II Maternal and Infant Health Section
III Maternal and Infant Health Best Practices
--Submitted by Nina Jetha, Manager, Canadian Best Practices Initiative, Public Health Agency of Canada, and Brittany Irvine, Program Assistant, Canadian Best Practices Initiative, Public Health Agency of Canada
The Public Health Agency of Canada’s (PHAC) Canadian Best Practices Portal (the Portal) increases access to information to support planning, implementing and evaluating public health programs. A key feature of the Portal is the Best Practices section, available online at http://184.108.40.206/. The Best Practices section of the Portal is a searchable list of chronic disease prevention and health promotion interventions which provide program planners and public health practitioners with easy and immediate access to successful public health programs, interventions and policies that have been evaluated and adapted for use in other settings. The Best Practices section of the Portal disseminates best practices from around the world in chronic disease prevention and health promotion so that effective programs can be shared and replicated among the public health community.
Interventions nominated for inclusion on the Portal undergo rigorous assessment. The complete inclusion and exclusion criteria are available online at http://220.127.116.11/selection_criteria-eng.html. In order to be included on the Portal, interventions must:
- Address a chronic disease or health promotion topic.
- Address one or more of the social determinants of health.
- Be designed for primary or secondary prevention, or for reducing risk factors.
- Have an evaluation described in the published or gray literature; if the evaluation of the intervention has not been reviewed by a collection source, or published in a peer-reviewed journal, then it must meet quality and rigour criteria appropriate to its study design.
- Show evidence of effectiveness in eliciting desired changes, i.e., positive effect on outcomes relevant to health.
- Be replicable and adaptable (practical).
- Have sufficient, descriptive information on the topic and population addressed, goals/objectives, strategies and activities, and evaluation design and outcomes.
Interventions are excluded from the Portal if they
- Do not use a population health or community-based approach.
- Do not have an evaluation or the evaluation is based on pilot study or small sample.
- Are clinical programs, offered in clinical settings, for individual treatment.
- Have been developed with commercial interests that may compromise the integrity of the intervention.
II Maternal and Infant Health Section
Recent work of the Canadian Best Practices Initiative (CBPI) has led to the development of a new section of the Portal dedicated to maternal and infant health in response to the Public Health Agency of Canada’s investment in this priority topic area. While motherhood is often a positive and fulfilling experience, for too many women it is associated with adverse social and economic conditions, ill-health and, though rare in Canada, even death. CBPI is committed to identifying and disseminating information on how to improve women’s health before, during, and after pregnancy and to identifying strategies to improve the health and well-being of newborns and infants. This is accomplished through the promotion of interventions which promote healthy living and strengthen chronic and infectious disease prevention among women and infants at risk. The Portal defines maternal health as the health of women during pregnancy, childbirth and in the postpartum period (PHAC, 2013). Maternal and infant health begins prior to conception, and includes early pregnancy, before women know they are pregnant (Best Start Resource Centre, 2012). It continues with appropriate prenatal care and preventing problems if they arise (CDC, 2012). The ideal result is a full-term pregnancy without unnecessary interventions, the delivery of a healthy baby, and a healthy postpartum period in a positive environment that supports the physical and emotional needs of the mother, baby, and family (CDC, 2012). Pregnancy and childbirth have a huge impact on the physical, mental, emotional and socioeconomic health of women and their families (CDC, 2012). Infant health refers to children aged 0–2 years of age.
A healthy pregnancy and birth, followed by a child’s healthy growth and development during the first years of life, will have long-lasting benefits. New research on maternal health and infant weight has shown that babies who are large for gestational age are more likely to be obese in early childhood and in later life. Therefore, interventions to promote healthy weight gain and nutrition in pregnancy are crucial to helping prevent and reduce obesity rates in the next generation.
The topic page of the new Maternal and Infant Health section is available online at http://18.104.22.168/topic/hp-pdls/7/page/1. This new section features interventions which aim to improve the health of pregnant and postpartum women and their babies. It includes best practices that develop community capacity and supportive environments, particularly for women coping with adverse social and economic conditions. Issues addressed by these interventions include:
- Prenatal Health
- Prenatal and Postpartum Mental Health
- Breastfeeding Promotion
- Parent-Infant Relationships
- Infant Health and Development
- Infant Dental Health
- Infant Injury Prevention
- Infant Abuse and Neglect
In order to support the development of this new section of the Portal, a Maternal and Infant Health Best Practices Working Group was formed to back the work of PHAC. The Working Group was composed of PHAC members from the Canadian Best Practices Initiative, the Division of Children, Seniors and Healthy Development, Aboriginal Head Start in Urban and Northern Communities (AHSUNC), the Canada Prenatal Nutrition Program (CPNP) and the Community Action Program for Children (CAPC). Leaders of community projects funded by AHSUNC, CPNP and CAPC also joined the Working Group. Health Canada colleagues interested in maternal and infant health contributed as well. The mandate of the Working Group was to review and comment on interventions and resources currently on the Portal; identify programs/tools/evidence and references to add to the Portal; provide feedback on the process used to identify and select interventions and resources; and provide suggestions on the layout and organization of information.
