Maternal and Child Health Journal

, Volume 7, Issue 1, pp 13–30 | Cite as

Racial and Ethnic Disparities in Birth Outcomes: A Life-Course Perspective

  • Michael C. LuEmail author
  • Neal Halfon


Background: In the United States, Black infants have significantly worse birth outcomes than do White infants. The cause of these persisting racial disparities remains unexplained. Most extant studies focus on differential exposures to protective and risk factors during pregnancy, such as current socioeconomic status, maternal risky behaviors, prenatal care, psychosocial stress, or perinatal infections. These risk factors during pregnancy, however, do not adequately account for the disparities. Methods: We conducted a literature review for longitudinal models of health disparities, and presented a synthesis of two leading models, using a life-course perspective. Traditional risk factors during pregnancy are then reexamined within their life-course context. We conclude with a discussion of the limitations and implications of the life-course perspective for future research, practice, and policy development. Results: Two leading longitudinal models of health disparities were identified and discussed. The early programming model posits that exposures in early life could influence future reproductive potential. The cumulative pathways model conceptualizes decline in reproductive health resulting from cumulative wear and tear to the body's allostatic systems. We propose a synthesis of these two models, using the life-course perspective. Disparities in birth outcomes are the consequences of differential developmental trajectories set forth by early life experiences and cumulative allostatic load over the life course. Conclusions: Future research on racial disparities in birth outcomes needs to examine differential exposures to risk and protective factors not only during pregnancy, but over the life course of women. Eliminating disparities requires interventions and policy development that are more longitudinally and contextually integrated than currently prevail.

racial–ethnic disparities infant mortality life course early life programming cumulative pathways allostatic load 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy people 2010, 2nd edn. Washington, DC: US Government Printing Office, 2000.Google Scholar
  2. 2.
    Minino AM, Arias E, Kochanek KD, Murphy SL, Smith BL. Deaths: Final data for 2000, Vol. 50, No. 15. (National vital statistics reports). Hyattsville, MD: National Center for Health Statistics, 2002.Google Scholar
  3. 3.
    Halfon N, Hochstein M. Life-course health development: An integrated framework for developing health, policy, and research. Milbank Q 2002;80:433–79.Google Scholar
  4. 4.
    Oliver M, Shapiro T. Black wealth/white wealth: A new perspective on racial inequality. New York: Routledge, 1995.Google Scholar
  5. 5.
    Krieger N. Women and social class: A methodological study comparing individual, household, and census measures as predictors of black/white differences in reproductive history. J Epidemiol Community Health 1991;45:207–10.Google Scholar
  6. 6.
    Schoendorf KC, Hogue C, Kleinman JC, Rowley D.Mortality among infants of black as compared with white college-educated parents. N Engl J Med 1992;326:1522.Google Scholar
  7. 7.
    McGrady G, Sung J, Rowley D, Hogue C. Preterm delivery and low birth weight among first-born infants of black and white college graduates. Am J Epidemiol 1992;136:266–76.Google Scholar
  8. 8.
    Collins JW, Butler AG. Racial differences in the prevalence of small-for-dates infants among college-educated women. Epidemiology 1997;8:315–7.Google Scholar
  9. 9.
    Singh GK, Yu SM. Infant mortality in the United States: Trends, differentials and projections, 1950 through 2010. Am J Public Health 1995;85:957–64.Google Scholar
  10. 10.
    Berg CJ, Wilcox LS, d'Almada PJ. The prevalence of socioeconomic and behavioral characteristics and their impact on very low birth weight in black and white infants in Georgia. Matern Child Health J 2001;5:75–84.Google Scholar
  11. 11.
    Kleinman JC, Kessel SS. Racial differences in low birth-weight—trends and risk factors. N Engl J Med 1987;317:749–53.Google Scholar
  12. 12.
    Starfield B, Shaprio S, Weiss J, Liang KY, Ra K, Paige D, Wang X. Race, family income, and low birth weight. Am J Epidemiol 1991;134:1167–74.Google Scholar
  13. 13.
