PREVENTING INFANT MORTALITY

Overview: Maternal and infant health has been improving across the United States. Based on preliminary data for the year 2003 (the latest year for which statistics are available), the infant mortality rate, which is the rate at which babies die before their first birthday, was 6.9 deaths per 1,000 live births. The rate of cigarette smoking by pregnant women continues to fall. Birth rates among teenagers in all ethnic groups continued to decline.

Despite these successes, problems remain. Although the U.S. infant mortality rate has fallen steadily in recent decades, the nation still ranked 27th among industrialized countries in an analysis of 2000 data. In 2000, Singapore reported the lowest recorded rate of infant mortality in history, with a rate of 2.5 deaths per 1,000 live births. In addition, disparities remain among racial and ethnic groups in many measures of maternal and child health. The infant mortality rate among infants of non-Hispanic black mothers is more than double that for non-Hispanic whites.

The Department of Health and Human Services (HHS) supports a wide range of programs designed to prevent infant mortality, led by the Maternal and Child Health Services Block Grant to States (Title V), administered by HHS’ Health Resources and Services Administration (HRSA) and funded at $730 million (FY 2005). Title V is the only federal program that focuses solely on improving the health of all mothers and children.

Other efforts to prevent infant mortality include programs to improve access to prenatal and newborn care, including Healthy Start, Medicaid, the State Children's Health Insurance Program (SCHIP). HHS also supports public health campaigns to promote healthy habits among parents expecting a child or caring for an infant to prevent child malnutrition, as well as medical research to better understand and prevent birth defects, premature birth and Sudden Infant Death Syndrome (SIDS) and to promote healthier growth and development.

RECENT TRENDS

Due in part to medical research, public health and social services supported by HHS, infant mortality has declined considerably during the past three decades. Overall, the nation's infant mortality rate has fallen from 20 deaths per 1,000 live births in 1970 to 6.9 deaths in 2003 (preliminary data). The 2002 rate of 7.0 deaths, based on complete data, was higher than the 2001 rate (6., but has fallen 8 percent since 1995 and 24 percent since 1990. In 2002, the leading causes of infant mortality were congenital anomalies, disorders related to immaturity (short gestation and unspecified low birthweight), SIDS, and maternal complications.

The mortality rate for infants of non-Hispanic white mothers in 2002 was 5.8 deaths per 1,000 live births, while the rate for non-Hispanic blacks was 13.9; these rates were not significantly different from their levels in 2001. Although the trend in infant mortality rates among non-Hispanic blacks and non-Hispanic whites has been on an overall decline, the proportional discrepancy between these populations remains. The total Hispanic infant mortality rate in 2002 was 5.6. The mortality rate among American Indians and Alaska Natives was 8.6 deaths per 1,000 live births, while the Asian/ Pacific Islander rate was much lower at 4.8 infant deaths per 1,000 live births.

In 2004, 83.9 percent of mothers began prenatal care within the first trimester of pregnancy (preliminary data). Disparities in access to prenatal care between non-Hispanic white, non-Hispanic black, and Hispanic mothers have narrowed during recent years. In 2004, the percentage of non-Hispanic black mothers who initiated first trimester prenatal care was 76.5 percent, compared to 77.4 percent for Hispanic mothers and 88.9 percent for non-Hispanic white mothers. For mothers 15 to 19 years of age, 29 percent received no early prenatal care in 2004.

The incidence of low birthweight babies (less than 5 pounds, 8 ounces) increased from 2003 to 2004 to 8.1 percent. Cigarette smoking during pregnancy has been declining since 1989, to 10.2 percent of mothers in 2004. In 2003, 12.4 percent of births to smokers were low birthweight, compared with 7.7 percent of such births to nonsmokers.

PROMOTING ACCESS TO PRENATAL AND INFANT CARE

Early and continuous prenatal care helps identify conditions and behavior that can result in low birthweight babies, such as smoking, drug and alcohol abuse, inadequate weight gain during pregnancy and repeat pregnancy in six months or less. Babies born to mothers who received no prenatal care are three times more likely to be born at low birth weight, and five times more likely to die, than those whose mothers received prenatal care. HHS supports many programs to improve access to prenatal and infant care, including:

Healthy Start. The Healthy Start program, administered by HRSA and funded at $98 million in FY 2005, 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. For more information, visit www.hrsa.gov

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 can identify and treat health problems. In addition, about 4.6 million children who otherwise would not have access to health care were covered under the State Children's Health Insurance Program (SCHIP) during fiscal year 2001 - a 38 percent increase from the previous year. HHS also allows states to provide SCHIP coverage for prenatal care.

