Infant Mortality

OVERVIEW

Each year more than four million families in the United States bring home from the hospital a healthy baby who has all of the potential for a full and productive life. The birth of a baby is a joyous event, and the baby's survival is taken for granted. But one family in 100 will suffer the loss of their child soon after birth (www.kidshealth.org). A baby is delicate and has not developed immunities to widespread diseases. When a country has a high rate of infant death, it usually signals high mortality risk from infectious, parasitic, communicable, and other diseases associated with poor sanitary conditions and malnourishment (www.prb.org). As a result, the infant mortality rate, which is the number of deaths of children under age 1 per 1,000 live births, is considered one of the most sensitive measures of a nation's health (McKenzie, 2005). Infant death is an important measure of a nation's health because it is associated with a variety of factors, such as maternal health, quality of access to medical care, socioeconomic conditions and public health practices (McKenzie, 2005).

Infant mortality has two components, neonatal mortality and post-neonatal mortality. Neonatal mortality is deaths that occur during the first 28 days after birth. The most common causes of neonatal deaths are premature deaths and low birth weight. Post-neonatal mortality is deaths that occur between 28 days and 365 days after birth. The most common causes of post-neonatal deaths are sudden infant death syndrome and congenital birth effects.

LOW BIRTH WEIGHT

Very little is known about the causes of low birth weight and preterm birth despite an extensive amount of research (www.futureofchildren.org). Low birth weight that results from suboptimal intrauterine growth is associated with three major risk factors: cigarette smoking during pregnancy, low maternal weight gain, and low pre-pregnancy weight. These three risk factors account for nearly two-thirds of all growth-retarded infants (Kramer, 1997). Other risk factors for low birth weight include race, first births, female sex, short maternal stature, maternal low birth weight, prior low birth weight birth, maternal illnesses, fetal infections, and a variety of metabolic and genetic disorders. While these risk factors may provide important clues about the causes of low birth weight, many of them are only weakly related to low birth weight and are generally not modifiable by intervention programs or changes in public policy (www.futureofchildren.org).

SUDDEN INFANT DEATH SYNDROME (SIDS)

SIDS, or Sudden Infant Death Syndrome, is defined as the sudden, unexpected, and unexplained death of any infant or young child (McKenzie, 2005). SIDS is the most widespread cause of infant death in developed countries. SIDS accounts for about half of the deaths that occur between one month and one year of age (McKenzie, 2005). The peak period for SIDS is between two and four months old. It is very rare before one month of age, and at least 95 percent of all the cases have occurred before children reach six months old (www.kidshealth.org). SIDS is rare in babies who sleep face up in a crib or who sleep face up with a mother not using alcohol, drugs, or cigarettes (and not on a waterbed or soft sofa). SIDS is more common in babies who sleep in humid environments, who are over-bundled, who nap in rooms with space heaters, who are exposed to cigarette smoke, who sleep on soft surfaces, who do not use pacifiers, and those who sleep face down or in a prone position (www.prb.org). The rate of SIDS is also elevated in those babies who do not receive timely well-child care and immunizations.

Situations that occur even before the baby is born may affect the risk of SIDS. Anything that causes a smaller amount of oxygen to get to the baby in the uterus will increase his or her risk. Usually, smoking during pregnancy doubles the likelihood, and the odds increase with each cigarette. Other drugs of abuse such as cocaine or heroine increase the risk by as many as thirty times. Genetics also plays a large role. SIDS is more common in boys than in girls, and it is more common in some population groups (Black, Native American, Hawaiian, and Filipino). Infants may have been born with immature brainstems, making it difficult for them to wake up when they are in trouble. While parents often feel responsible after SIDS, sometimes there is nothing they could have done to prevent it. There are many factors outside of our control.

STATISTICS

Maternal and infant health has been improving across the United States. Due to medical research, public health and social service programs, the United State's infant mortality rate has fallen from 20 deaths per 1,000 births in 1970 to 6.9 deaths in 2000 (www.hhs.gov). Many countries have even lower rates, with Japan, Sweden and Finland heading the list (see table 1). However, in 2002 the nation's infant mortality rate climbed to 7.0 deaths per 1,000 live births. This was the first time in more than four decades the infant mortality rate increased. Analysts suggest this rise may reflect the long trend among American women toward delaying motherhood (www.cnn.com). Recent birth rates for women ages 35 to 44 were the highest levels for that age group in three decades, the Center for Disease Control reported.

PROGRAM INITIATIVES

The United States Department of Health and Human Services (HHS) supports many programs to help improve access to prenatal and infant care as well as support a wide range of outreach and education efforts aimed at reducing behavior that increases the risks of infant mortality. The following is just a few of these programs all taken from the HHS's website (www.hhs.gov):

Healthy Start. The Healthy Start program, administered by the Health Resources and Services Administration (HRSA), works to expand the availability and accessibility of prenatal health care in more than 100 communities nationwide with higher-than-average infant mortality rates. Designed to meet community needs, the projects include outreach, case management, health education and community consortia. www.healthystart.net

Medicaid and SCHIP. Medicaid is a state and federal partnership that provides access to prenatal care for eligible mothers and health coverage for millions of infants from low-income families. States can expand eligibility and services for pregnant women and their infants. As part of such expansions, states have streamlined application procedures to encourage early and continuous access to prenatal care and added coverage for parenting education. Families are encouraged and offered assistance to obtain well-child screenings that