    Kaufman JS, Cooper RS, McGee DL. Socioeconomic status and health in blacks and whites: The problem of residual confounding and the resiliency of race. Epidemiology 1997;8:621–28.Google Scholar
  14. 14.
    Kramer MS, Seguin L, Lydon J, Goulet L. Socioeconomic disparities in pregnancy outcome: Why do the poor fare so poorly? Paediatr Perinat Epidemiol 2000;14:194–210.Google Scholar
  15. 15.
    Beck LF, Morrow B, Lipscomb LE, Johnson CH, Gaffield ME, Rogers M, Gilbert BC. Prevalence of selected maternal behaviors and experiences. Pregnancy Risk Assessment and Monitoring System (PRAMS 1999). MMWR 2002;51:1–26.Google Scholar
  16. 16.
    Ebrahim SH, Floyd RL, Merritt RK, Decoufle P, Holtzman D. Trends in pregnancy-related smoking rates in the United States, 1987—1996. JAMA 2000;283:361–6.Google Scholar
  17. 17.
    Mathews TJ, MacDorman MF, Menacker F. Infant mortality statistics from the 1999 period linked birth/infant death data set, Vol. 50, No. 4 (National vital statistics reports).Hyattsville, MD: National Center for Health Statistics, 2002.Google Scholar
  18. 18.
    ChasnoffIJ, Landress HJ, Barrett ME. The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida. N Engl J Med 1990;332:1202–6.Google Scholar
  19. 19.
    Serdula M, Williamson DF, Kendrick JS, Anda RF, Byers T. Trends in alcohol consumption by pregnant women—1985 through 1988. JAMA 1991;265:876–9.Google Scholar
  20. 20.
    Goldenberg RL, Cliver SP, Mulvihill FX, Hickey CA, Hoffman HJ, Klerman LV, Johnson MJ. Medical, psychosocial, and behavioral risk factors do not explained the increased risk for low birth weight among black women. Am J Obstet Gynecol 1996;175:1317–24.Google Scholar
  21. 21.
    Institute of Medicine. Preventing low birth weight. Washington, DC: National Academy Press, 1985.Google Scholar
  22. 22.
    Alexander GR, Kotelchuck M. Assessing the role and effectiveness of prenatal care: History, challenges, and directions for future research. Public Health Rep 2001;116:306–16.Google Scholar
  23. 23.
    Fiscella K. Does prenatal care improve birth outcomes? A critical review. Obstet Gynecol 1995;85:468–79.Google Scholar
  24. 24.
    Alexander GR, Korenbrot G. The role of prenatal care in preventing low birth weight. Future Child 1995;5:103–20.Google Scholar
  25. 25.
    Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM. Births: Final data for 2000, Vol. 50, No. 5. (National vital statistics reports). Hyattsville, MD: National Center for Health Statistics, 2002.Google Scholar
  26. 26.
    Lobel M, Dunkel-Schetter C, Scrimshaw SCM. Prenatal maternal stress and prematurity: a prospective study of socio-economically disadvantaged women. Health Psychol 1992;11:32–40.Google Scholar
  27. 27.
    Hedegaard M, Henriksen TB, Sabroe S, Secher NJ. Psychological distress in pregnancy and preterm delivery. BMJ 1993;307:234–9.Google Scholar
  28. 28.
    Paarlberg KM, Vingerhoets JJM, Passchier J, Dekker GA, Van Geijn HP. Psychosocial factors and pregnancy outcome: A review with emphasis on methodological issues. J Psychosom Res 1995;39:653–95.Google Scholar
  29. 29.
    Copper RL, Goldenberg RL, Das A, Elder N, Swain M, Norman G, Ramsey R, Cotroneo P, Collin BA, Johnson F. The preterm prediction study: Maternal stress is associated with spontaneous pretrem birth at less than 35 weeks' gestation. Am J Obstet Gynecol 1996;175:1286–92.Google Scholar
  30. 30.
