Health Policy–Breastfeeding

The health policies surround breastfeeding leaves much of a loophole for companies to climb though to avoid providing a facility for women to pump With the ACA, it required “employers to provide reasonable break time” and a facility (not bathroom) for mothers to pump. This law is known as “Break Time for Nursing Mothers”. This law only applies to companies with at least 50 employees. However this law does not describe how much time is “reasonable” and what this “facility” is nor what the “facility” would include.

Certainly, we are all aware of the benefits of breastfeeding but having to go back to work makes it nearly impossible to breastfeed. If we first address the “facility”, the law is very vague on what this could possibly entail. It only requires the company to provide a facility. So say we are talking about a woman who works for a big company, hundreds of employees. The company could decide to select a small unused room at the other end of the building as this designated area. Since the law only covers pumping breast milk rather than breastfeeding, the facility should include a way for mothers to store the breast milk, but the law does not include this aspect. Also, the employer is not “required to compensate an employee receiving reasonable break time for any work time spent for such purpose”. So not only can the facility be far away from the mother but the time that the mother is gone could put her work at risk. As an employee, you certainly do not have the leisure to get up and leave for any amount of time whenever you want. If you fear your job being in jeopardy, you might be less inclined to breastfeed.

Many many studies show the potential positive effects breastfeeding has on the mother and child but yet these laws are not supportive of this view. This law, “Break Time for Nursing Mothers” appears to allow for more mothers to breastfeed while working but the law is too broad and not specific enough. It leaves much of the details for the individual companies to interpret. I personally think that more effort should be put to make the laws more rigid and make the companies more accountable so that women can breastfeed during work. I see it with the same as allowing time for people to take breaks to smoke. If the company can allow for this to happen, then certainly they can provide a convenient facility for women to breastfeed and/or pump.

What are your thoughts about this law?

What do you think should be done policy wise to make it easier for mothers to breastfeed/pump while at work?


Information about the law:

Information about breastfeeding:

Choosing Cesarean Birth

This article caught my eye this morning as I was scrolling through the NPR health news feed and I wanted to share it with you all. In class, we have briefly discussed health outcomes of cesarean section births, but I am not sure if we have talked very much about elective cesarean section births. As someone who is passionate about natural childbirth, this issue really interests me. An article from ACOG explains that elective cesarean, or Cesarean delivery on maternal request, is prelabor cesarean delivery on maternal request in the absence of any maternal or fetal indications (ACOG, 2013). However, the aspect of elective cesarean sections that I am most interested in regards providers who either:

a) allow women to electively schedule cesarean section births despite the evidence that claims poorer outcomes for both mothers a babies (potential risks include a longer maternal hospital stay, an increased risk of respiratory problems for the infant, and greater complications in subsequent pregnancies, including uterine rupture, placental implantation problems, and the need for hysterectomy ACOG 2013)



b) do not facilitate adequate education to women about the benefits of vaginal delivery, especially if the case of women who may desire a VBAC if the option was provided

The NPR article discusses a recent report that claims approximately 9% of births covered by medicaid are elective cesarean sections. However, because of the potential negative outcomes of elective cesarean deliveries some states (2) are now refusing to pay for elected cesareans while others are finding other ways to discourage this practice.

What do you all think about providers allowing elective cesarean section births? What are some reasons you all think women, and providers, might prefer elective cesarean sections? And, how do you all think this might (or might not) be primarily an “American” problem?

Cesarean delivery on maternal request. Committee Opinion No. 559. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013:121;904–7.

Last post

I just wanted to say how great it has been being in this class and how much I learned, and saw how much more I still need to learn. Being one of two guys in the class, I did not know what to expect and really just wanted to listen. But everyone has been so receptive to any comments I have made in class, and Dr. Foster has obviously been very helpful. As a Global Health minor I have seen how structurally, and physically obviously, violent heteropatriarchy can be. This class demonstrated to me how violent it is in terms of maternal health, as this is a topic that is glossed over in a lot of my classes. We saw how pervasive in daily life it was for someone as strong as Monique. We saw in various presentations how government’s obstinance can cause major problems in terms of contraception and abortion, just to name one of the many examples people gave to demonstrate structural violence against women in terms of maternal health. Overall, this class demonstrated to me how urgent the issue of maternal health is in many parts of the world, and in many instances in the United States. But also all the little things we can do to help the cause like raising awareness or getting involved with the Safe Motherhood movement. Thanks again and good luck to all in your future endeavors!

