Maternal and child health (MCH) programs protect people before, during, and after pregnancy, and infants and children through adolescence. The ultimate goals are to reduce maternal, infant, and child deaths and illness and to promote healthy growth and development — with special attention to populations with higher risk and less access.

Key indicators

The IMR is a sensitive summary indicator of a community's overall health, social conditions, and health care access. The US IMR was 5.6 per 1,000 live births in 2022. The leading causes of infant death are birth defects, preterm birth and low birth weight, sudden infant death syndrome, unintentional injuries, and maternal pregnancy complications. Large racial and geographic gaps persist, which is why many programs focus on equity. Maternal mental health conditions (including suicide and overdose) are a leading underlying cause of pregnancy-related death.

Types of program indicators: input (staff, funding), process (services delivered or used — for example, percentage of pregnant clients with first-trimester prenatal care), output, and outcome (health results — infant mortality, low birth weight rate). Effectiveness asks whether the program reached its outcome objectives.

Life course perspective — health in one stage shapes the next; preconception health, safe pregnancy, and early childhood experiences affect lifelong health. Adverse childhood experiences (ACEs) and toxic stress raise later risk; safe, stable, nurturing relationships are protective.

Major US programs

Well-child care follows the AAP Bright Futures periodicity schedule: growth, development, vision and hearing, oral health, anticipatory guidance, immunizations, and screening for maternal depression at infant visits.

Preconception and prenatal

• Promote a reproductive life plan, folic acid 0.4–0.8 mg (400–800 mcg) daily for anyone who could become pregnant, chronic disease control, and vaccination
• Early (first-trimester) prenatal care; screen for risk factors using standardized risk-assessment forms: age, obstetric history, chronic disease, substance use, intimate partner violence, depression, social needs
• Teach avoidance of tobacco, alcohol (no known safe amount), cannabis, and other drugs; review medications; avoid environmental hazards (lead, certain fish high in mercury, cat litter, raw or undercooked meat)
• Link eligible clients to Medicaid, WIC, and home visiting

Postpartum and newborn

• Postpartum home visits: maternal warning signs (heavy bleeding, severe headache, vision change, chest pain, shortness of breath, calf pain, fever, thoughts of self-harm), infant feeding, jaundice, safe sleep, car seat use
• Breastfeeding: exclusive for about 6 months and continued with complementary foods for 2 years or beyond as mutually desired (AAP 2022); for breast pain, check latch and positioning, feed on demand, use cold packs and anti-inflammatory analgesia, and avoid deep forceful massage and overpumping; fever with a red, painful area of one breast needs prompt evaluation for mastitis while breastfeeding continues
• Depression screening at postpartum visits and at infant well-child visits (1, 2, 4, and 6 months); the National Maternal Mental Health Hotline is 1-833-TLC-MAMA (1-833-852-6262); use 988 or 911 for emergencies
• Hepatitis B vaccine birth dose within 24 hours is the current recommendation for medically stable infants of 2,000 g or more (changes adopted from 2025 onward were stayed by a federal court in March 2026 and are under appeal)

Infancy and early childhood

• Safe sleep (AAP 2022): back to sleep for every sleep, firm flat surface, no soft bedding or bumpers, room-sharing without bed-sharing, no smoke exposure, avoid overheating, offer a pacifier
• Injury prevention: rear-facing car seats as long as the seat allows, water safety, safe storage of medicines and firearms, poison control (1-800-222-1222)
• Developmental surveillance and screening; early intervention referral for delays (IDEA Part C serves infants and toddlers)
• Lead: no safe level; CDC's blood lead reference value is 3.5 µg/dL (0.17 µmol/L); children at or above it need follow-up and exposure investigation

Culturally responsive care

• Qualified interpreters, translated materials, respect for traditional practices that are safe, community health workers and doulas as bridges

