DEPARTMENT: Epidemiology
COURSE NUMBER: EPI 596
(also BSHE 596, HPM 596, GH 596)
SECTION NUMBER:
N/A
SEMESTER: Spring, CNR 1034
CREDIT HOURS: 3 (2 hours in-class & 1 hour lab credit)
COURSE TITLE: Foundations of Maternal and Child Health
INSTRUCTOR: Carol J Hogue
Co-instructors: Aimee Webb Girard, Jessica Sales, Silke von Esenwein
INSTRUCTOR CONTACT INFORMATION
EMAIL: chogue@emory.edu
PHONE: 404-727-8095
SCHOOL ADDRESS OR MAILBOX LOCATION: 3005 CNR
OFFICE HOURS on request
Teaching Assistant: Jennifer Richards (jrich26@emory.edu)
BRIEF COURSE DESCRIPTION
This is the foundational course for the Maternal and Child Health Certificate. Lectures and readings
cover historical and theoretical underpinnings of maternal and child health problems and programs
aimed to reduce morbidity, mortality, and health disparities. Laboratory utilizes a multi-disciplinary
team approach, supervised weekly by a combination of course faculty, field-based faculty, and teaching
assistant. The laboratory reinforces MCH concepts through practical application in program planning
and evaluation in local, state, federal, and non-governmental agencies. Maternal and child health
programs are unique to reproduction and life course development; more common in women, infants,
children, or adolescents; more serious in women, infants, children, or adolescents; or have
manifestations, risk factors, or interventions that are different in women or during life course
development.
ACADEMIC HONOR CODE
The RSPH requires that all material submitted by a student in fulfilling his or her academic course of study must be
the original work of the student.
RSPH COMPETENCIES
This course contributes to the achievement of the RSPH competencies as they relate to maternal
and child health. By the end of this course students will be able to
1. Describe environmental conditions, including biological, physical and chemical factors, which affect
the health of individuals, communities and populations
2. Discuss how health policy and finance affects the delivery, quality, access and costs of health care for
individuals, communities and populations
3. Apply skills and knowledge in public health setting(s) through planned and supervised experience(s)
related to professional career objectives
4. Describe behavioral, social and cultural factors that contribute to the health and well being of
individuals, communities and populations
MCH CERTIFICATE COMPETENCIES
Additionally, upon completion of this course, students will have gained the following MCH related skills
and perspectives.
1. Describe in depth the major domestic and international causes of mortality and morbidity within
MCH populations (defined as women and children along a life course trajectory) including
differences between the United States and other countries.
2. Apply methodological and analytical skills in the interpretation of data on the health of MCH
populations in order to detect meaningful findings and translate them into information for program
planning and evaluation.
3. Determine the appropriate use of networking, team building, small group process, advocacy,
negotiation and conflict resolution towards the solution of maternal and child health issues and
problems.
4. Assign a maternal and child health program within the historical and current context of related
programs.
5. Write a clear and concise policy statement, position paper, and/or testimony appropriate for a specific
audience.
6. Conduct ethical practice and research within MCH populations with sensitivity to confidentiality of
information and in culturally appropriate contexts.
LIST LEARNING OBJECTIVES ASSOCIATED WITH THE COMPETENCIES
Learning objectives for this course are keyed to the Association of Teachers of Maternal and Child
Health (ATMCH) Competencies (http://www.atmch.org/documents/mchcomps.PDF)
1. Learn the scientific and historical basis for MCH programs (ATMCH competencies: A1, A2, A9, D1,
D2, D5, D9)
2. Develop key management and communication skills (ATMCH competencies: C4, C5, C6, C10, C11)
3. Develop key policy and advocacy skills (ATMCH competencies D10, D11, D12, D13, D14)
4. Learn and practice skills through ethical public health practice (ATMCH competencies: E1, E2, E3,
E4, E5, E6)
EPI596 Foundations in Maternal and Child Health
Spring 2015 In-class Schedule (subject to change)
Friday, 8 – 9:50am, CNR 1034
Date
1/16
Topic
Introduction &
MCH Theory
Class Activity (Instructor)
HR1: Introductions, review
syllabus & assignments (Sales)
HR2: MCH Theory—Life Course
(Sales)
1/23
Project
Introductions
Introduction to class projects
(agency representatives)
Pre-Class Readings
Required reading:
1. Fraser MR. Bringing it All Together: Effective
Maternal and Child Health Practice as a Means to
Improve Public Health. Matern Child Health J. 2012
Jun 22.
