Trends in infant mortality are considered to be a barometer of technology and an accurate indicator of the health of a society. Despite technological excellence and numerous social programs offered throughout the country, the infant mortality rate (IMR) in the United States continues to be a national concern. For many, “infant mortality” brings to mind the deprivation and poverty found in third world countries. Yet in the United States, nearly 40,000 children die every year for some of the same reasons that cause infant death in underdeveloped parts of the world (Anderson, 1987).
Infant mortality is prevalent in this country despite a richly developed and technologically advanced society. According to the Census Bureau, the IMR in the United States has dropped almost 66 percent in the past three decades (Eberstadt, 1991). In 1960, out of every thousand babies born, 26 died within their first year of life. By 1991, that number had dropped to less than nine out of every thousand babies (Eberstadt et al. , 1991).
According to the US Department of Health and Human Services (HHS), the US infant mortality rate in 1987 was higher than in 23 other countries r territories, including most of Western Europe, Hong Kong, and Singapore. The US infant mortality rate was about 20 percent higher than Norway’s, nearly 50 percent higher than in the Netherlands, and 200 percent higher than Japan’s (Eberstadt et al. , 1991). The United States has not always fared so poorly in this international ranking. In the early 1950’s it ranked sixth best (Anderson et al. , 1987).
The Select Committee on Hunger held a Congressional hearing on infant mortality in the United States on April 29, 1987. Representative Mickey Leland (D. , TX), the ommittee’s chairperson, acknowledged the continued statistical improvements over the prior two decades. But he was very critical of the decline of the United States in the international ranking, expressing dismay that a country as wealthy and powerful as the United States should have an infant mortality rate worse than that of 16 other industrialized nations (Anderson et al. 1987).
Through mediums such as this hearing and other forums, the federal government addresses this concern and establishes programs that may aid the fight against infant mortality. The decrease in the occurrence of infant death is, if considered on statistical merit, a valid picture of a society that is implementing advances in technology against killers of our babies. The gap between infant mortality rates in the United States and other countries points to what is principally a parental problem.
Nicholas Eberstadt of the Harvard Center for Population and Development Studies writes that the dramatic increases in illegitimate births, drug, alcohol and tobacco abuse, and the failure of parents to take advantage of prenatal care are the primary reasons for the higher than expected ates of infant mortality in the United States. This social problem will not be eliminated by addressing it when a doctor is standing in a delivery room with a newborn baby who may already have a death sentence cradled in his arms.
Instead, infant mortality must be addressed by educating and providing social programs that benefit the expectant mother. In 1960, the ten leading causes of infant mortality in the United States were (in order of occurrence): postnatal asphyxia, immaturity, birth defects, birth injuries, influenza/pneumonia, accidents, pneumonia/newborn, gastritis nd other GI disorders, hemolytic disease, and immaturity with other complications. Over the past three decades, advances in neonatal intensive care have changed the leading causes of infant mortality.
In 1992, the ten leading causes were: birth defects, sudden infant death syndrome (SIDS), preterm/low birthweight, respiratory distress syndrome (RDS), maternal complications of pregnancy, complications during birth, infections, accidents, hypoxia/birth asphyxia, and pneumonia/influenza (March of Dimes Birth Defects Foundation, 1996). Since 1960, advances in prenatal care for high-risk pregnancies and postnatal care have provided more effective preventative strategies and better treatment of neonatal conditions.
This has decreased infant deaths related to conditions such as postnatal asphyxia, birth injuries, and bacterial infections. In 1992, birth defects and prematurity, which have multiple causes and require complex preventative measures, have become the leading causes of infant death. In 1992, birth defects accounted for 7,449 infant deaths (183. 2 per 100,000 live births) and SIDS accounted for 120. 3 deaths per 00,000 live births (March of Dimes Birth Defects Foundation et al. , 1996). This statistical data points to the following conclusion.
The behavior of the biological mother and father before and during pregnancy is killing many of the infants born today in the United States. No matter the level of technology available, an infant that has been abused gestationally throughout pregnancy poses a variety of problems that increases the likelihood of neonatal (from birth through 27 days of life) and postneonatal (from 28 days through 1 year) death. As a country, the United States has acquired technological advances that are incomparable o other cultures.
As a society, the United States has inflicted conditions upon our infants that challenge even the vastest technological capabilities. Therefore, improving existing social programs and implementing new programs to combat infant mortality must continue. In the federal “Healthy Start” program there are four strategies for reducing infant mortality. They are: reducing high-risk pregnancies; reducing the incidence of low birthweight and preterm births; improving birthweight-specific survival; and reducing specific causes of postneonatal mortality (Strobino, 1995).
Reducing high-risk pregnancies and the incidence of low birthweight and preterm births can only be accomplished through education and prenatal care. Proper infant care following the birth of a child, whether or not the child is obviously at risk, can only increase the likelihood of a long productive life. Resources, Education, and Care in the Home (REACH) is an interagency program implemented in Chicago designed to reduce preventable causes of death among infants at risk due to social factors (Boyd, 1996). Home visits were made by a trained team consisting of a nurse and community worker during the first year f the child’s life.
The visits focused on the relationship between the family and health professionals. Services were offered free of charge at reasonably convenient times. Cases were individually assigned to registered nurses who coordinated the mother’s contact with participating agencies, made referrals to social service agencies, and provided individual counseling (Boyd et al. , 1996). Results show that repeated home visits offering infant health monitoring plus individualized teaching helped mothers maintain good health practices and identify illnesses early.
The postneonatal rate among REACH infants was 4. 7 deaths per 1000 live births in communities where rates for nonparticipants ranged from 5. 2 to 10. 9 per 100 (Boyd et al. , 1996). This study demonstrates a need for more intensive services following the birth of a child to “socially challenged” families. Many illnesses can be identified in the early, treatable stages of development by educated individuals. These programs and others like them lead the fight against infant mortality by educating families about infant care and programs that are available to them.
Lack of adequate and early prenatal care is a leading factor associated with infant mortality (Anderson et al. , 1987). Prenatal care should begin within the first trimester of pregnancy. Low-income women are deterred by circumstances ranging from cost to long waits and limited clinic hours. More often, a lack of self-worth is observed in women who do not seek prenatal care. Margaret Gallen, Director of Nurse Midwifery Services at D. C. General Hospital in Washington, reports that many times women seek prenatal care for the first time during their eighth month f pregnancy.
In Miss Gallen’s opinion, lack of universal health care for pregnant women and insufficient maternity leave policies depict a government that doesn’t truly value motherhood. Governments of other industrialized nations are more committed. In fact, women in France are offered cash incentives to ensure they receive proper prenatal care (Anderson et al. , 1987). Until commitments are made to provide the unborn infant with the quality of prenatal care that the child deserves, infant mortality will continue to plague this country.
The mother must refrain from the use of drugs, alcohol, and tobacco and seek care in the first trimester of pregnancy. The government must increase the funds available to established and new programs to enable these programs to reach expectant mothers. Every person must strive to ensure that babies survive. No amount of technological skill can combat the preventative measures of proper prenatal care. The ultimate voice of prevention will only be heard by women who have enough maternal instinct to seek available prenatal and infant care.