• Case-finding and outreach to pregnant people who are not in care
• Home visiting (assessment, teaching, support, referral)
• Screening and follow-up (newborn screening results, developmental screening, lead, depression)
• Health teaching on nutrition, breastfeeding, safe sleep, immunization, injury prevention
• Care coordination for children and youth with special health care needs
• Surveillance and data use (vital statistics, PRAMS, fetal and infant mortality review, maternal mortality review committees)
• Advocacy for access to coverage, paid leave, and breastfeeding support

• Mandated reporting of suspected child abuse and neglect
• Safe haven laws in every state allow a parent to relinquish an infant safely at designated places without prosecution for abandonment (age limits vary by state)
• Newborn screening is required by state law; parents' ability to opt out and rules on storage of blood spots vary by state
• Workplace breastfeeding: the PUMP for Nursing Mothers Act (2022) extends break time and a private, non-bathroom space to express milk for most employees for 1 year after birth
• Confidentiality for adolescents seeking care follows state minor-consent laws
• Equity and respect: avoid bias; screen for social needs and respond without judgment
• Informed consent for immunizations includes giving the current Vaccine Information Statement

Case 1 — Breast pain at 2 weeks postpartum. A breastfeeding mother reports a sore, full breast without fever.

Action: observe a feeding, correct latch and positioning, encourage feeding on demand, cold packs between feedings, an anti-inflammatory analgesic, and gentle rather than deep massage; teach her to seek care for fever, a red wedge-shaped area, or flu-like symptoms.

Why: current lactation guidance favors reducing inflammation and avoiding overpumping and forceful massage; continuing breastfeeding is safe.

Case 2 — Eligibility and referral. A 19-year-old first-time mother at 20 weeks of pregnancy with low income has no prenatal care.

Action: link her to prenatal care and Medicaid, refer to WIC, and refer to Nurse-Family Partnership now (enrollment requires a first visit by 28 weeks).

Why: early linkage to evidence-based programs improves outcomes; waiting could make her ineligible.

Case 3 — Indicator selection. A health department wants a process indicator for its prenatal program.

Action: choose the percentage of pregnant clients receiving first-trimester prenatal care, not the infant mortality rate.

Why: process indicators measure service delivery or use; mortality is an outcome indicator.

• Confusing IMR (deaths under 1 year per 1,000 live births) with neonatal (under 28 days) or postneonatal rates
• Mixing maternal death (within 42 days) with CDC's pregnancy-related death (within 1 year)
• Thinking WIC serves children to age 6 or requires only low income — it ends at the fifth birthday and requires nutritional risk
• Stating that WIC is run by HHS — it is a USDA program
• Recommending heat and vigorous massage for breast pain — outdated
• Presenting the 2025 hepatitis B "individual decision" change as current — it is stayed; the universal birth dose remains in effect
• Counting a Nurse-Family Partnership referral at 32 weeks as appropriate — first visit must be by 28 weeks

• IMR = infant deaths under 1 year per 1,000 live births; US 5.6 (2022); leading causes: birth defects, preterm/low birth weight, SIDS, unintentional injury, maternal complications
• Low birth weight < 2,500 g; preterm < 37 weeks
• Title V: HRSA block grant; 30% preventive and primary care for children, 30% children and youth with special health care needs; $3 state match per $4 federal
• WIC (USDA): pregnant, postpartum to 6 months, breastfeeding to 1 year, children to 5th birthday; ≤ 185% poverty plus nutritional risk
• Healthy Start (1991) targets high infant mortality communities; MIECHV funds evidence-based home visiting
• Nurse-Family Partnership: RN visits, first-time low-income mothers, first visit by 28 weeks, until child's 2nd birthday
• Newborn hearing 1-3-6; blood lead reference value 3.5 µg/dL (0.17 µmol/L)
• Safe sleep: back, alone, crib, room-share without bed-share
• Postpartum depression screening at postpartum and infant well-child visits
• Universal hepatitis B birth dose within 24 hours is current