Maternal and Child Health Journal

, Volume 16, Issue 3, pp 649–655 | Cite as

Integrating the Life Course Perspective into a Local Maternal and Child Health Program

  • Cheri Pies
  • Padmini Parthasarathy
  • Samuel F. Posner


For many decades, early access to prenatal care has been considered the gold standard for improving birth outcomes. In Contra Costa County, a diverse urban and suburban county of over one million people in the San Francisco Bay Area, the Family Maternal and Child Health Programs of Contra Costa Health Services (CCHS) have seen high rates of early entry into prenatal care since 2000. Yet despite our best efforts to increase access to quality prenatal care, our rates of low birth weight and infant mortality, especially among African Americans, continue to be high. When we were introduced to the Life Course Perspective in 2003 as an organizational framework for our programmatic activities, we recognized that emerging scientific evidence in the literature demonstrated the importance of social and environmental factors in determining health and health equity, and supported a general impression in the field that prenatal care was not enough to improve birth outcomes. The Life Course Perspective suggests that many of the risk and protective factors that influence health and wellbeing across the lifespan also play an important role in birth outcomes and in health and quality of life beyond the initial years. In this article, we describe the Life Course Perspective and how one local Maternal and Child Health Program adopted and adapted this paradigm by creating and launching a Life Course Initiative to guide our programs and services. The Life Course Initiative implemented by CCHS is designed to reduce inequities in birth outcomes, improve reproductive potential, and change the health of future generations by introducing a longitudinal, integrated, and ecological approach to implementing maternal and child health programs.


Life Course Perspective Birth outcomes Social determinants of health Health equity Local health department 



The authors want to thank the following individuals for their insights, suggestions, and critical review of this article: Wendel Brunner, MD, PhD; Debbie Casanova, MPH; Dawn Dailey, RN, PhD; Chuck McKetney, PhD, MPH; Michael C. Lu, MD, MPH; Milton Kotelchuck, PhD, MPH; the Contra Costa Health Services Writers Group, Meredith Minkler, DrPH, MPH, and Amy Fine, MPH. Funding for the writing of this article was provided by the Public Health Institute’s Adeline Hackett Innovation Award; Contra Costa Health Services; and California Department of Public Health, Maternal, Child and Adolescent Health Program.