    Hobel CJ, Dunkel-Schetter C, Roesch S. Maternal stress as a signal to the fetus. Prenat Neonat Med 1998;3:116–120.Google Scholar
  31. 31.
    Hobel CJ, Dunkel Schetter C, Roesch SC, Castro LC, Arora CP. Maternal plasma corticotropin-releasing hormone associated with stress at 20 weeks' gestation in pregnancies ending in preterm delivery. Am J Obstet Gynecol 1999;180:S257–63.Google Scholar
  32. 32.
    Wadhwa PD, Culhane JF, Rauh V, Barve SS, Hogan V, Sandman CA, Hobel CJ, Chicz-DeMet A, Dunkel Schetter C, Garite TJ, Glynn L. Stress, infection, and preterm birth: A biobehavioural perspective. Paediatr Perinat Epidemiol 2001;15:17–29.Google Scholar
  33. 33.
    Dudley DJ. Hormonal pathways of preterm birth. Am J Obstet Gynecol 1999;180:S251–6.Google Scholar
  34. 34.
    James SA. Racial and ethnic differences in infant mortality and low birth weight: A psychosocial critique. Ann Epidemiol 1993;3:130–36.Google Scholar
  35. 35.
    Savitz DA, Pastore LM. Causes of prematurity. In: McCormick MC, Siegel JE, editors. Prenatal care: Effectiveness and implementation Cambridge: Cambridge University Press, 1999:80–2.Google Scholar
  36. 36.
    Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and premature delivery. N Engl J Med 1998;339:313–20.Google Scholar
  37. 37.
    Fiscella K. Race, perinatal outcome, and amniotic infection. Obstet Gynecol 1995;51:60–6.Google Scholar
  38. 38.
    Smaill F. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev 2000;2:CD000490.Google Scholar
  39. 39.
    King J, Flenady V. Antibiotics for preterm labour with intact membranes (Cochrane Review). In: The Cochrane library, (Issue 3). Oxford: Update Software, 2002.Google Scholar
  40. 40.
    CareyJC, Klebanoff MA, Hauth JC, Hillier SL, Thom EA, Ernest JM, Heine RP, Nugent RP, Fischer ML, Leveno KJ, Wapner R, Varner M. (for National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units). Metronidazole to prevent preterm delivery in pregnant women with asymptomatic bacterial vaginosis. N Engl J Med 2000;342:534–40.Google Scholar
  41. 41.
    Schiono PH, Rauh VA, Park M, Lederman SA, Zuskar D. Ethnic differences in birth weight: The role of lifestyle and other factors. Am J Public Health 1997;87:787–93.Google Scholar
  42. 42.
    Bernfield WD, Wise PH, Rust FP, Rust KJ, Gould JB, Gortmaker SL. Racial disparities in outcomes of military and civilian births in California. Arch Pediatr Adolesc Med 1996;150:1062–7.Google Scholar
  43. 43.
    Cramer JC. Racial and ethnic differences in birth weight: The role of income and financial assistance. Demography 1995;32:231–47.Google Scholar
  44. 44.
    Kermack WD, McKendrick AG, McKinlay PL. Death rates in Great Britain and Sweden: Some general regularities and their significance. Lancet 1934;1:698–703.Google Scholar
  45. 45.
    Barker DJP. Fetal and infant origins of adult disease. BMJ 1990;301:1111.Google Scholar
  46. 46.
    Rich-Edwards JW, Stampfer MJ, Manson JE, Rosner B, Hankinson SE, Colditz GA, et al. Birth weight and risk of cardiovascular disease in a cohort of women followed up since 1976. BMJ 1997;315:396–400.Google Scholar
  47. 47.
    Barker DJP, Hales CN, Fall CHD, Osmond C, Phipps K, Clark PMS. Type 2 (non-insulin-dependent) diabetes mellitus, hypertension and hyperlipidaemia (Syndrome X): Relation to reduced fetal growth. Diabetologia 1993;36:62–7.Google Scholar
  48. 48.
    Law CM, de Swiet M, Osmond C, Fayers PM, Barker DJP, Cruddas AM, et al. Initiation of hypertension in utero and its amplification throughout life. BMJ 1993;306:24–7.Google Scholar
  49. 49.
