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Improving Health in the Community: A Role for Performance Monitoring
Programs that address economic disadvantage have included Aid to Families with Dependent Children (AFDC),1 WIC (Special Supplemental Food Program for Women, Infants, and Children), and Medicaid. Changes in state and federal welfare programs that limit benefit periods and emphasize employment requirements will have an as yet undetermined impact on the financial resources available to families and on the demand for day care services. The cost and quality of those services may have implications for infant health.
Many of the points discussed in the domain of individual response are part of an infant's social environment because parental behavior, in large measure, defines the social environment. In this regard, nutrition, smoking, domestic violence, and other behavioral factors influence the social environment.
Indicators that might be considered include the following:
Of pregnant women and women who have a child less than 1 year of age and who are eligible for AFDC, WIC, or related programs, percentage who are enrolled in those programs.
Programs such as WIC and AFDC provide nutritional and income support to low-income families in the community. WIC participation has been associated with improved pregnancy outcomes (Mayer et al., 1992).
Percentage of low-income pregnant adolescents served by home visiting programs.
Percentage of families with preterm or low birth weight infants or with infants with chronic illness or disabilities served by home visiting programs.
Programs addressed by these two indicators can provide a range of assistance that, for mothers or families at special risk, contributes to better pregnancy outcomes and better infant health (Olds and Kitzman, 1993). A community would want to ensure that programs are culturally appropriate for the families they serve.
In August 1996, as this report neared completion, federal legislation—the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193)—substantially modified many public assistance programs. Under this legislation, Aid to Families with Dependent Children (AFDC) is replaced by a new program designated Temporary Assistance to Needy Families (TANF).