2. Grason H and Misra D. 2006. Application of a
Lifecourse and Multiple Determinants Framework to
Improve Maternal Health. Baltimore, MD
3. Thurston, WE.; Vissandjée, B. An ecological model
for understanding culture as a determinant of women's
health. Critical Public Health. Sep. 2005, Vol. 15
Issue 3, p229-242.
4. Wingood GM, DiClemente RJ. Application of the
theory of gender and power to examine HIV-related
exposures, risk factors, and effective interventions for
women. Health Educ Behav. 2000 Oct;27(5):539-65.
Review.
1. Organization assigned readings / websites – field
faculty introductions (see Blackboard for links to the
organizations’ websites)
8-8:20: Bethany Kotlar,
Motherhood Beyond Bars
8:25-8:45: Staci Fox, PPSE
8:50-9:10: TBD
9:15-9:35: TBD
1/30
History of MCH
in the US
History of MCH in the US
(Hogue)
Assignments Due/Given Out
Before class, read the 1-page
description of your group project.
Assigned today: Assignment 1 (due
2/6): Describe a specific, small
portion of US landmark legislation
that is assigned to you. Each student
will do this individually. See rubric.
Required reading:
1. Hogue C, Gibbs-Pickens C. Maternal and child
health. Chapter 19 In: Principles of Public Health
Practice. Forthcoming
2. Peoples-Sheps MD, Alexander GR. Introduction to
the Delta Omega Public Health Classic entitled
“Landmark Federal MCH Legislation.” (First 3 pages)
Assigned today: Assignment 2 (due
2/13): Describe health programs in
Georgia designed to meet a specific
MCH need (i.e., contraception,
prenatal care, child nutrition, and
mental health). This is a group
project. See rubric.
3. Alexander GR. Our legacy for leadership in MCH.
MCH Journal 2003;7:145-150.
4. Explore the website http://mchb.hrsa.gov/timeline
/resources.htm
Individual 3-minute briefings on
None- come to class prepared to give a brief summary to
US laws—each student will
the class of your piece of legislation and the points
briefly describe the law assigned to touched on in the executive summary.
them in Assignment 2 (class)
f
2/6
US landmark
legislation:
Briefings and
Discussion
2/13
Class
presentations of
health program
assignment
Group presentations
Contraception
Prenatal Care
Child Nutrition
Mental Health
Read the case narratives for each Georgia health program.
Be prepared to give a 15-minute presentation on your
group’s health program topic.
Due today: Assignment 1,
Executive Summary of Landmark
Legislation (submit to Blackboard by
8 am). Also be ready to briefly
describe your piece of legislation to
the class today.
Due today: Assignment 2, MCH
Program description
(submit to Blackboard discussion
board, and to assigned faculty
members by 5pm on 2/12).
Assigned today: Assignment 3 (due
3/6): Group case study/presentation
on MDGs related to a specific
country
2/20
Life Course
Methods
History of lifecourse methods;
qualitative and quantitative
methods; strengths and limitations
of approaches with examples from
MCH data bases
PRAMS
Linked vital records
Databases Handout (vital records,
Revised NSCH, BRFSS, YRBSS,
American Community Survey,
National Immunization Survey)
(Hogue)
Required readings:
1. Tu YK, Tilling K, Sterne JA, Gilthorpe MS. A critical
evaluation of statistical approaches to examining the
role of growth trajectories in the developmental
origins of health and disease. Int J Epidemiol. 2013
Oct;42(5):1327-39.
2. Russ SA, Larson K, Tullis E, Halfon N. A lifecourse
approach to health development: implications for the
maternal and child health research agenda. Matern
Child Health J. 2014 Feb;18(2):497-510.
