1.82 ± 1.01), indulgence coaxing (2.11 ± 1.18), indulgence pampering (1.90 ± 0.95), and pressuring to soothe (1.92 ± 0.86), indicating lesser maternal indulgence and pressuring/controlling beliefs. A sub-sample (n = 14) participated in semi-structured interviews in order to understand the balancing sources of information and cultural preferences, the influence of traditional Chinese medicine, and language difficulties in accessing health services. The mothers reported barriers of IYCF beliefs and the introduction of solid foods earlier than the NHS guidelines. This study can promote optimal IYCF in Chinese immigrants and show health services the need to reconcile differences between the perceptions of British and Chinese health beliefs. Full article
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