The importance of infant mental health

After searching through topics that we’ve reviewed in this class this semester, I found a couple of articles about infant mental health, which piqued my interest because it hadn’t been covered so much in class.  Human health does not only comprise of physical health but consists of elements that lend to mental and spiritual health as well.  Unfortunately, there are many circumstances where infant mental health is at jeopardy, such as in the presence of child abuse, violence, attachment problems, depression, and anxiety. So what is currently being done for these infants?  What are the current interventions and health promotions being enacted for infant mental health?

What is infant mental health?  According to The Center on the Social and Emotional Foundations for Early Learning at Vanderbuilt University, infant mental health is the social and emotional development of a child from birth to 3 years of age.

How do we measure infant mental health?  In addition to developmental milestones related to speech, recognition, and social cues, infant mental health is also measured by the infant’s ability to experience, regulate, and express emotions.

What influences infant mental health?  These include the availability of close, secure, and interpersonal relationships with caregivers and family members.  Culture is a huge factor as well, contributing to parenting style and childrearing practices.  What is also considered is the infant’s “inborn” capacity to explore his or her own environment and participate in sensory-filled activities?

What interventions are available to help ensure positive infant mental health?  Prevention via early childhood care, focused intervention for families experiencing domestic issues, crises, etc., and intensive intervention which includes family support, therapy groups, and coping and stress management workshops.

I feel infant mental health is often not given the attention it deserves.  The social relationships and coping behaviors that shape an individual begin at a very early age. What are your thoughts on the importance of mental health in infants?  Should it be given more attention?  How do you think parenting affects attachment styles and how does that affect current and future mental health in children?

A Focus on Preventing Preterm Birth

I had been thinking about our class discussion on the lack of priority given to the Safe Motherhood Initiative, and in particular, how difficult it is to show the burden of infant and maternal mortality.  Interestingly enough, when looking at recent articles on birth and global health, I came across several articles on a report in The Lancet on the toll of prematurity.  Researchers from the World Health Organization, the Johns Hopkins Bloomberg School of Public Health and the London School of Hygiene and Tropical Medicine looked at the causes of child mortality in 194 countries from 2000 to 2013, and found that premature birth was the single greatest cause of death among babies and young children.

For the first time, an infectious disease is not the leading killer of children under five.  This could drastically shift the focus of most international health organizations from solely targeting infectious diseases to broader and longer-term health solutions that would combat infectious diseases and the underlying causes of preterm birth.  As an NPR article noted, “Babies born premature are more fragile, more susceptible to infection.  This may not happen at the time of birth but can happen soon after, during the first month of life.  They may get pneumonia, sepsis, a systemic infection.”

In looking at preventions for preterm births and deaths, the NPR article discusses many of the same maternal health interventions we looked at in our class, such as improving nutrition, reducing infections (especially syphilis), and reducing smoking.  On the newborn side, thermal care is imperative, such as keeping preterm babies warm by wrapping them in a blanket.  These ideas are central to many of the programs implemented by the Safe Motherhood Initiative, with an educational focus.  With reports like this, do other students think there might be a greater international focus on maternal and newborn health programs?  Does this reflect a greater epidemiological shift in developing countries that require deeper and overarching health systems?


“Parentese” and a Positive Affect: What really matters?

Weeks ago there was a tangential discussion in class during which I unfairly mischaracterized a phenomenon known as “baby talk”; I meant to get back and correct my error, but there is surprisingly little data on this after the 1980s. From what I can gather that still applies and the few more recent studies, here’s the down low on infant communication.