3. Berney LR, Blane DB. Collecting retrospective data:
accuracy of recall after 50 years judged against
historical records. Soc Sci Med. 1997
Nov;45(10):1519-25.
4. David R, Rankin K, Lee K, Prachand N, Love C,
Collins J Jr. The Illinois transgenerational birth file:
life-course analysis of birth outcomes using vital
records and census data over decades. Matern Child
Health J. 2010 Jan;14(1):121-32.
2/27
Global MCH:
Priorities and
Progress
HR 1-2: Global MCH—priorities
and progress (Webb Girard)
Recommended readings (application of various life-course
methods):
1. Brown RA, Rehkopf DH, Copeland WE, Costello EJ,
Worthman CM. Lifecourse Priorities Among
Appalachian Emerging Adults: Revisiting Wallace's
Organization of Diversity. Ethos. 2009 Jun;37(2).
2. Tarter KD, Simanek AM, Dowd JB, Aiello AE.
Persistent Viral Pathogens and Cognitive Impairment
Across the Life Course in the Third National Health
and Nutrition Examination Survey. J Infect Dis. 2013
Dec 23.
3. Christian P, Lee SE, Donahue Angel M, Adair LS,
Arifeen SE, Ashorn P, et al. Risk of childhood
undernutrition related to small-for-gestational age and
preterm birth in low- and middle-income countries. Int
J Epidemiol. 2013 Oct;42(5):1340-55.
4. Nuru-Jeter A, Dominguez TP, Hammond WP, Leu J,
Skaff M, Egerter S, Jones CP, Braveman P. "It's the
skin you're in": African-American women talk about
their experiences of racism. an exploratory study to
develop measures of racism for birth outcome studies.
Matern Child Health J. 2009 Jan;13kay (1):29-39.
5. Collins JW Jr, Wu SY, David RJ. Differing
intergenerational birth weights among the descendants
of US-born and foreign-born Whites and African
Americans in Illinois. Am J Epidemiol. 2002 Feb
1;155(3):210-6.
Required readings:
1. Listen to the podcast from the Lancet series on
maternal health
(http://www.thelancet.com/series/maternal-survival),
and peruse the series commentaries. In addition, select
1 series paper of your choice for in depth review.
2. Bryce J, Victora CG, Black RE. The unfinished
agenda in child survival. Lancet. 2013 Sep
21;382(9897):1049-59. Review.
3.
Victora CG, Wagstaff A, Schellenberg JA, Gwatkin
D, Claeson M, Habicht JP. Applying an equity lens to
child health and mortality: more of the same is
notenough. Lancet. 2003 Jul 19;362(9379):233-41.
4. Rosato M, Laverack G, Grabman LH, Tripathy P,
Nair N, Mwansambo C, Azad K, Morrison J, Bhutta
Z, Perry H, Rifkin S, Costello A. Community
participation: lessons for maternal, newborn, and child
health. Lancet. 2008 Sep 13;372(9642):962-71.
5. World Health Organization and UNICEF (2013).
Countdown to 2015. Accountability for Maternal,
Newborn & Child Survival.
Instructions: Briefly review the countdown 2015
website, and familiarize yourself with the 2013
accountability report on the global situation for MCH
and MC survival. We will review this in more detail in
class.
Recommended readings:
1. Ahmed S, Li Q, Liu L, Tsui AO. Maternal deaths
averted by contraceptive use: an analysis of 172
countries. Lancet. 2012 Jul 14;380(9837):111-25. doi:
10.1016/S0140-6736(12)60478-4. Epub 2012 Jul 10.
2. Hulme, D. (2009) The Millennium Development
Goals (MDGs): A Short History of the World’s
Biggest Promise.
3. Hsu J, Berman P, Mills A. Reproductive health
priorities: evidence from a resource tracking analysis
of official development assistance in 2009 and 2010.
Lancet. 2013 May 18;381(9879):1772-82.
4. Hsu J, Pitt C, Greco G, Berman P, Mills A.
Countdown to 2015: changes in official development
assistance to maternal, newborn, and child health in
2009-10, and assessment of progress since 2003.
Lancet. 2012 Sep 29;380(9848):1157-68.
