and perinatal care, childhood immunization, regular home visitation, parenting education, promotion of healthy parent-infant interaction, appropriate cognitive and language stimulation, well-baby health care, family support, and center-based infant day care.

Physical Health Interventions with Applications to Mental Health
High-Quality Prenatal and Perinatal Care

Prenatal and perinatal care provide examples of universal preventive interventions directed at the entire population of pregnant women for the protection of the developing fetus and the newborn baby. There is a strong general health promotion and wellness aspect to prenatal care, but such care is also known to prevent prematurity and low birthweight, as well as specific disabilities and disorders in newborns.

There is general agreement that all pregnant women should receive early, regular, and comprehensive prenatal care. In Healthy People 2000: National Health Promotion and Disease Prevention Objectives (DHHS, 1991), the U.S. Public Health Service affirmed that ensuring all infants a healthy start in life and enhancing the health of their mothers must be a top priority in the 1990s if we are to ensure the future health of the nation. Despite this consensus, however, there continue to be large numbers of women in the United States who do not receive prenatal care. Teenage mothers, mothers who are members of disadvantaged minorities, and unmarried mothers all tend to receive prenatal care that is late or inadequate, or they receive no prenatal care at all (IOM, 1985). Well-established medical guidelines define the timing and protocol for appropriate prenatal care, but frequently these are not followed for these high-risk groups (IOM, 1985).

Lack of prenatal care has important implications for mental disorders. Inadequate or absent prenatal care is the main cause of a mixed group of preventable disorders that appear in low-birthweight babies. In the United States, there are disproportionately high rates of low-birthweight babies in some racial and ethnic groups, particularly among African-Americans (Center for the Study of Social Policy, 1992). Low-birthweight babies constitute about 60 percent of all infant deaths. Those babies that survive often do so with major lifelong disorders, such as mental retardation and cerebral palsy, as well as behavioral, emotional, and learning problems (IOM, 1985). There is also some preliminary limited evidence that pregnancy and birth complications may play a role in later development of schizophrenia (see Chapter 6). Improving prenatal and perinatal care and delivering this care to all pregnant



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