Creating a Paradigm Shift in Maternal and Child Health: Advancing the Life Course Perspective

Leading Maternal and Child Health (MCH) practitioners, academics, and policy advocates have been working together to develop a broad new paradigm in MCH that has the potential to change MCH practice, particularly with regard to addressing racial-ethnic disparities in birth outcomes. This Life Course Perspective (LCP) offers a new way of looking at an individuals' health over their life span, not as disconnected stages (infancy, latency, adolescence, childbearing years) unrelated to each other, but as an integrated whole. It suggests that a complex interplay of biological, behavioral, psychological, social and environmental factors contribute to health outcomes across the span of a person's life and builds on recent social science and public health literature that posits that each life stage influences the next.

In June 2008, a meeting of 25 MCH experts from around the U.S. was held to begin a substantive dialogue examining this new approach for the field, identifying critical next steps for effective dissemination and application in key arenas, and planning for a national conference. The purpose of this meeting, funded in large part by The California Endowment, was to learn from these national experts how five distinct MCH domains – theory, research, practice, policy, and education and training – would need to change and evolve in order to successfully adopt and utilize the Life Course Perspective. Participants included MCH practitioners from health departments; leaders in national organizations focusing on women and children's health, academics working in MCH epidemiology, policy, and training; CityMatCH staff, and representatives from community based organizations and community clinics.

Through a series of presentations by invited participants, and structured and unstructured sessions for questions and discussion, participants identified future directions for each of these five domains and developed a framework for bringing this dialogue to a larger group.

Several concrete products will be developed as a result of the meeting, designed to influence the practice of MCH in academic and practice settings nationally. These include: Policy Briefings based on the five MCH domains – theory, policy, practice, research, and education and training; Guidelines of Core Competencies for MCH professions on the integration of the Life Course Perspective into MCH work; a Life Course Perspective Toolbox for use in academic and practice settings; publication of a meeting report; and an agenda and planning document for a national conference.

Over the past four decades, millions of dollars have been directed to large-scale national efforts in the U.S. to ensure that every woman, regardless of her ability to pay, has access to quality prenatal care services. Despite the successful implementation of comprehensive prenatal care services, significant and substantial disparities in birth outcomes between racial and ethnic groups still persist. The Life Course Perspective offers us an opportunity to substantially transform theoretical knowledge and actual practice in MCH, while proposing a broader, more environmental, and ultimately more effective, approach to the ways in which we work in the field.