5. The Partnership for Maternal, Newborn & Child
Health (PMNCH). Analysing commitments to
advance the global strategy for women’s and
children’s health. The PMNCH report. 2011 (pg 147)
3/6
3/13
3/20
Millennium
Development
Goals country
presentations
SPRING BREAK
Life Course I:
Infants
Team presentations and discussion
of MDG case studies (class)
None
Due today: Assignment 3, MDG
case study presentation
1) normal development from
womb to puberty; 2)
environmental, including
psychosocial impediments to
healthy development; and 3) how
public health can make a
difference. (I. Leslie Rubin, MD)
Required reading:
1. Brown, P. (2014, January 4.) Can We Have
Capitalism Without Racism? The Invisible Chains of
Debt and the Catastrophic Loss of African American
Wealth. AlterNet.
http://www.alternet.org/economy/can-we-havecapitalism-without-racism-invisible-chains-debt-andcatastrophic-lossafrican?akid=11367.1074977.2GpXdE&rd=1&src=ne
wsletter943371&t=15&paging=off&current_page=1#
bookmark
2. Garner AS, Shonkoff JP; Committee on Psychosocial
Aspects of Child and Family Health; Committee on
Early Childhood, Adoption, and Dependent Care;
Section on Developmental and Behavioral Pediatrics.
Early childhood adversity, toxic stress, and the role of
the pediatrician: translating developmental science
into lifelong health. Pediatrics. 2012 Jan;129(1):e22431.
3. Kristof, N. (2014, January 8). Progress in the War on
Poverty. The New York Times: The Opinion Pages.
http://www.nytimes.com/2014/01/09/opinion/kristofprogress-in-the-war-onpoverty.html?ref=opinion&_r=0
4. Shonkoff JP, Garner AS; Committee on Psychosocial
Aspects of Child and Family Health; Committee on
Early Childhood, Adoption, and Dependent Care;
Section on Developmental and Behavioral Pediatrics.
The lifelong effects of early childhood adversity and
toxic stress. Pediatrics. 2012 Jan;129(1):e232-46.
Assigned today: Assignment 4 (due
4/3): PRAMS survey design and new
question proposal.
Recommended reading:
Rubin LI, Ed., and Merrick J., Ed. Break the cycle of
environmental health disparities: Maternal and child
health aspects. Ed. Joav Merrick. New York: Nova
Science Publishers, Inc, 2013. Print.
3/27
Health Policy
Analysis through
Surveillance
Analysis
Health Policy Analysis through
Surveillance Analysis (PRAMS &
Perinatal Periods of Risk) (Hogue)
1. AMCHP Life Course Indicators
2. Core State Preconception Health Indicators –
Pregnancy Risk Assessment Monitoring System and
Behavioral Risk Factor Surveillance System, 2009.
MMWR: Morbidity and Mortality Weekly Report,
63(ss03), 1-62, 25 Apr 2014. Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss630
3a1.htm
4/3
Life Course III:
Adolescence
Life Course III:
1. Steinberg L. A Social Neuroscience Perspective on
Adolescent Risk-Taking. Dev Rev. 2008
Mar;28(1):78-106.
2. Sawyer SM, Afifi RA, Bearinger LH, Blakemore SJ,
Dick B, Ezeh AC, Patton GC. Adolescence: a
foundation for future health. Lancet. 2012 Apr
28;379(9826):1630-40.
30 minutes: Adolescent
development (Sales)
80 minutes: Adolescents with
Special Health Care Needs:
transition to adulthood, with
special emphasis on Adolescents
with Autism (Daniel Crimmins,
PhD, MPH. Director of
GaLEND*)
4/10
Life Course IV:
Women
(Community,
Policy)
Life Course IV: Women
Current MCH Policy Issues
(von Esenwein)
Required reading:
1. Chin, J.L.,Yee, B.W.K. & Banks, M.E. (2014).
Women's Health and Behavioral Health Issues in
Health Care Reform. Journal of Social Work in
Disability & Rehabilitation. Volume 13, Issue 1-2,
Pages 122-138.
2. ASTHO Issue Brief: Disparities and Inequities in
Maternal and Infant Health Outcomes, 2012.
