For the Love of Babies

by Sue L. Hall, M.D.

Home

About

Book Information

Reading Group Questions

About Premature Babies

Pictures of Babies

Links

News and Reviews

Updates in Neonatology

What's New in Neonatology

Recommended Reading

Media Kit

Contact

Minimizing Racial Disparities in Infant Mortality and Preterm Birth

An alarming statistic is that black infants born in the U.S. have more than double the chance of dying during their first year of life compared with white infants. (1)  The death rate for black infants born here is as high as it would be if they were born in a developing country.  The following facts surely have something to do with the poor survival rates of black infants in the U.S.:  Twice as many blacks as whites live in poverty (20% vs. 10%), and nearly twice as many blacks as whites are among the 45 million people in this country who lack health insurance (43% vs. 24%). (2, 3)

Infant mortality (death within the first year of life) is most often a consequence of preterm birth (before 37 weeks gestation) and low birthweight.  It’s no surprise, then, to learn that the rate of preterm birth is much higher in black women than in white women.  In fact, the rate of preterm birth in black women in America is higher than it is in black women in Africa (18.5% vs. 11.9%). (4)  Besides poverty and lack of access to healthcare, other factors such as psychosocial stress, bottle-feeding, exposure to lead, intrauterine growth and diet also play into the health of a mother and her infant.  (5)

Racial disparities in infant mortality between blacks and whites are nothing new, but they’re not improving.  However, a recent three year study in Ohio shows one way they might be changed:  Prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) dramatically reduced the racial disparity in infant mortality rates among participants.  While infant mortality rates among non-participants was 21% for blacks vs. 7.8% for whites, black women who did participate had infant mortality rates in line with white participants’ (9.6% vs. 6.7%). (6)

Other specific factors have been linked to increased infant mortality, including inadequate prenatal care, younger maternal age and lower educational levels.  It only makes sense, then, that earlier initiation of prenatal care, and access to risk-appropriate OB and neonatal care would help improve outcomes in populations at risk.  Programs to support parenting of premature and low birthweight infants should also help improve infant mortality statistics. (7) 

We can also learn from the European and Scandanavian countries which have laudable, low rates—far lower than ours—of both preterm birth and neonatal/infant mortality.  Their numerous social programs supporting pregnant women have been instrumental in achieving these results.  In many of these countries, paid maternity leave begins 6-12 weeks before birth, with a specific eye towards minimizing preterm births.  Mothers also have access to sick leave from their jobs after birth, which may or may not be paid.  Prenatal care is comprehensive and free.  Other supports include housing and social supports for more vulnerable populations of women. (8)

Our infant mortality rate is a national embarrassment—we rank 28th out of 32 countries in the world, falling behind such countries as the Czech Republic, Slovenia, Estonia, Greece, Hungary, Poland, Slovakia and even Cuba. (9) The major solution to improving our infant mortality rate is to first improve our preterm birth rate, and especially to work towards minimizing the differences in outcomes between blacks and whites.  This will require reordering our priorities and putting some political muscle into the mix.  Money spent upfront to prevent preterm birth will go a long way towards reducing the current economic burden related to preterm birth, estimated by the Institute of Medicine in 2006 to be 26 billion dollars. (10)  Hopefully, the emotional burden of losing a child too early can be lessened as well.

Please help the March of Dimes in their mission to help moms have full-term pregnancies and research the problems that threaten the health of babies.

References:

(1)    “U.S. Infant Mortality Rate Decline Stalls, Racial Disparities Remain, CDC Data Indicate.”  Online at http://www.medicalnewstoday.com/articles/116767.php.

(2)   Income Inequality: Millions Left Behind. February 2004. Third Edition. Americans for Democratic Action, Inc. Washington, DC. Online at http://www.inequality.org/incineqada.pdf.  Accessed June 29, 2004.

(3)   Snyder, U.  “Preterm Birth as a Social Disease.”  Medscape Pediatrics, May/June, 2004.  Online at http://www.medscape.com/viewarticle/481732. 

(4)   March of Dimes.  “Preterm Births Rise by 36 Percent Since Early 1980s; Late Preterm Infants Drive the Increase,” Press Release January 7, 2009.

(5)   Fiscella, K.  “Racial Disparity in Infant and Maternal Mortality:  Confluence of Infection, and Microvascular Dysfunction.”  Maternal and Child Health Journal 2004;8:45-54.

(6)   Khanani et al.  “The Impact of Prenatal WIC Participation on Infant Mortality and Racial Disparities.”  American Journal of Public Health 2010 Apr 1;100 Suppl 1:S204-9. Epub 2010 Feb 10.

(7)   Kitsantas & Gaffney.  “Racial/Ethnic Disparities in Infant Mortality.”  2010;38(1):87-94.

(8)   Williams BC.  “Social Approaches to Lowering Infant Mortality:  Lessons from the European Experience.”  Journal of Public Health Policy 1994;15: pp. 18-25. 

(9)   Dezen & Lynch.  “Babies Born Just a Few Weeks Too Soon are Three Times More Likely to Lose the Battle to Survive.”  Press Release from March of Dimes, May 3, 2010.  Online at http://www.marchofdimes.com/news/may3_2010.html.