There are about four ways scientists typically characterize the speech with which caretakers address infants: inflection, affect, repetition, and emphasis. All of this is exaggerated in the universal application of “parentese”, found in most every country and every language for a very good reason. Each one of these categories shows benefits to the child; inflection is comforting, engaging, and teaches conversational patterns, while affect works on connecting words and emotions, and both repetition and emphasis aid in the child’s ability to learn by imitation and understand before they are attuned to perceiving meaning through less exaggerated cues. In studies where parents do not use this ridiculous speech pattern, children show less ability to engage with others and experience more temperamental fits. “Parentese” has long been compared to adult-directed speech, and in such a comparison, adult-directed speech is found wanting. It does not have the comforting and attention-grabbing inflections of so-called “baby-talk” and thus is found less engaging to the infant. All signs point to the necessity of the four traits we call “parentese” and tout its benefits quite clearly.

However, while we frequently promote speaking to babies in this theatrical manner, we fail to define what it is to most parents. Comparing only baby-directed and adult-directed makes it sound as though any maturity to speech is a negative, which is incorrect; adult-directed fails in affect and emphasis, but certainly not content. Adopting a lisp, for example, or making up new and non-English words do not fit within this framework of beneficial parentese features. To be blunt, there is a vast difference between “baby talk” and stupid talk. Parents often excuse improper “cute” grammar and simplistic lingual redundancy as a typical manner of communication with infants, but that disregards the intent of this communication: emphasis for ease of imitation. Repetition is positive for infant learning, but deliberate lisping, low vocab levels, and improper grammar result in improper speech patterns and diminished vocabulary when the child is learning to speak, and in this sense, “baby talk” can be damaging when applied incorrectly. Additionally, prolonged use of baby-talk into the speaking years for toddlers can even result in speech impediments, as children parrot and learn what they hear.

In summary, “baby talk” is a net positive when used in a conscious way, focused primarily on happy, repetitive exaggeration. Using infancy as an excuse to not address your child with words used in everyday life, however, is simply dampening their abilities at word acquisition, and though you may understand that your lisp or silly word is not meant to be taken or used seriously, your infant and later toddler does not yet have the framework to understand that. Every day and daily experience shapes your child’s mindset, so play with nonsense words when your school-age child is old enough to understand the rules you’re breaking. Make sure your language use, also, is age appropriate; this is baby-talk, not toddler talk. Language has a strong impact on children, and just as people are conscious of not cussing around children, parents should be cautioned not to give them any other habits they do not desire to later see in their school-age child.

Best, C. T., Singh, L., & Morgan, J. L. (2002). Infants’ listening preferences: baby talk or happy talk? Infancy, 3(3). 365-95.

Papousek, M. (2007). Communication in early infancy: An arena of intersubjective learning. Infant Behavior and Development, 30(2). 258-66.

Feeding practices of infants and children during diarrhea in Lima, Peru

During my presentation about infant morbidity and mortality, I just barely touched on infants and children that suffer from diarrhea and malnutrition.  These are two of the most serious afflictions faced by young children, especially in low-resource settings.  This particular article looks at the feeding practices of children with diarrhea in a semi-urban setting in Lima, Peru (I chose to look at Peru because my family is Peruvian).  In 2010, 4% of deaths among children younger than 5 years occurred because of diarrhea.  In addition, chronic malnutrition is prevalent (roughly about 32% in rural areas and 11% in urban areas).  Although such illnesses, when recognized, are easily resolved with home interventions such as increased breastfeeding, oral rehydration, and increasing the intake of foods (especially with high water content), the feeding practices in Lima are not coherent with these practices.  In fact, in this article, a survey revealed that of 390 caregivers, 71.9% discontinued or lessened normal feeding (40% of those withheld vegetables and fruits), and 22.1% believed feeding to children during episodes of diarrhea was harmful.  Yet, after an educational intervention (which included pamphlets with advice for breastfeeding throughout diarrheal episodes, signs and symptoms of dehydration, and improved feeding measures), only 23% of caregivers would recommend withholding feeding during diarrhea.  The second follow-up survey was taken 3 months after the intervention.

