Infant
Mortality Within the United States Infant
Mortality Within the United States TABLE OF CONTENTS
Abstract
Introduction
Applicable
National Standards
Causes
and Contributing Factors
State
to State Analysis
Conclusion
Endnotes
Bibliography
Abstract: Herein I
briefly
overview the Infant Mortality Rate (IMR) within the United States.
Initially,
I discuss specific causes of infant death and then, contributing
factors
which put babies at risk. Next, the distribution of various IMR is
surveyed
on a state to state basis. States possessing the ten highest
infant
mortality rates are discussed, including possible reasons for higher
IMR.
In addition, those states with the ten lowest IMR are mentioned.
In conclusion, I consider preventative measures for minimizing the
number
of babies that die each year.
Return to Table of Contents
Every eight seconds a
baby
is born in the United Sates (U.S.), and within one hour four babies die
(1). The
infant
mortality rate (IMR) measures the rate at which babies die before their
first birthday and is calculated per 1,000 live births. According
to government figures 7.2 babies out of every 1,000 born in 1996 died (2,
p 6). Although this figure declines steadily each year and is
406%
lower than the 1950 figure (3)
the United States IMR is still higher than twenty four other nations (1).
More importantly, the IMR for black U.S. citizens is over twice the
rate
of white citizens (6.3 and 14.6 respectively) (4,
p 9). The National Commission to Prevent Infant Mortality even
calls
some regions "disaster areas" (5, p 18). What are the leading
causes
of infant death, and what areas within the United States are most
affected?
What preventative measures can ensure a child its first birthday?
These questions are addressed herein. In addition, certain
National
Standards for Geography are met.
Return to Table of Contents
In 1994 a committee
of educators came together with the intent of providing national
standards
for history and geography students on the elementary and high school
level.
Upon graduation from high school, students should master eighteen basic
principles. This paper provides an opportunity for students to
know
and understand three of these guidelines. First, students will
know
how to use maps and graphical tools to acquire, process, and report
information
(number one of the National Standards). Hot links connect data
presented
throughout the text to pie graphs, bar graphs, charts, tables, and a
map
located at appropriate web sites. Second, the students will know
and understand that people define regions and will be able to use them
to interpret the world’s (or the United States) changing complexity
(number
five of the National Standards). For various reasons infant
mortality
rate within the United States is higher among regions in which certain
populations live. Knowledge concerning the distribution of these
populations facilitates the students’ understanding of IMR
distribution.
Third, the student will know and understand that culture and experience
influence people’s perceptions of places and experiences (number six of
the National Standards). People tend to form opinions about other
people and places based on their own background and biases. Students
must
realize and contend with factors that influence their perception, thus
avoiding "the dangers of egocentric and ethnocentric stereotyping,..."
and engage in "...accurate and sensitive analysis of people, places,
and
environments (6, p 74). Social issues must be managed
objectively,
pure of personal predilections.
Return to Table of Contents
Causes and Contributing Factors
Specific causes of
infant deaths are easily determined; however, they vary depending on
race.
For the U.S. population as a whole congenital anomalies (birth defects)
has been the leading cause of infant mortality (7)
for more than twenty years. Heart defects account for the largest
percentage of anomalies (31.4 percent) (8).
Premature and unspecified low birthweight rank number two. For
babies
born with birthweights less than 1,500 grams the infant mortality rate
is 264—89 times the rate of healthy babies (4,
p 1). Sudden infant death syndrome (SIDS) is the third leading
cause.
Fourth is respiratory distress syndrome; fifth, maternal complications
during pregnancy; sixth, complications due to the placenta, cord, and
membranes;
seventh, accidents and adverse conditions; eighth, infections specific
to the perinatal period. The ninth leading cause of infant mortality is
pneumonia and influenza, and finally, the tenth leading cause is
intrauterine
hypoxia and birth asphyxia. The order of these causes remains the
same for the white and Hispanic population. However, the leading
cause of infant death among the black population is premature birth and
unspecified low birthweight. Steinbrook found that "black or
white
babies of normal weight with college-educated parents have an equal
chance
of surviving the first year (9, p 26)." This study coupled with
the
fact that after four years of college disparity of infant
mortality
rates between whites and blacks (4.2 and 11.3 respectively) still
exists
emphasizes the fatality of low weight babies. Although accidents
and adverse conditions rank number eight among black Americans,
homicide
makes the list at number ten (2,
p 34). For American Indians the number one cause of infant death
is SIDS (2,
p 19). In addition, the rate of deaths relating to accidents and
adverse conditions is 3.6 times higher for American Indians than for
white
babies (4,
p 1).