3. Megan L. Kavanaugh, Jenna Jerman, Kathleen
Due today: Assignment 4 (submit to
Blackboard by 8 am).
4/17
Life Course II:
Child
Development &
Breaking the
Cycle
Case Study of Infant Mortality in
Puerto Rico
(José Cordero, MD, MPH)
4/24
Breaking the
intergenerational
cycle of
psychiatric
vulnerability.
Life Course IV: Women
(von Esenwein)
Last 20 minutes of class:
Class evaluations
Ethier, Susan Moskosky, Meeting the
Contraceptive Needs of Teens and Young Adults:
Youth-Friendly and Long-Acting Reversible
Contraceptive Services in U.S. Family Planning
Facilities, Journal of Adolescent Health, Volume
52, Issue 3, March 2013, Pages 284-292.
4. Laurent G. Glance1, Andrew W. Dick, J.
Christopher Glantz ,Richard N. Wissler, Feng
Qian, Bridget M. Marroquin, Dana, Mukamel and
Arthur L. Kellermann. (2014) Rates Of Major
Obstetrical Complications Vary Almost Fivefold
Among US Hospitals. Health Aff August
2014 vol. 33 no. 8 1330-1336
1. Listen to Dr. Michael Lu’s presentation at
http://mchb.hrsa.gov/blockgrant/index.html
Additional readings TBD
1. Childhood Abuse History, Posttraumatic
Stress Disorder, Postpartum Mental Health,
and Bonding: A Prospective Cohort Study.
Julia S. Seng CNM, PhD, Mickey Sperlich
CPM, MA, MSW, Lisa Kane Low CNM,
PhD, David L. Ronis PhD, Maria Muzik MD
and Israel Liberzon MD
2. Prevention of Mental Disorders: effective
interventions and policy options. WHO (2004).
Part III: Reducing stressors and enhancing
resilience; promoting a healthy start in life, pp.
28-35.
3. National Scientific Council on the Developing
Child. (2008/2012). Establishing a Level
Foundation for Life: Mental Health Begins in
Early Childhood: Working Paper.
http://www.developingchild.harvard.edu
4. Center on the Developing Child at Harvard
Pre-class Assignment due today:
TBD
5/01—
Final
Exam
Day
5/05—
Final
Report
due
Team
Presentations and
breakfast with the
partners
[No class]
Breakfast with partners starting at
7:30 a.m.
Final group presentations (class)
8-8:25:
8:30-8:55:
9-9:25
9:30-9:55:
[No class]
University (2009). Maternal Depression Can
Undermine the Development of Young Children:
Working Paper
No.8. http://www.developingchild.harvard.edu
5. Prevention of Mental Disorders, Substance Abuse,
and Problem Behaviors: A Developmental
Perspective. William R. Beardslee, M.D.; Peter L.
Chien, M.D.; Carl C. Bell, M.D. Psychiatric
Services, 2011.
None
Due today:
Final presentation (submit to
Blackboard by 8 am).
Peer/self-evaluation forms due
to Jennifer Richards
(jrich26@emory.edu) today at 5 pm
Please incorporate any feedback you get on your final
presentation into your final report.
Due today: Final Assignment
(submit to Blackboard by 5 pm).
Evaluation
Grades for the course will be assigned as follows:
Assignment
Lab & Class participation, evaluated by faculty
Lab participation, evaluated by lab group
(group’s average grade for you)
Assignment 1, Landmark legislation executive summary
Assignment 2, Group presentation on MCH Programs
Assignment 3, Group presentation on MDGs for a specific country
Assignment 4, PRAMS adolescent data interpretation for program
Final presentation
Final written report
Grade Distribution
95.0-100% = A
90.0-94.9% = A87.0-89.9% = B+
83-86.9% = B
80.0-82.9% = B77.0-79.9% = C+
74.0-76.9% = C
70.0-73.9%= C-
Points
10
5
10
10
10
15
15
25
TOTAL POINTS = 100
Individual (I)
or Group (G)
I
I
I
G
G
I
G
G
Laboratory Schedule (Times TBD with each group)
Projects are community-based, with extensive contact outside class in the community and with the designated agencies for whom the
project teams are working. The four teams, comprised of students from each discipline (i.e., Epidemiology, Behavioral Sciences,
Health Policy, Global Health, Environmental Health) will meet weekly with their in-house faculty advisory, the teaching assistant,
and/or their field faculty advisor. Community hours will vary from week to week, with a minimum number of 30 expected
community-based hours outside of laboratory hours. Teams will track both laboratory and community-based effort.