  1. 1.
    Gortmaker, S. I. (1979). The effects of prenatal care upon the health of the newborn. American Journal of Public Health, 69, 653–660.PubMedCrossRefGoogle Scholar
  2. 2.
    Quick, J. D., Greenlick, M. R., & Roghmann, K. J. (1981). Prenatal care and pregnancy outcome in an HMO and general population: a multivariate cohort analysis. American Journal of Public Health, 71, 381–390.PubMedCrossRefGoogle Scholar
  3. 3.
    Showstack, J. A., Budetti, P. P., & Minkler, D. (1984). Factors associated with birth weight: an exploration of the roles of prenatal care and length of gestation. American Journal of Public Health, 74, 1003–1008.PubMedCrossRefGoogle Scholar
  4. 4.
    Alexander, G. R., & Korenbrot, C. (1995). The role of prenatal care in preventing low birth weight. Future Child, 5, 103–120.PubMedCrossRefGoogle Scholar
  5. 5.
    Kogan, M. D., Alexander, G. R., Kotelchuck, M., & Nagey, D. A. (1994). Relation of the content of prenatal care to the risk of low birth weight: Maternal reports of health behavior advice and initial prenatal care procedures. JAMA: The Journal of the American Medical Association, 271, 1340–1345.CrossRefGoogle Scholar
  6. 6.
    Moore, T. R., Origel, W., Key, T. C., & Resnik, R. (1986). The perinatal and economic impact of prenatal care in a low-socioeconomic population. American Journal of Obstetrics and Gynecology, 154, 29–33.PubMedGoogle Scholar
  7. 7.
    Institute of Medicine. (1993). Access to health care in America. Washington DC: National Academy Press.Google Scholar
  8. 8.
    Kaiser Family Foundation. (2007). Medicaid’s role for women. Menlo Park (CA): KFF.Google Scholar
  9. 9.
    National Center for Health Statistics. (2010). Health, United States, 2009: With special feature on medical technology. Hyattsville (MD): NCHS.Google Scholar
  10. 10.
    Hamilton, B. E., Martin, J. A., & Ventura, S. J. (2010). Births: Preliminary data for 2008. National Vital Statistics System, 58(16), 1–17.Google Scholar
  11. 11.
    Heron, M. P. (2010). Deaths: Leading causes for 2006. National Vital Statistics System, 58(14), 1–100.Google Scholar
  12. 12.
    Misra, D. P., & Grason, H. (2006). Achieving safe motherhood: Applying a life course and multiple determinants perinatal health framework in public health. Womens Health Issues, 16, 159–175.PubMedCrossRefGoogle Scholar
  13. 13.
    National Partnership for Action to End Health Disparities [Internet]. (2010). Rockville (MD): Office of Minority Health, US Department of Health and Human Services; c2010. The National Plan for Action, Draft as of February 17, 2010: Changing outcomes—achieving health equity, [cited 2010 April 12], [about 2 screens]. Available from
  14. 14.
    Robert Wood Johnson Foundation. (2008). Overcoming obstacles to health. Princeton (NJ): The Foundation.Google Scholar
  15. 15.
    Adler, N. E., Stewart, J., et al. (2007). Reaching for a healthier life: Facts on socioeconomic status and health in the US. San Francisco: The John D. and Catherine T. MacArthur Foundation Research Network on Socioeconomic Status and Health.Google Scholar
  16. 16.
    National Partnership for Action to End Health Disparities [Internet]. (2008). Rockville (MD): Office of Minority Health, US Department of Health and Human Services; c2008. A strategic framework for improving racial/ethnic minority health and eliminating racial/ethnic health disparities, [cited 2010 April 12]; [about 26 screens]. Available from:
  17. 17.
    Misra, D. P., & Guyer, B. (1998). Benefits and limitations of prenatal care: From counting visits to measuring content. JAMA: The Journal of the American Medical Association, 279, 1661–1662.CrossRefGoogle Scholar
  18. 18.
    Barker, D. J. P., Osmond, C., Golding, J., Kuh, D., & Wadsworth, M. E. J. (1989). Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease. BMJ, 298, 564–567.PubMedCrossRefGoogle Scholar
  19. 19.
    Barker, D. J. P. (1990). The fetal and infant origins of adult disease. British Medical Journal, 301, 1111.PubMedCrossRefGoogle Scholar
  20. 20.
    Barker, D. J., Hales, C. N., Fall, C. H., Osmond, C., Phipps, K., & Clark, P. M. (1993). Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (syndrome X): Relation to reduced fetal growth. Diabetologia, 36, 62–67.PubMedCrossRefGoogle Scholar
  21. 21.
    Ben-Shlomo, Y., & Kuh, D. (2002). A life course approach to chronic disease epidemiology: Conceptual models, empirical challenges and interdisciplinary perspectives. International Journal of Epidemiology, 31, 285–293.PubMedCrossRefGoogle Scholar
  22. 22.
    Shonkoff, J. P., Boyce, W. T., & McEwan, B. S. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention. JAMA: The Journal of the American Medical Association, 301, 2252–2259.CrossRefGoogle Scholar
  23. 23.
    Misra, D. P., Guyer, B., & Allston, A. (2003). Integrated Perinatal Health Framework: A multiple determinants framework with a life span approach. American Journal of Preventive Medicine, 25, 65–75.PubMedCrossRefGoogle Scholar
  24. 24.
    Braveman, P., & Barclay, C. (2009). Health disparities beginning in childhood: A life-course perspective. Pediatrics, 124(Suppl 3), S163–S175.PubMedCrossRefGoogle Scholar
  25. 25.
    Lu, M. C., & Halfon, N. (2003). Racial and ethnic disparities in birth outcomes: A life-course perspective. Maternal and Child Health Journal, 7, 13–30.PubMedCrossRefGoogle Scholar
  26. 26.