    Kaplan GA, Salonen JT. Socioeconomic conditions in childhood and ischaemic heart disease during middle age. BMJ 1996;301:1121–3.Google Scholar
  50. 50.
    Powers C, Hertzman C. Social and biological pathways linking early life and adult disease. Br Med Bull 1997;53:210–21.Google Scholar
  51. 51.
    Seckl JR. Physiologic programming of the fetus. Emerging Concepts in Perinatal Endocrinology 1998;25:939–62.Google Scholar
  52. 52.
    Hertzman C. The biological embedding of early experience and its effects on health in adulthood. Ann NY Acad Sci 1999;896:85–95.Google Scholar
  53. 53.
    Soumi SJ. Early determinants of behaviour: Evidence from primate studies. Br Med Bull 1997;53:170–84.Google Scholar
  54. 54.
    Meaney MJ, Aitken S, Sharma S, Viau V, Sarrieau A. Postnatal handling increases hippocampal type II glucocorticoid receptors and enhances adrenocortical negative-feedback efficacy in the rat. J Neuroendocrinol 1989;5:597–604.Google Scholar
  55. 55.
    Gunnar MR, Nelson CA. Event-related potentials in year-old infants: Relations with emotionality and cortisol. Child Dev 1994;65:80–94.Google Scholar
  56. 56.
    Dawson G, Hessel, D, Frey K. Social influences on early developing biological and behavioral systems related to risk for affective disorder. Dev Psychopathol 1994;6:759–79.Google Scholar
  57. 57.
    Heim C, Newport DJ, Heit S, Graham YP, Wilcox M, Bonsall R, Miller AH, et al. Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. JAMA 2000;284:592–7.Google Scholar
  58. 58.
    Coe CL. Psychosocial factors and pscyhoneuroimmunology within a lifespan perspective. In: Keating DP, Hertzman C, editors. Developmental health and the wealth of nations: Social, biological and educational dynamics. New York: Guilford Press, 1999;201–19.Google Scholar
  59. 59.
    Ounsted M, Ounsted C. Rate of intrauterine growth. Nature 1968;220:599–600.Google Scholar
  60. 60.
    Sanderson M, Emanuel I, Holt VL. The intergenerational relationship between mother's birthweight, infant birthweight and infant mortality in black and white mothers. Paediatr Perinat Epidemiol 1995;9:391–405.Google Scholar
  61. 61.
    Hackman E, Emanuel I, Belle GV, Daling J. Maternal birth weight and subsequent pregnancy outcome. JAMA 1983;250:2016–9.Google Scholar
  62. 62.
    Klebanoff MA, Graubard BI, Kessel SS, Berendes HW. Low birth weight across generations. JAMA 1984;252:2423–7.Google Scholar
  63. 63.
    Wang X, Zucherman B, Coffman GA, Corwin MJ. Familial aggregation of low birth weight among whites and blacks in the United States. N Engl J Med 1995;333:1744–9.Google Scholar
  64. 64.
    Coutinho R, David RJ, Collins JW. Relation of parental birth weights among African Americans and whites in Illinois: A transgenerational study. Am J Epidemiol 1997;146:804–9.Google Scholar
  65. 65.
    Porter TF, Fraser AM, Hunter CY, Ward RH, Varner MW. The risk of preterm birth across generations. Obstet Gynecol 1997;90:63–7.Google Scholar
  66. 66.
    Emanuel I. Invited commentary: An assessment of maternal intergenerational factors in pregnancy outcome. Am J Epidemiol 1997;146:820–5.Google Scholar
  67. 67.
    Lumey LH. Decreased birth weights in infants after maternal in utero exposure to the Dutch famine of 1944–1945. Paediatr Perinat Epidemiol 1992;6:240–53.Google Scholar
  68. 68.
    Emanuel I. Intergenerational studies of human birthweight from the 1958 birth cohort. II: Do parents who were twins have babies as heavy as those born to singletons? Br J Obstet Gynecol 1992;99:836–40.Google Scholar
  69. 69.
