Bringing it All Together: Effective Maternal and Child Health Practice as a Means to Improve Public Health

Effective maternal and child health (MCH) practice requires skillfully combining a number of theoretical models and frameworks
to support systems addressing the health needs of women, children, and families. This paper describes three perspectives relevant
to current MCH practice: the federal Maternal & Child Health Bureau’s Pyramid of MCH Health Services [1], Frieden’s Health Impact Pyramid [Frieden in Am J Public Health 100(4):590–595, (2010)], and life course theory [Halfon in Milbank Quart, 80:433–79, (2002); Kotelchuck in Matern Child Health J, 7:5–11, (2003); Pies (2009)], an emerging conceptual framework that addresses a number of pressing maternal and child health issues including health
disparities and the social determinants of health. While developed independently, a synthesis of these three frameworks provides
an important analytical perspective to assess the adequacy and comprehensiveness of current public health programs and systems
supporting maternal and child health improvement. Synthesizing these frameworks from the specific vantage point of MCH practice
provides public health practitioners with important and dynamic opportunities to promote improvements in health, especially
for state and local governmental health agencies with the statutory authority and public accountability for improving the
health of women, children, and families in their jurisdictions. A crucial finding of this synthesis is that significant improvements
in MCH outcomes at the state and local levels are the result of collaborative, integrated, and synergistic implementation
of many different interventions, programs and policies that are carried out by a number of stakeholders, and administered
in many different settings. MCH programs have a long history of coordinating disparate sectors of the health care and public
health enterprise to create systems of services that improve maternal and child health. Future improvements in MCH build on
this legacy but will come from a “paradigm shift” in MCH practice that blends (1) evidence–based interventions and best practices that improve the health of individuals, communities, and populations, and crosscuts health service settings with (2) public policies that promote and improve maternal and child health needs at the local, state, and national levels, and (3) supports MCH leadership to implement such changes in MCH systems nationwide. As such, the challenge presented by this synthesis is not merely technical,
i.e. having the scientific and organizational capacity to address identified MCH needs. Instead, a more pressing challenge
is providing effective leadership in the coordination and integration of these frameworks and using them in practice to develop
a vision that guides programs and policies to improve maternal and child health nationwide.