Note that 10% of your final grade will be from peer evaluations of your contribution to the semester-long project. We will average the
scores provided about you by each peer in your group. This peer evaluation can have a large effect on your final letter grade—in fact,
it did for some students in the past.
Spring 2015 projects are as follows:
Child Health
Adolescent Health
Women’s Health
Maternal Health
Lab Schedule & Goals (Note: This is a rough guideline of when you should be finished with each component of the group
project.)
Lab #
1
2
3
4
5
6
Topic/Deadline
Team Orientation
Work on Assignment 1 (MDG Group Presentation)
Discuss progress made on introduction
Discuss progress made on introduction and literature review
Discuss progress made on literature review/logic model of organization
Due today: Draft of introduction and literature review
Introduction (3-4 pages)




Brief overview of problem addressed by program
Background information on agency & program
Brief overview of program
What is the program’s theory/model of action/logic model? (Show it visually and write an
accompanying narrative)
 Stakeholders—mention primary intended users and stakeholders
Problem addressed by your project
Literature review (3-4 pages) should include:



7
Review of outcome evaluations of similar programs
Review of process evaluations of similar programs
Implications of previous evaluations and/or research for current evaluation
Due today: Draft of logic model for semester project and Project Questions & Design
Project Questions and Design (3-4 pages)
 Restate the purpose of your project
 What is your project’s logic model? (Show it visually and write an accompanying narrative)
 What are the main questions to be answered?
 What type of analysis is appropriate for answering these questions?
What study design (e.g., pre-test/post-test, formative research) do you propose? Why is it appropriate for your
study?
8
9
NO LAB- SPRING BREAK
Revise logic model, project questions, etc.
Due today: Draft of Evaluation methods & Quality control
Evaluation Methods (3-4 pages)
Measurement and Data Collection
 What is your sample (size & description)? Include response rate in final report
 How will you recruit participants and/or how will you gain access to the data?
 What data collection methods will you use? What are your data collection procedures?
 What are you going to measure? List key variables/indicators
 How will you measure your key variables/indicators—include a table showing evaluation
questions, indicators/measures, data collection method for each indicator/measure
 Include in narrative or table which items/sections from data collection instruments will be used to
measure which variables/indicators
 Describe data collection instrument(s), include a copy in the appendix
 What steps are you taking to enhance validity and reliability of your measures?
 Describe plans for protection of human subjects (e.g., confidentiality)
 What are the potential threats to internal and external validity of your evaluation?
Quality Control and Data Analysis (1 page)
 What steps will you take to ensure quality control in data collection and analysis?
 How will you analyze the data you have collected?
If applicable, what statistical tests do you expect to use? Why?
10
11
Discuss progress on evaluation methods & results/deliverables
Due today: Draft of deliverables (& updated evaluation methods, if relevant)
Deliverables/Results (6-10 pages)
 Description of participants or target population

12
Explanation of main findings with relevant statistics or, if qualitative, the representative quotes or
major themes identified from your data collection. Use tables, figures, and graphs as necessary. It is ok
to put them in the appendix, but they will be graded as part of this section. (Note: organizing by
project question works well)
Include other deliverables (e.g., the curriculum developed)

Due today: Draft of interpretation, utilization & recommendations, & public health contribution
Interpretation, Utilization and Recommendations (3-5 pages)
 Discussion of major findings and possible interpretations
 Discussion of limitations (including validity/reliability)
 Discussion of how the findings can be used and implications for the program
 Discussion of recommendations and rationale based on the findings
Contribution to Public Health (1 page)
 What are the implications of the findings for similar programs and/or public health in general?
13
Continue discussing the above sections & get feedback on presentation from advisor