    Marmot MG, Davey Smith G, Stansfeld S, Patel C, North F, Head J, et al. Inequalities in health twenty years on: The Whitehall II study of British Civil Servants. Lancet 1991;337:1387–94.Google Scholar
  70. 70.
    Power C, Matthews S. Origins of health inequalities in a national population sample. Lancet 1997;350:1584–9.Google Scholar
  71. 71.
    McEwen BS. Protective and damaging effects of stress mediators. N Eng J Med 1998;338:171–9.Google Scholar
  72. 72.
    Sapolsky RM. Social subordinance as a marker of hypercortisolism: Some unexpected subtleties. Ann NY Acad Sci 1995;771:626–39.Google Scholar
  73. 73.
    Kristenson M, Kucinskien Z, Bergdahl B, Calkauskas H, Urmonas V, Orth-Gomer K. Increased psychosocial strain in Lithuanian versus Swedish men: The LiVicorida study. Psychosom Med 1998;60:277–82.Google Scholar
  74. 74.
    Chrousos GP. Stress response and immune function: Clinical implications. Ann NY Acad Sci 2000;917:38–67.Google Scholar
  75. 75.
    Amory JH, Hitti J, Lawler R, Eschenbach DA. Increased tumor necrosis factor-alpha production after lipopolysaccharide stimulation of whole blood in patients with previous preterm delivery complicated by intra-amniotic infection or inflammation. Am J Obstet Gynecol 2001;185:1064–7.Google Scholar
  76. 76.
    Geronimus AT. Black/white differences in the relationship of maternal age to birthweight: A population-based test of the weathering hypothesis. Soc Sci Med 1996;42:589–97.Google Scholar
  77. 77.
    Stein JA, Lu MC, Gelberg L. Severity of homelessness and adverse birth outcomes. Health Psych 2000;19:524–34.Google Scholar
  78. 78.
    Illsley R. Social class selection and class differences in relation to stillbirths and infant deaths. BMJ (Clin Res Ed) 1995;11:1523–4.Google Scholar
  79. 79.
    Emanuel I, Hale CB, Berg CJ. Poor birth outcomes of American black women: An alternative explanation. J Public Health Policy 1989;299–307.Google Scholar
  80. 80.
    Jones J. American work: Four centuries of black and white labor. New York: Norton, 1998.Google Scholar
  81. 81.
    Foster HW, Wu L, Bracken MB, Semenya K, Thomas J. Intergenerational effects of high socioeconomic status on low birthweight and preterm birth in African Americans. J Natl Med Assoc 2000;92:213–21.Google Scholar
  82. 82.
    Mullings L, Wali A, McLean D, Mitchell J, Prince S, Thomas D, Tovar P. Qualitative methodologies and community participation in examining reproductive experience: The Harlem Birth Right Projects. Matern Child Health J 2001;5:85–93.Google Scholar
  83. 83.
    Salafia C, Shiverick K. Cigarette smoking and pregnancy. II: Vascular Effects. Placenta 1999;20:273–9.Google Scholar
  84. 84.
    Hogan VK, Njorge T, Durant TM, Ferre CD. Eliminating disparities in perinatal outcomes—lessons learned. Matern Child Health J 2001;5:135–40.Google Scholar
  85. 85.
    Hueston WJ, Knox MA, Eilers G, Pauwels J, Lonsdorf D. The effectiveness of preterm-birth prevention educational programs for high-risk women: A meta-analysis. Obstet Gynecol 1995;86:705–12.Google Scholar
  86. 86.
    Moos MK, Cefalo RC. Preconceptional health promotion: A focus for obstetric care. Am J Perinatol 1987;4:63–7.Google Scholar
  87. 87.
    Murray JL, Bernfield M. The differential effect of prenatal care on the incidence of low birth weight among blacks and whites in a prepaid health care plan. N Engl J Med 1998;319:1385–91.Google Scholar
  88. 88.
