-$he $rgeon Gem-d's Workshop on:

--
M.zernal
Infant
Health

S. DEPARTMENT OF HEALTH AND HUMAN SERVICES~Publk Health sBvico.Offic4 of the Assistant Secretary for Health


"Every woman should have quality prenatal care during the
first three months of pregnancy. "
     Julius B. Richmond

Surgeon General of the United States

ii


Preface

The Surgeon General's Workshop on Maternal and Infant Health was
held because of our abiding interest in improving the health of this Nation's
children. We can take great satisfaction with the recent decline in infant
mortality which has been substantial; however, we may once again reach a
plateau similar to that which occurred between 1955 and 1965, if we do not
target our resources effectively. In addition, several population groups in
the United States continue to have a significantly higher infant mortality
and morbidity. These disparaties require very careful attention if we, as a
Nation, can reduce and eliminate them.

The participants at this Surgeon General's Workshop were called on to
develop recommendations for a social strategy to insure that all of our
knowledge is being applied fully in the service of better health for parents
and their infants and to help target our efforts, especially for those who re-
main vulnerable-the unserved and the underserved.fi

   B. Richmond, M.D.
Surgeon General

. . .
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Planning Committee

Planning Commitee for the Surgeon General's Workshop On Maternal and
Infant Health

CHAIRMAN         Ezra C. Davidson, Jr., M.D.

COMMITTEE MEMBERS  Kathryn Barnard, Ph.D.
              Alfred Brann, M.D.
              Stanley C. Graven, M.D.
              Ruby Hearn, Ph.D.
              Arthur Salisbury, M.D.

Federal Represen tives
Charlotte Catz, M.D.
Stanley Greenspan, M.D.
Don Hopkins, M.D.
Mary Grace Kovar

STEERING COMMITTEE  Vince Hutchins, M.D. Workshop Director
              Woodie Kessel, M.D. Workshop
                 Co-Director

Carol Galaty, Executive Director
Florence Foelak, Assistant to the
Executive Director

Morton Lebow, Director of Public Affairs


Contents

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  1
RECOMMENDATIONS AND FINDINGS . . . . . . . . . . . . . . . . . . . . . , . .  3
EXCERPTS FROM KEYNOTE ADDRESSES . . . . . . . . . . . . . . . . . . . . . 18
Julius B. Richmond - Opening Remarks. . . . . . . . . . . . . . . . . . . . . . . . . 18
Patricia Roberts Harris - Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
George I. Lythcott - The Invisible Children . . . . . . . . . . . . . . . . . . . . . . 21
An International Perspective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
  Norman Kretchmer
  Robert E. Greenberg

A Domestic View: Federal Maternal and Infant Health . . . . . . . . . . . . . 24
Services Programs
Gilbert S. Ommen

PANEL PRESENTATION SUMMARIES AND EXCERPTS. . . . . . . . .27
Review and Assessment of the Current Status of
Knowledge, Services and Deficiencies . . . . . . . . . . . . . . . . . . . . . . . . . .27
Obstetrical Perspective (Ryan)
  Pediatric Perspective (Avery)
  Psychosocial Perspective (Barnard)
Dimensions of the Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1
  Who are the Underserved? (Davis)
The Multi-Risk Family: Clinical Perspectives (Greenspan)
  The Promise of Regional Perinatal Care (Johnson)
Social Strategy Influences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
  The Epidemiology of Adverse Outcomes (Oakley)
  Statewide Strategies for Developing Effective
    Perinatal Care Systems (Graven)
Data Systems and Information as Tools for Making the
   System Operate More Effectively (Brann)

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The Needed Resources. . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Public/Private Financing of Maternal and
  Child Health Care (Jones)

Highlights from the Report of the Select Panel
   for the Promotion of Child Health (Schorr)
  Human Resources for Delivering Needed Maternal and
   Child Health Services (Green)
Appendix A - Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Appendix B - NeededServices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
      (from Report of Select Panel for The Promotion
       of Child Health)

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