Significance of Infant Mortality
Pregnancy is a dynamic process involving actual and potential health status changes . These changes necessitate frequent assessments of risk in order to initiate the type and range of services that will ensure the best outcomes. For individuals with increased medical, nutritional or psycho-social risks, the benefits of comprehensive health care, result in significantly lower mortality and morbidity rates. In all cases, perinatal care that focuses on the client's individual needs, can improve health outcomes of mothers and their infants.
The goal for reducing infant mortality and closing the disparities in health outcomes between the racial and ethnic groups, is to educate women of child-bearing age of the importance of early access to prenatal services. Through the Bureaus of Maternal and Infant Health, and Community Health Nursing, programs, such as Family Case Management, WIC, Targeted Intensive Prenatal Case Management, and Family Planning, have focused attention on public education, reducing unplanned pregnancies, and sexually transmitted diseases. In spite of several years of steady progress, and general improvement in health outcomes for child -bearing women, in many communities of Illinois, infant mortality, unintended pregnancies, and high STD rates continue to challenge our health care delivery system.
Infant mortality is frequently used as an indicator of the health of a community and a nation. During the 20th century, infant mortality rates declined in the United States by 90%. Many of the large cities of the U.S however, continue to have high infant mortality rates compared with national rates. Studies of U.S infant mortality by region document persisting geographic disparities and differences across racial and ethnic groups (CDC. MMWR Weekly April19, 2002/51(15;329-332,343)
Trends in Infant Mortality
Overall, the U.S infant mortality rate has declined from 20 deaths per 1,000 live births in 1970 to 6.9 deaths in 2000. The 1999 rate of 7.1 deaths has fallen 4% since 1995 and 22% since 1990. In1999, the leading causes of infant mortality were congenital anomalies, disorders related to immaturity (short gestations and unspecified low birth-weight, SIDS, and maternal complications.
Trends by Race/Ethnicity
Trends by Race/Ethnicity Between 1998 and 1999, the mortality rate for white infants decreased 3% to 5.8 deaths per 1,000 live births, while the rate for black infants was 14.6%. Although the trend in infant mortality rates among blacks and whites have been on the decline, the proportional discrepancy between black and white rates has increased. The total Hispanic infant mortality rate in 1999 was 5.8 In the year 2000, 83,2% of mothers began prenatal care within the first trimester of pregnancy, continuing a positive trend dating back to 1989. Disparities in access to prenatal care between white, black, and Hispanic mothers narrowed during this period. In 2000 the percentage of black mothers who initiated first trimester prenatal care was 74.3%, compared to 74.4% for Hispanic mothers and 88.5% for whites. 33% of teen mothers received no prenatal care in the year 2000. (United States Department of Health & Human Services. Fact Sheet, March 18, 2002)
Trends by Geography
Since 1970 there has been a consistent decline in the infant mortality in Illinois from 21.3 per 1,000, to 8.3 in 1900, to 7.2 deaths per 1000 live births in the year 2002. Between 2001 and 2002 the decline of 3.6 percent.. Although there is an overall decline in infant mortality rates in Illinois, infants born to African American mothers died at a higher rate than white or Hispanic babies during 2002. In Chicago, the infant mortality rates have steadily declined from 15.6 in 1990, to 11.5 in 1999 to 8.6 in 2002, the lowest rate recorded by the city. However, the death rate for African-American children in Chicago was 14.8 in 2002, down slightly from 15.1/1,000 in 2001, while deaths for white infants declined from 5.5 in 2001 to 5.1 in 2002. The downstate rate in 2002 for African American babies was 16.7, an increase of 14.6 from 2001, while the rate for whites dropped from 6.0 in 2001 to 5.6 in 2002. (IDPH, 3/04)
Trends by Maternal Age
There is a definite relationship between maternal age and infant mortality, with rates being highest for infants born to teenage mothers, lowest for mothers in their late twenties and early thirties, and again higher for mothers in their forties and over. (National Vital Statistics report, Vol. 48, No. 12 July 20, 2000) Children born to young adolescent mothers are at greater risk for infant mortality and low birth weight. Teen mothers are less likely to receive prenatal care and have the financial resources, social supports, and parenting skills required for child rearing. At the beginning of the 1990s, school age birth rates peaked and declined during the decade. There was a 29% decline in the rate of teenagers giving birth in this country from 1991-2000. This decline was found in the three major ethnic groups. This decline followed a period of increase in the 1970s and1980s. In general the highest mortality rates are found among infants born to teens less than 16 years of age (Grand Round. Pediatrics Vol 110 No. 6 December 2002, pp1163-1168)
Causes of Infant Mortality
Over four million babies are born in the United States every year. In the year 2002, 12.1% of these babies were born prematurely. This represented a 29% increase in the premature births since 1981. (NGA Center for Best Practices. Issue Brief; June 28, 2004) The leading cause of infant mortality is prematurity. In combination with congenital anomalies, disorders associated with unspecified low birth-weight and SIDs, accounted for 46% of all infant deaths in the United Stated in1998.(CDC. MMWR Weekly April 19, 2002)
Low birth-weight also contributes to infant mortality. Together with short gestation, low birth weight accounts for one out of five deaths that occur in the first 28 days of life. The United States Department of Health and Human Services reports that the percentage of births that are low birth weight or vary low birth weight has actually been increasing in this country in the past decade. (National Vital Statistics Report; CDC Vol. 48, Number 12)
Sudden Infant Death Syndrome (SIDS) is yet another cause of infant mortality. The sudden and unexpected death of an infant under one year of age, which remains unexplained after a thorough investigation, is the leading cause of death among infants beyond the newborn period.
Approximately 2,100 babies die each year of SIDS in the United States at the rate of about one baby every four hours. In 2001, 1,379 infants died of SIDS and other causes, at the rate of one child every six hours. These statistics demonstrate a need for measures for reducing the infant mortality rates in Illinois, and closing gap in racial disparity.
Although there is still no known cause of SIDS, research in early 1990 revealed specific behaviors that can lower the risk of SIDS, and ultimately reduce infant mortality. These are:
- Preventing accidental suffocation and entrapment by not adding of bumper padding, pillows, stuffed toys, fluffed blankets etc.
- Prevent overlay by not having baby sleep with mother but in a crib
- Put babies to sleep on their backs
- Educating the public and MCH professionals about bereavement support for client referral.
- Smoking cessation
Barriers to achieving desired maternal-child-disease prevention outcomes for all citizens of Illinois include access to comprehensive Perinatal services, including preconception/inter-conception care, and social services. These barriers can be removed with an integrated approach to identification and prevention of medical and psycho-social risks that begins pre-conceptionally, and extends throughout pregnancy and the postpartum periods. Important goals of perinatal care are, improving early entrance to prenatal services, and parent-newborn-family relationships. This involves integrating concepts of family-centered care into every aspect of perinatal care beginning with the first prenatal visit. This includes a review of the parents' attitudes toward the pregnancy, family life, child care practices, environmental stressors, support systems and interest in childbirth education classes. This continues throughout the perinatal period in both ambulatory and hospital settings. Active participation of prospective parents in decision -making during pregnancy, labor, delivery, and the postpartum period is strongly encouraged.
Finally, case management is a component of the care provided to pregnant women. This is an effective mechanism for determining client needs, developing a plan of care, and providing referral and follow-up services when elements of risk presents. A detailed description of case management can be found in the Maternal Child Health Services Code (77 Ill. Admin. Code 630.220