    Gortmaker SL. The effects of prenatal care upon the health of the newborn. Am J Public Health 1979;69:653–60.Google Scholar
  89. 89.
    Kogan MD, Kotelchuck M, Alexander GR, Johnson WE. Racial disparities in reported prenatal care advice from health care providers. Am J Public Health 1994;84:82–8.Google Scholar
  90. 90.
    Brett K, Schoendorf K, Kiely J. Differences between black and white women in the use of prenatal care technologies. Am J Obstet Gynecol 1994;170:41–6.Google Scholar
  91. 91.
    Hodnett ED. Support during pregnancy for women at increased risk of low birthweight babies (Cochrane Review). In: The Cochrane library (Issue 3). Oxford: Update Softeware, 2002.Google Scholar
  92. 92.
    Guyll M, Matthews KA, Bromberger JT. Discrimination and unfair treatment: relationship to cardiovascular reactivity among African American and European American women. Health Psychol 2001;20:315–25.Google Scholar
  93. 93.
    Hauth JC, Goldernberg RL, Andrew WW, DuBard MB, Copper RL. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 1995;333:1732–6.Google Scholar
  94. 94.
    McDonald HM, O'Loughlin JA, Vigneswaran R, Jolley PT, Harvey JA, Bof A, McDonald PJ. Impact of metronidazole therapy on preterm birth in women with bacterial vaginosis flora (Gardnerella vaginalis): A randomised, placebo controlled trial. Br J Obstet Gynaecol 1997;104:1391–7.Google Scholar
  95. 95.
    Cassel J. The contribution of the social environment to host resistance. Am J Epidemiol 1976;104:107–23.Google Scholar
  96. 96.
    Culhane JF, Rauh V, McCollum KF, Hogan VK, Agnew K, Wadhwa PD. Maternal stress is associated with bacterial vaginosis in human pregnancy. Matern Child Health J 2001;5(2):127–34.Google Scholar
  97. 97.
    Herrera JA, Alvardo JP, Martinez JE. The psychosocial environment and cellular immunity in the pregnant patient. Stress Med 1998;4:49–56.Google Scholar
  98. 98.
    DNA studies challenge the meaning of race (News Section). Science 1998;282:654–55.Google Scholar
  99. 99.
    Wang XB, Chen D, Niu T, Wang Z, Wang L, Ryan L, et al. Genetic susceptibility to benzene and shortened gestation: Evidence of gene—environment interaction. Am J Epidemiol 2000;152:701–3.Google Scholar
  100. 100.
    Wang X, Zuckerman B, Pearson C, Kaufman G, Chen C, Wang G, Niu T, Wise PH, Bauchner H, Xu X. Maternal cigarette smoking, metabolic gene polymorphism, and infant birth weight. JAMA 2002;287:195–202.Google Scholar
  101. 101.
    Meaney MJ, Diorio J, Francis D, Widdowson J, LaPlante P, Caldji C, Sharma S, Seckl JR, Plotsky PM. Early environmental regulation of forebrain glucocorticoid receptor gene expression: Implications for adrenocortical responses to stress. Dev Neurosci 1996;18:49–72.Google Scholar
  102. 102.
    Krieger N. Epidemiology, racism, and health: The case of low birth weight. Epidemiology 2000;11:237.Google Scholar
  103. 103.
    Williams DR. Race and health: Basic questions, emerging directions. Ann Epidemiol 1997;7:322.Google Scholar
  104. 104.
    Collins JW, David RJ, Symons R, Handler A, Wall SN, Dwyer L. Low-income African-American mothers' perception of exposure to racial discrimination and infant birth weight. Epidemiology 2000;11:337–9.Google Scholar
  105. 105.
    Jones CP. Levels of racism: A theoretic framework and a gardener's tale. Am J Public Health 2000;90:1212–5.Google Scholar
  106. 106.
    Smedley BD, Stith AY, Nelson AR. (editors). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press,2002.Google Scholar
  107. 107.
    Polednak AP. Trends in urban black infant mortality, by degree of residential segregation. Am J Public Health 1996;86:723–6.Google Scholar
  108. 108.