    Jensen, C. D., Block, G., Buffler, P., et al. (2004). Maternal dietary risk factors in childhood acute lymphoblastic leukemia (United States). Cancer Causes and Control, 15, 559–570.PubMedCrossRefGoogle Scholar
  27. 27.
    Van den Bergh, B. R. H., & Marcoen, A. (2004). High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8- and 9-year olds. Child Development, 75, 1085–1097.PubMedCrossRefGoogle Scholar
  28. 28.
    Li, J., Vestergaard, M., Obel, C., Precht, D. H., Christensen, J., Lu, M., et al. (2009). Prenatal stress and cerebral palsy: A nationwide cohort study in Denmark. Psychosomatic Medicine, 71, 615–618.PubMedCrossRefGoogle Scholar
  29. 29.
    Virk, J., Li, J., Vestergaard, M., Obel, C., Lu, M., & Olsen, J. (2010). Early life disease programming during the preconception and prenatal period: Making the link between stressful life events and type-1 diabetes. PLoS One, 5(7), 1–5.CrossRefGoogle Scholar
  30. 30.
    Huang, J. S., Lee, T. A., & Lu, M. C. (2007). Prenatal programming of childhood overweight and obesity. Maternal and Child Health Journal, 11, 461–473.PubMedCrossRefGoogle Scholar
  31. 31.
    McEwan, B. S. (1998). Protective and damaging effects of stress mediators. The New England Journal of Medicine, 338, 171–179.CrossRefGoogle Scholar
  32. 32.
    Geronimus, A. T. (1992). The weathering hypothesis and the health of African-American women and infants: Evidence and speculations. Ethnicity and Disease, 2, 207–221.PubMedGoogle Scholar
  33. 33.
    Geronimius, A. T. (1996). Black/white differences in the relationship of maternal age to birthweight: A population-based test of the weathering hypothesis. Social Science and Medicine, 42, 589–597.CrossRefGoogle Scholar
  34. 34.
    Geronimus, A. T. (2001). Understanding and eliminating racial inequalities in women’s health in the United States: The role of the weathering conceptual framework. Journal of the American Medical Women’s Association, 56, 133–136.PubMedGoogle Scholar
  35. 35.
    Kotelchuck, M., & Fine, A. (2010). Rethinking MCH: The life course model as an organizing framework. Washington (DC): Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services.Google Scholar
  36. 36.
    Lu, M. C., Kotelchuck, M., Hogan, V., Jones, L., Wright, K., & Halfon, N. (2010). Closing the black-white gap in birth outcomes: A life-course approach. Ethnicity and Disease, 20(1 Suppl 2), 62–76.Google Scholar
  37. 37.
    California Department of Health Services Birth Statistical Master Files 2000–2007. Prepared by Contra Costa Health Services—Community Health Assessment, Planning and Evaluation (CHAPE).Google Scholar
  38. 38.
    Wang, C. C., & Pies, C. A. (2004). Family, maternal, and child health through photovoice. Maternal and Child Health Journal, 8, 95–102.PubMedCrossRefGoogle Scholar
  39. 39.
    Pies, C. A., & Parthasarathy, P. (2007). Photovoice: Giving local health departments a new perspective on community health issues. Martinez (CA): Contra Costa Health Services, Public Health Division.Google Scholar
  40. 40.
    Rattray, T., Brunner, W., & Freestone, J. (2002). The new spectrum of prevention: A model for public health practice. Martinez (CA): Contra Costa Health Services, Public Health Division.Google Scholar
  41. 41.
    Family, Maternal and Child Health Programs’ Life Course Initiative, Overview [Internet]. Martinez: Contra Costa Health Services; c2010 [cited 2010 Sept 7]. Available from:
  42. 42.
    Family, Maternal and Child Health Programs’ Life Course Initiative, 12-Point Plan to Close the Black-White Gap in Birth Outcomes [Internet]. Martinez: Contra Costa Health Services; c2008 [cited 2010 Sept 7]. Available from:
  43. 43.
    Family, Maternal and Child Health Programs’ Life Course Initiative, Building Economic Security Today [Internet]. Martinez: Contra Costa Health Services; c2010 [cited 2010 Sept 7]. Available from:
  44. 44.
    Unnatural Causes [Internet]. San Francisco: California Newsreel; c2008 [cited 2010 May 26]. Available from:
  45. 45.
    Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E. (2010). Socioeconomic disparities in health in the United States: What the patterns tell us. American Public Health Association, 100(Suppl 1), S186–S196.CrossRefGoogle Scholar
  46. 46.
    Marshall, H. R., & Magruder, L. (1960). Relations between parent money education practices and children’s knowledge and use of money. Child Development, 31, 253–284.PubMedGoogle Scholar
  47. 47.
    Moschis GP. (1985). The role of family communication in consumer socialization of children and adolescents. The Journal of Consumer Research, 11, 898–913.CrossRefGoogle Scholar
  48. 48.
    Pritchard, M. E., Myers, B. K., & Cassidy, D. J. (1989). Factors associated with adolescent savings and spending patterns. Adolescence, 24, 711–723.PubMedGoogle Scholar
  49. 49.
    Danes, S. M. (1994). Parental perception of children’s financial socialization. Financial Counseling and Planning, 5, 127–146.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Cheri Pies
    • 1
  • Padmini Parthasarathy
    • 2
  • Samuel F. Posner
    • 3
  1. 1.School of Public HealthUniversity of California, BerkeleyBerkeleyUSA
  2. 2.Family Maternal and Child Health ProgramsMartinezUSA
  3. 3.Center for Chronic Disease and Health Promotion, Centers for Disease Control and PreventionAtlantaUSA

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