After a thorough review of what was already available on the Portal in terms of maternal and infant health, a number of gap areas were identified. These included prenatal health, prenatal and postpartum mood disorders, breastfeeding, and parent-infant relationships. A systematic search of the literature and contact with experts in the field brought many interventions to the attention of Canadian Best Practices Initiative. The interventions were reviewed by the Working Group. Those that met the rigorous standards for inclusion will be live on the Portal by the summer.
III Maternal and Infant Health Best Practices
Three of the new Maternal and Infant Health Best Practices featured on the Portal are highlighted below:
Breaking the Cycle
Breaking the Cycle is a Toronto-based program for pregnant women and mothers of young children who are struggling with problems related to substance abuse and recovery issues. The program also focuses on their young children (prenatal to 6 years) whose physical, developmental and psychosocial health and well-being are at risk because of their prenatal exposure to drugs or because of their exposure to postnatal environments in which substances are being used.
An evaluation using clinical outcome data confirms that program participation was related to: decreased isolation, completion of treatment and intervention plans, greater contact with and custody of children, maintenance of recovery from substance use, increased relational capacity, decreased parental stress and increased child developmental skills.
A program participant says ““They all know we have problems, and the fact that we’re making an effort they think is a very positive thing. A lot of it is encouragement.”
Link to Breaking the Cycle: http://www.mothercraft.ca/index.php?q=ei-btc
The SHEWAY Project
Sheway is a community outreach program for childbearing women and their children who live in the Downtown Eastside of Vancouver. The program aims to:
- Help women access prenatal care and a range of other supports during pregnancy.
- Provide education, referral and support to women to help them reduce risk behaviour (particularly the reduction or abstinence from alcohol and drug use during pregnancy).
- Support mothers in their capacity as parents and caregivers; and promote the health, nutrition and development of children.
An evaluation of the Sheway program highlighted improvements among program participants with regards to: access to prenatal and delivery care, nutritional status, substance misuse, action on sexually transmitted diseases and other health concerns, housing status, parenting and custody issues, healthy birth weight, connections to other social supports and living conditions.
A program participant says: “When you’re first coming off the street for the first year, it’s kind of rough and Sheway’s there to support you and you start getting some of your self-esteem back.”
Link to Sheway: http://sheway.vcn.bc.ca/about-sheway/program-overview/
Parent-Child Mother Goose Program
This national community-based 10-week program uses rhymes, songs and stories to strengthen parent-child relationships.While in the program, parents are taught songs, stories and rhymes that can be used to entertain and calm their infants and /or toddlers. A study found that compared to parents who do not participate in the program, Parent Child Mother Goose participants report greater parenting efficacy and greater secure child attachment.
A program participant says: “I liked meeting with other mothers and comparing notes. It was a weekly outing that was safe, consistent, friendly, and constructive and I really appreciated the morning out with my daughter in a fun social environment.”
Link to Parent-Child Mother Goose Program: http://www.ncbi.nlm.nih.gov/pubmed/22533052.
Another phase of work aimed at further populating the Portal with maternal and infant health interventions in other priority gap areas in underway. This phase of work will focus on father involvement in pregnancy and the postpartum period, maternal obesity prevention, prevention or reduction of substance misuse in pregnancy, preconception health, parenting infants with special needs, and maternal and infant health promotion for new Canadians. We will also be working on the identification of maternal and infant health best practices tailored specifically to Aboriginal populations.
We are pleased to announce that a poster about the new Maternal and Infant Health section of the Portal is being presented at the upcoming Canadian Public Health Association Annual Conference being held at the Ottawa Convention Centre on June 9th-12th. The conference’s theme is “Moving Public Health Forward: Evidence, Policy, Practice.” We hope to see you at the conference. Please stop by to see the poster.
To nominate your organization’s best practice intervention for inclusion on the Canadian Best Practices Portal please visit: http://22.214.171.124/recommend-eng.html.
The Interventions Section of the Canadian Best Practices Portal is a searchable list of chronic disease prevention and health promotion interventions which provides program planners and public health practitioners with easy and immediate access to successful public health programs, interventions and policies that have been evaluated and have the potential to be adapted and used: http://126.96.36.199/.
Best Start: Ontario's Maternal Newborn and Early Child Development Resource Centre supports service providers across the province of Ontario who are working on health promotion projects to improve the health of expectant parents and their young children. The Centre provides workshops and conferences, resources, consultations, and subject-specific information: http://www.beststart.org/index_eng.html.
Canadian Public Health Association (CPHA) 2103 Annual Conference Moving Public Health Forward: Evidence, Policy, Practice is taking place in Ottawa June 9-12, 2013. Information available on the CPHA site at