    LaVeist TA. Segregation, poverty, and empowerment: Health consequences for African Americans. Milbank Q 1993;71:41–64.Google Scholar
  109. 109.
    Singer B, Ryff CD. Hierarchies of life histories and associated health risks. Ann NY Acad Sci 1999;896:96–115.Google Scholar
  110. 110.
    O'Campo P, Xue X, Wang M, Caughy MO. Neighborhood risk factors for low birthweight in Baltimore: A multilevel analysis. Am J Public Health 1997;87:1113–8.Google Scholar
  111. 111.
    Roberts EM. Neighborhood social environments and the distribution of low birthweight in Chicago. Am J Public Health 1997;87:597–603.Google Scholar
  112. 112.
    Lu MC, Chuan S, Tache V, Shaw J, Katzburg J, Alexander GR, Kotelchuck M. A research agenda on obstetric and perinatal health services. Washington, DC: Agency for Healthcare Research and Quality, 2002 (contract # 02R000200).Google Scholar
  113. 113.
    National Research Council (U.S.) 2001. New horizons in health: An integrative approach. Committee on Future Directions for Behavioral and Social Sciences Research at the National Institute of Health, Singer BH, Ryff CD, editors. Washington, DC: National Academy Press,2001.Google Scholar
  114. 114.
    Chavkin W, St Clair D. Beyond prenatal care: A comprehensive vision of reproductive health. J Am Med Womens Assoc 1990;45:55–7.Google Scholar
  115. 115.
    Grason HA, Hutchins JE, Silver GB. (editors). Charting a course for the future of women's and perinatal health. Baltimore, MD: Women's and Children's Health Policy Center, Johns Hopkins School of Public Health,1999.Google Scholar
  116. 116.
    Brown SS, Eisenberg L. (editors). The best intentions: Unintended pregnancy and the well-being of children and families. Washington, DC: National Academy Press,1995.Google Scholar
  117. 117.
    Evans RG, Stoddart GL. Producing health, consuming health care. In: Evans RG, Barer ML, Marmor TR, editors. Why are some people and others not? The determinants of health of populations. New York: Aldine De Guyter,1994.Google Scholar
  118. 118.
    Klerman LV. Promoting the well-being of children: The need to broaden our vision— the 1996 Martha May Eliot Award Lecture. Matern Child Health J 1997;1:53–9.Google Scholar
  119. 119.
    Emmons KM. Health behaviors in a social context. In: Berkman LF, Kawachi I, editors. Soc Epidemiol Oxford: Oxford University Press, 2000;242–66.Google Scholar
  120. 120.
    Lumley J, Oliver S, Waters E. Interventions for promoting smoking cessation during pregnancy. (Cochrane Review). In: The Cochrane library (Issue 3). Oxford: Update Software, 2002.Google Scholar
  121. 121.
    Korenbrot CC, Moss NE. Preconception, prenatal, perinatal and postnatal influences on health. In: Smedley BD, Syme SL, editors. Promoting health: Intervention strategies from social and behavioral research. Washington, DC: National Academy Press, 2000:125–69.Google Scholar
  122. 122.
    Minkler M. Using participatory action research to build healthy communities. Public Health Rep 2000;15:191–7.Google Scholar
  123. 123.
    Buekens P. Is there an indirect effect of European prenatal care policies on preterm births? Prenat Neonat Med 1998;3:145–6.Google Scholar
  124. 124.
    Centers for Disease Control and Prevention. Achievements in public health, 1900–1999: Healthier mothers and babies. MMWR 1999;48:849–58.Google Scholar

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  1. 1.Department of Obstetrics & Gynecology, Department of Community Health Sciences, Center for Healthier Children, Families, and CommunitiesUCLA Schools of Medicine & Public HealthLos Angeles
  2. 2.Department of Pediatrics, Department of Community Health Sciences, Center for Healthier Children, Families, and CommunitiesUCLA Schools of Medicine & Public HealthLos Angeles

Personalised recommendations