It would be beneficial to continue follow up of these caregivers to see if they continue to follow these guidelines.  Also, there could be implementation of community awareness, with some sort of community educator program to further educate all caregivers in Lima.  No child should die from something as treatable as diarrhea.

Pantenburg, B., Ochoa, T.J., Ecker, L., & Ruiz, J.  (2014).  Feeding of Young Children during Diarrhea: Caregivers’ Intended Practices and Perceptions.  Am. J. Trop. Med. Hyg, 91(3): 555-562.  doi: 10.4269/atjmh.13-0235

Service Learning

I really enjoyed the final article we are reading for our last class, “Introducing Nursing Students to Childbearing Practices in Rural Guatemala”. I especially think that reading a piece like this is important for all of us, as many of us are going into nursing and other health care professions. The author outlined the ways to maximize the benefits for both students and the communities involved in service learning, and how much thought and preparation must go into a service learning trip, even a short one. The author discussed the importance of cultural competency and humility, student qualifications, the scope of work, and how to avoid making mistakes that may seem insensitive or ignorant. I would like to discuss a trip I’ve went on last summer and how it relates to each aspect of this reading.

I went to Ghana for 10 days on the Global Medical Brigades trip through Emory. Out of the 10 days, 2 were spent traveling, 1 was spent preparing medicine, 2 were spent hanging out with the community, 1 was spent sight-seeing, and only 4 were spent in the free medical clinic we set up in the rural village of Ekumfi Engo. I would have preferred a longer program, but I was familiar with this trip from friends who had gone the year before. Also, I knew everybody that was going. I am happy that I went, because I have always wanted to travel to Africa and work in a medical setting. But overall, I cannot say I was completely satisfied with the experience. Global Medical Brigades could be improved if some of the aspects the author talks about were implanted in the program. Even though the trip wasn’t specific to maternal health, it is still relevant to what is discussed in this article.

The author mentions the importance of pre-trip meetings, where they went over procedures, aspects of the culture, and expectations of the students. We had a couple of meetings before the trip, but I felt incredibly unprepared. We were only taught how to triage ONCE before the trip. I went into our first clinic day barely knowing how to use a blood pressure cuff. The people lined up outside our clinic were not going to be my guinea pigs, so I made a more experienced girl do it when we were both assigned to a triage station. I felt way too uncomfortable to learn how to take blood pressure on these people who were expecting experienced medical staff. We should have had many more training sessions. I didn’t have access to a pressure cuff to practice with on my own.

The scope of our trip was similar to what the author discussed – mainly based on observation, and helping only when we were qualified to do so (like taking temperature, measuring height and weight, and sorting medicine at the pharmacy). However, none of us knew the local language (many Ghanians who live in the big cities know English, but the people who live in small rural villages do not). The author talks about how Spanish-speakers were a high priority, and I can understand why – it is hard to be helpful when you can’t understand the people you are trying to help. We had translators at each triage station, and the Ghanian doctors, dentist, pharmacist and OBGYN all knew English and could translate for us. This aspect of the trip made me a little bit embarrassed. What were we really doing there? The entire clinic could have been run by the translators and Ghanian medical staff. So many times throughout the clinic days, I thought about how pointless we all were, in our scrubs looking useful but not actually being useful. I had to keep reminding myself that we were there to shadow Ghanian medical staff (which was an awesome experience – they were incredibly knowledgeable and also taught us about the Ghanian healthcare system) and provide free medicine to this rural community, whose nearest health clinic was an incredibly far walk away (most didn’t have cars, and even if they did, the road was barely drivable). Even though we were only there for 4 days, free medicine one time is better than nothing at all.

One thing I’m glad our trip did right was the gift giving aspect. We all provided donations before leaving, but did not distribute them ourselves. This way, there would be no inequality in gift receiving, and we wouldn’t appear as “white-savior”-esq.