Toll-free prenatal care hotline. HHS supports a toll-free hotline to assist pregnant women and others seeking information on prenatal care, including referrals to local clinics and physicians. Assistance is available in English at 1-800-311-BABY (2229) and in Spanish at 1-800-504-7081.

Childhood immunization initiative HHS efforts to promote and provide childhood immunizations have helped to increase immunization rates among children, with 90 percent or more of America's toddlers receiving the most critical doses of vaccines for children by age 2. With childhood vaccination levels in the United States at or near an all-time high, disease and death from preventable diseases are at or near record lows.

PROMOTING HEALTHY CHOICES TO REDUCE MORTALITY RISKS

As part of its broader efforts to reduce infant mortality, HHS agencies support a wide range of outreach and education efforts aimed at reducing behavior that increases the risks of infant mortality. These efforts include:

Folic acid campaign. HHS participates in the National Folic Acid Campaign to promote the use of folic acid to prevent serious birth defects such as spina bifida and anencephaly. The goal of the campaign is to educate all women who could possibly become pregnant to consume 400 micrograms (400 mcg) of folic acid daily from vitamin supplements and/or fortified foods, in addition to eating certain foods with folic acid. The campaign involves the Centers for Disease Control and Prevention (CDC), the March of Dimes and the National Council on Folic Acid. More information is available at www.cdc.gov/ncbddd/folicacid

"Back to Sleep" campaign. The public-private "Back to Sleep" campaign educates parents and caregivers that babies who sleep on their backs have a lower risk of SIDS. The 1999 National Institute of Child Health and Human Development (NICHD) household survey found that 85 percent of infants were sleeping either on their sides or backs. The number of SIDS deaths has decreased from 4,891 in 1992 to 2,295 in 2002, a 53 percent decrease. The campaign is led by HHS and co-sponsored by other organizations, including the American Academy of Pediatrics, the SIDS Alliance and the Association of SIDS and Infant Mortality Programs. Information about the campaign is available at www.nichd.nih.gov

Reducing mother-to-child HIV transmission. HHS provides information to women and their physicians on HIV testing and treatment with zidovudine (AZT) and other anti-viral drugs, as well as obstetrical approaches, to reduce transmission of HIV from mother to child. HHS guidelines and educational materials are available at www.aidsinfo.nih.gov

Maternal and Child Health Services (MCH) Block Grant (Title V) HRSA provides block grants to states to develop service systems to meet critical challenges in maternal and child health, including reducing infant mortality. These state efforts are developed with careful attention to Health Status Indicators and National Performance Measures, among them those that emphasize the importance of adequate prenatal care in improving the health of pregnant women and reducing infant mortality. In an average year, about 60 percent of U.S. women who give birth receive services through MCH programs.

Reducing teen pregnancy. Infants born to teenage mothers are at higher risk of being born low birthweight babies and have a higher mortality rate. HHS directly funds teen pregnancy prevention programs in more than 2,200 communities - about 47 percent of all communities nationwide. By focusing on abstinence and personal responsibility, HHS hopes to help young people make the choices that will lead to a successful future. More information on HHS' teen pregnancy prevention efforts is available at www.hhs.gov/news/press/2002pres/teenpreg.html.

Healthy People 2010. Reducing infant mortality is one of the major goals of Healthy People 2010, the nation's prevention initiative developed by HHS in partnership with the private sector, universities, state and local health departments and community groups. Healthy People's framework relies on science and consensus to guide efforts to promote health and prevent disease. The initiative includes 22 measurable health objectives specific to risk factors for infant mortality and more than 100 related objectives on issues such as cigarette smoking. More information on Healthy People 2010 is available at www.health.gov/healthypeople.

PROMOTING RESEARCH TO REDUCE INFANT MORTALITY

HHS supports a wide range of medical research to prevent and treat birth defects, premature birth, SIDS and other life-threatening conditions. For example:

The wider use of antenatal corticosteroid treatments to prevent premature labor and promote lung maturation -- clinical practice endorsed by the National Institutes of Health (NIH) Consensus Development Conference -- has reduced deaths of premature infants and lowered the incidence of respiratory distress syndrome and internal hemorrhage in the infant.

Treatment with surfactant, discovered and developed through research supported by the National Institute of Child Health and Human Development (NICHD) and the National Heart, Lung and Blood Institute (NHLBI), has also reduced deaths of premature infants from respiratory distress syndrome.

NHLBI, with input from NICHD, is developing an enhanced research agenda to address key issues regarding hypertensive disorders of pregnancy, such as preeclampsia -- an abnormal increase in blood pressure during pregnancy that affects 5 percent to 8 percent of pregnancies and contributes to maternal, fetal and infant morbidity and mortality. The CDC is examining sociocultural, behavioral and environmental factors, including stress and social support, related to preterm births among African-American women in Harlem, N.Y., and Los Angeles, Calif.