(10)  Institute of Medicine.  “Preterm Birth:  Causes, Consequences, and Prevention.”  National Academies Press, Washington, DC.  July 13, 2006. 


Preventing Teen Pregnancy

Did you know that three in ten American girls get pregnant by age 20?  That adds up to 2,000 teen girls getting pregnant every day.  Over the course of a year, four hundred thousand teenagers, half of whom are 17 years old or less, give birth.  Our teen pregnancy rate is twice that of any other advanced country, and nearly ten times as high as Japan’s, despite similar levels of sexual activity.  However, after reaching a peak in 1990, the teen pregnancy rate is now at a record low, at 39 births among 1,000 teenagers, a positive change that has been attributed to the more widespread use of condoms.  Still, more than ten percent of all U.S. births are to women less than 20 years old, and one fourth of moms younger than 18 go on to have a second baby within 2 years after the birth of their first one.

Babies born to teens are more likely to end up in the NICU than babies born to mothers older than twenty, because of their high rates of prematurity and low birthweight.  Teens are the least likely group of women giving birth to get early and regular prenatal care, and they’re also smokers more often than mothers over 25.  They are at higher risk for complications of pregnancy such as pregnancy-associated high blood pressure (pre-eclampsia) and premature labor.  Their infants are less likely to survive to their first birthdays, compared with women who give birth in their twenties or thirties.

In addition, consequences of teen pregnancy are far-reaching.  For the young mothers, they include being a single parent, living in poverty and depending on welfare, and failing to continue education beyond high school (only 40% graduate).  Children born to teen moms tend to have educational problems, too.  They are fifty percent more likely to repeat grades in school and to drop out of high school than kids whose mothers gave birth in their twenties or beyond.  They are more likely to be victims of child abuse and neglect, to have worse physical health, and to have a higher a rate of incarceration when they become adults than children born to mothers who delay childbearing.   Costs to society are substantial:  About $4 billion a year is spent providing public benefits to support the health and welfare of teen parents and their children, and the total increases to $9 billion if costs for foster care, incarceration, and other social services needed to manage the negative consequences of teen pregnancy are included.

Which teens are most at risk for becoming pregnant?  Those who are doing poorly in school, who are economically disadvantaged, and who have single parents or parents who were themselves teens as first-time mothers.

How are teen pregnancies best prevented?  Teens themselves say that their parents’ influence is the most important factor in helping them to avoid pregnancy.  Parents need to talk with their teens honestly about sex, love, relationships and responsibility, not just once (“the talk”), but repeatedly from a young age, always in an age-appropriate way.  Parents need to tell teens directly why teen pregnancy is a bad idea.  Perhaps surprisingly, the MTV reality show, “16 and Pregnant,” may be a positive force in preventing teen pregnancy.  Eighty-two percent of teens who watch the show say it has helped them understand the challenges of teen pregnancy and parenthood, and why they should avoid it.  The show can be a good launching off point for conversations between parents and their teens.

School or community-based educational programs are more likely to be helpful if they are comprehensive sex education programs that review specifics of contraceptive use.  Teens who have been through abstinence-only education tend to have sex at a similar rate to those who’ve been through comprehensive sex education programs, only they use birth control less frequently.

With more open dialogue between parents and teens, and more sex education that focuses on specific ways to avoid pregnancy, besides abstinence, the teen pregnancy rate can be further reduced.

Several parents in my book, FOR THE LOVE OF BABIES, are teenagers.  Read their stories in the book, now available on Amazon's and Barnes and Noble's websites.

 

Does It Matter Where You Deliver a Preemie?  Yes!!

Delivering your baby in a hospital that has a Level III Neonatal Intensive Care Unit is a particularly wise choice if you have a high risk pregnancy, and definitely improves your baby’s chance of survival if the baby is born at less than 32 weeks of gestation or weighs less than 1,500 grams (about 3.3 pounds).  A baby's risk of death within the first month of life or before discharge was 50% lower if born in a hospital with a Level III NICU (one that can care for babies no matter how early they’re born or how small they are) rather than one where the nursery provides only basic care (Level I) or care for moderately ill infants (Level II).  This was the finding of a study done by the Centers for Disease Control and published in September, 2010 in the Journal of the American Medical Association.  This study is described further on the www.marchofdimes.com.

Is the Rate of Prematurity Starting to Decline?  Maybe...

Wouldn't it be nice if after thirty years of increasing rates of premature birth in the U.S., the data showing a small decline from 2006 to 2008 marked the beginning of a trend?  The rate of prematurity dropped from 12.8% to 12.3% during these two years.  Although it doesn't sound like much, given the baseline rate, this means that 21,000 fewer babies were born prematurely.  Hopefully, part of the reason for the drop in premature births is due to increased awareness and attention to the problem; if so, we may continue to see progress in tackling this long-standing problem.  Some of the progress may also be attributed to a decline in fertility treatments and a decrease in rates of elective Cesarean delivery.  Fertility treatments tend to produce more multiple births, like twins, which are often born slightly early, and Cesarean deliveries scheduled before 39 weeks of pregnancy are associated with increased preterm births because pregnancy dating is not always accurate.  Read more about this news here.
Sue Lyddon Hall, M.D.          Copyright, 2011