Reading this article, I realize that the trip I went on probably wasn’t the most successful service learning trip. I feel that the community did not benefit as much from the trip as the students did. We got to explore Ghana and learn about a culture completely different than our own, which was a valuable experience. But overall, the community would have benefited much, much more from students who were more experienced medically (such as nursing students!) or students who actually knew their language.

Doctors attributing to maternal mortality rates

I came across an interesting article written last year regarding to maternal mortality rates and the cause of such a high rate in the US specifically. The article does not blame what we have normally attributed causing maternal mortality, in fact it shifts the blame to the one person we entrust with most of our medical decisions-doctors, specifically in hospitals. It blames how the new medical technology is constantly putting the mothers and their children at risk of dying.

This is an interesting aspect that I would have never considered. Doctors are the ones that we tend to entrust with our lives and we rely on them to provide us the best care there is. I certainly do believe in that over use of technology and how the high prevalence of infection is in hospitals that could potentially affect the rates of maternal mortality. But I would have never blamed the medical technology as the reason for the higher rates of maternal mortality. I have always thought of medical technology being a good aspect and one that helps the United States stand apart from the rest of the world’s healthcare system. However, this article seem to argue that there is such thing as too much technology with birth. It does seem to be true to a certain extent. I mean, birth has been occurring for so many thousands of years without one piece of equipment that we have hooked up everywhere in hospitals. Births in third world countries lack these modern day equipment and they still fare well.

What are your thoughts on medical technology for births? Do you think it does more harm than good?


Teen Pregnancy

After reading Chapter 9 in the RAMS book, I find it interesting that the issue brought up about policy making is just as relevant to the United States as it is to Iran. Certainly, the US is not dealing with early marriages of girls at the age of 9, or even younger. However, we are constantly battling sex education policy. The push for sex education started around 1892 when the National Education Association passed a resolution for “moral education in the schools”. The city of Chicago was the first to implement sex education in 1913 for high schools but this did not last long as the Catholic Church fought against this type of education resulting in Ella Flagg, the superintendent of schools, to resign. Congress took action with sex education after the end World War I when rates of STDs rose drastically. Congress passed the Chamberlain-Kahn Act, which provided money for educating soldiers about syphilis and gonorrhea. This Act raised awareness about STDs and made Americans view sex education as a public-health issue. However, controversy arose in the 60s when religious groups felt that sex education should not be taught in schools but rather at home. They felt that this topic should be left for parents to discuss with their children and that teaching it in schools will result in more kids having sex.

Similar to the situation in Iran with controlling the population growth, the US had a joined effort to educate students regarding to sex education but differences grew when it came to the details of how to educate the students. It is a nationwide consensus that the younger generation needs to be educated but there is much controversy as to whom should educate the younger generation, the school or their parents? Both groups think they have the best interest of the students with each of their ways to educate but neither consults the student of which way would work best. I personally think student views are not incorporated since during this time frame (from middle school through high school), the students are still seen as children. I do not think it will ever be possible that the voice of the student will be involved in the policy making of sex education.

For me personally, I am from South Carolina. I remember that we had little to no sex education. In my freshmen year, we had a class called “Freshmen Success”, which incorporated sex ed into it. We talked a lot about studying skills and getting to know ourselves for the semester. Our sex education took about 2 classes out of the entire school year. We watched a movie called “The Miracle of Life” and that was just about it. There was no discussion before or after and my teacher seemed uncomfortable about the subject in its entirety. Before high school, my gym teacher taught sex education and took out about a week of class (essentially 3 class days in total) and we talked mainly about abstinence and how we should wait until marriage.

It is interesting to note thought, that despite all of the drastic differences with the teachings of sex education, the rate of teen pregnancies has dropped from one-third of teenagers (between ages 13-19) will become pregnant as teenagers in 2006 less than one in four teenagers in 2010. It seems that even with the conservative way of teaching, teen pregnancy rates are falling nationwide.

What were your experiences with sex education, if any at all, in school?

What ideas do you think will help influence the laws of the teachings of sexual education?