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Improving Maternal, Newborn, and Child Health

Global Tobacco Use in Pregnancy

CDC’s Division of Reproductive Health (DRH) is funding a 4-year project to evaluate a brief smoking cessation counseling intervention with nurse midwives and system reminders in prenatal clinics in Buenos Aires, Argentina, and Montevideo, Uruguay. Prenatal smoking rates in these countries are among the highest in the world, 15% and 20%, respectively; however, pregnancy-specific smoking cessation interventions are not systematically integrated into prenatal clinics. The project aims to decrease the frequency of women who smoke at the end of pregnancy, and increase positive attitudes and readiness among clinic staff toward providing smoking cessation counseling. Research is being led by Tulane University in collaboration with the Institute for Clinical Effectiveness and Health Policy and Montevideo Clinical and Epidemiological Research Unit. The intervention began in the spring of 2012 with baseline and follow-up data collection. If found to have an effect on outcomes, the intervention will be disseminated for use in similar settings.

stop smokingDRH recently analyzed the patterns and predictors of cigarette smoking among reproductive age women in Ecuador, El Salvador, Guatemala, and Honduras. The analysis found that smoking prevalence ranged from 2.6% in Guatemala to 13.1% in Ecuador, and that smoking prevalence was highest in women who lived in urban areas, were previously married, or had high socioeconomic status.

Although tobacco use is known to negatively influence maternal and child health outcomes and there are effective interventions to help pregnant women quit smoking, there are no published guidelines on treating tobacco dependence during pregnancy that are specifically designed for low and middle income countries. CDC is supporting the development of World Health Organization (WHO) guidelines for treating tobacco dependence during pregnancy. The process will include conducting systematic reviews and meta-analyses and consultating with a technical panel. The expected outcome will be a WHO document to provide guidance and support to member states for treating tobacco dependence during pregnancy. This project started in October 2011 and will last approximately 2 years.

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Obstetric Fistula

Woman and child. Prolonged labor without adequate medical care can result not only in the death of the infant but also in permanent injury or death to the mother when the long pressure from the fetal head creates necrosis and breakage in the wall of the vagina, urethra, bladder, or rectum. This condition, which particularly affects young mothers whose pelvises are not fully grown, is known as obstetric fistula. Fistula formation results in uncontrollable leaking of urine and, less frequently, feces, through the vagina, which often leads to rejection and ostracism of the young women by family and society.

An important step in tackling this problem is collecting and disseminating accurate information on the extent of fistula formation and its risk factors, prevention, and treatment approaches; and the assistance needed for women living with fistula. This information can be used to convince decision makers of the gravity of the situation and of the need for urgent and effective action. CDC/DRH leads the Data, Indicators, and Research Committee, one of the three components of the International Obstetric Fistula Working Group, a global alliance to end fistula. The committee is currently drafting a compendium of indicators that can be used to monitor and evaluate existing programs that aim to eliminate fistula occurrence and its consequences.

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Border Maternal and Child Health (Border MACH)

Pregnany womanTo improve maternal and child health (MCH) along the U.S.-Mexico border, CDC/DRH is working with health program staff at the local and regional levels helping them work collaboratively and increasing their use of MCH data to meet the health needs of the region.

Partnering with the Mexican Secretariat of Health, the U.S.-Mexico Border Health Commission and other United States and Mexican institutions, CDC/DRH has established binational teams of program directors, epidemiologists, data managers, and other local health organization staff in sister cities along the border. These sister city pairs are Tijuana, Baja California—San Diego, California;  Nogales, Chihuahua—Santa Cruz County, Arizona; Ciudad Juarez, Chihuahua—El Paso,  Texas—Dona Ana, New Mexico; and Matamoros, Tamaulipas—Cameron County, Texas.

CDC/DRH provides training and technical assistance to the teams to design and carry out MCH capacity-building projects in their communities. In CDC training workshops, the binational teams learn how to access and use available data to bring about local change, and learn how to work binationally to provide the needed maternal and child care on both sides of the border. These efforts are ongoing and teams that have received training are carrying out binational projects around shared MCH priorities.

CDC has assisted many nations with surveillance and research in maternal and infant health, and continues to provide global technical assistance.

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