Reproductive health and child and adolescent health and development are inextricably linked. Declines in fertility rates often occur in tandem with economic and educational advancement and are associated with benefits in child health. Infant health (in the first 1000 days since conception) can influence longer-term child, adolescent, and adult health. Maternal nutrition and quality of life influences long-term child outcomes. Child nutrition and infections may alter neurodevelopment and long-term educational and vocational outcomes. Finally, adolescent health may influence adult outcomes and reproductive decision-making as well as next-generation health. Together these intertwined areas contribute a perspective of lifecycle trajectories that addresses outcomes for each population (mothers, infants, children, and adolescents) not in silos—recognizing that each group has distal impact on the other groups and that addressing these relationships at critical windows of risk (preconception adolescence, pregnancy, delivery, neonatal, under-5, and teen years) with tailored interventions could leverage opportunities to improve outcomes of mother-child, adolescent-adult, neonate-child (Fig. 22-1).
Using a lifecycle framework to link reproductive, maternal, child, and adolescent health.
Globally, Maternal Child Health (MCH) clinic systems are well established. They provide opportunities for broad coverage of healthcare and public health approaches for populations at-risk and improved maternal child health outcomes. Over the past decades, new interventions have been successfully added to the existing MCH infrastructure. The MCH system can be leveraged to address reproductive and maternal and child health issues, although additional platforms are required to efficiently address adolescent health issues.
In the subsections below we address the different relevant domains in detail: (1) Maternal and reproductive health, (2) Adolescent health, (3) Neonatal health, (4) Infant and child health, and (5) Conclusions, which address cross-cutting approaches to all four populations.
MATERNAL AND REPRODUCTIVE HEALTH
The world’s population is currently over 7.6 billion, with an annual growth rate of 1.07%.1 Population growth rates accelerated to unprecedented levels following World War II, due to the success of public health interventions that resulted in significant declines in mortality. With rising concerns about rapid expansion of the world’s population, and impact on economic and social development, an international movement sparked goals of curbing population growth. Efforts focused on achieving demographic targets through reductions in the total fertility rate (TFR), the number of children born per women each year, were largely successful through early family planning programs. TFR declined by 50%, from 6 to 3, between 1974 and 1994.2
Human Rights-based Approach to Sexual and Reproductive Health
Progress in decreasing TFR was not universal and unintended pregnancy rates remained high, which made achievement of demographic targets to curb population growth challenging. A fundamental shift from these demographic targets to a human rights-based approach to sexual and reproductive health (SRH) followed the landmark 1994 International Conference on ...