Numerous indirect
risk factors contribute to infant mortality such as sex of infant,
multiple
births, maternal age, maternal education, live birth order, martial
status,
maternal smoking, alcohol abuse and drug abuse, available income, and
finally,
prenatal care. The following information is derived from MacDorman and
Atkinson’s article in the Monthly Vital Statistics Report (4,
p 1-24). Infant mortality rates are higher for boys of all races
than for girls. Multiple births increase the rate of infant death
by 522%. Infants born to mothers under twenty years old have a
mortality
rate of 10.8, infants born to women forty and over have a mortality
rate
of 9.0. Women between the ages of twenty five and thirty four
have
the lowest infant mortality rate. In general, maternal education
is indirectly proportional to infant death—the higher the education the
fewer the deaths. The infant death rate for women with nine to eleven
years
of education is 10.8. After four years of college, this rate
drops
to an astounding 4.7. Short intervals between delivery of one child and
conception of another child may contribute to low birthweight and
preterm
delivery. In addition, the order in which babies are born into a
family affects their survival rate. The second baby born has the
lowest mortality rate (6.8), and beyond the third baby the infant
mortality
rate rises drastically (9.5-12.7) (4,
p 9). Marital status interacts with many other risk factors, for
instance, "economic and social support for the mother; whether or not
the
pregnancy was wanted; as well as maternal age, educational level, and
prenatal
care attendance (4,
p 6)." The IMR is nearly twice as high for babies of unmarried
women
(4,
p 6).
Smoking, alcohol and drug abuse
during pregnancy reduces infants’ chances of survival. Smoking
increases
infant mortality rate by 162% (4,
p 6)! Smoking increases the risk of low birthweight , preterm delivery,
and mental retardation. According to Bond, sixty-three percent of
women who quit smoking during pregnancy relapse. Thus, promoting
respiratory illnesses and tripling the risk of SIDS by exposing
their
child to passive smoke (10, p 3). The highest percentage of
mothers
who smoked during pregnancy is among American Indians(4,
p 10)—the only ethnic group of U.S. citizens whose leading cause
of infant death is SIDS (2,
p19). Alcohol and drug abuse lead to deformities, the number one
cause of infant death. Although no statistics relating
income
and infant mortality rates are found, the effects of inadequate funds
are
logical. Without money mothers cannot receive proper nutrition or
prenatal assistance; thus increasing the risk of preterm and low
birthweight
babies, maternal complications during pregnancy, complications due to
the
placenta, cord, and membranes, infections, and pneumonia and
influenza.
Cowley stated, "Poor children are more likely to suffer from low
birthweight,
more likely to die during the first year of life,..., and less likely
to
benefit from immunizations or adequate medical care (5, p 21)."
The risk factors
mentioned
above are difficult to measure because women with one factor often
exhibit
other risk factors. For example, teenage mothers are more
likely
to be unmarried, less educated, and have lower incomes. However,
the majority of these factors somehow relate to amount of prenatal care
obtained by the mother. After several years of work, the National
Commission to Prevent Infant Mortality concludes that "at least half of
the country’s infant deaths could be prevented with better prenatal
care...(11,
p 8)." Prenatal care can detect and manage pre-existing maternal
medical conditions and provide healthy living advice. Herman
states
in an article in the Washington Post Health that "prenatal care alone
makes
a tremendous difference in the infant mortality rate (12, p 9)."
According to 1995 statistics, prenatal care obtained during the first
trimester
reduces infant mortality rate 574% (4,
p 9)!
Return to Table of Contents
State
to State Analysis
The National Commission
to Prevent Infant Mortality considers certain areas of the United
States
"disaster areas" (5, p 18). In 1998 Infant Health Statistics
published
the 1994 infant mortality rates (IMR) of each state (13),
and a demographic map of national IMR distribution was published
on the web by the Annie E. Casey Foundation (14).
As the "infant mortality capital (15, p 15)" of the United States, the
District of Columbia has overwhelmingly the highest rate at 18.2 deaths
per 1,000 live births (five percent higher than 1993 IMR). Mississippi
has the second highest rate at 11.0. Louisiana ranks third with an IMR
of 10.6. Georgia, Alabama, and North Carolina run a close race
with
infant mortality rates of 10.2, 10.1, and 10.0 respectively.
South
Dakota has the seventh highest rate at 9.6. South Carolina and
Illinois
tie with an IMR of 9.3. Arkansas follows closely behind
with
9.2. Why are the infant death rates so high in these
states?
What is the common factor? Unfortunately, the reason is partially
linked to race.
The majority of the high
rates are in states with a large percentage of back Americans. In
fact, Washington D.C. is the only state or would-be state with an
African
American majority, and as Nicholas Eberstadt states, "It is a well
known
fact that black babies in America are much more likely to suffer a low
birthweight than white ones... (15, p 4, 8)." The reason for this
disparity is not fully understood. Even after various risk
factors
are taken into account, Goldenberg and his associates find that black
women
still may have more low birthweight and premature babies than white
women
(16, p1317). Their study includes white women with more risk
factors
than the black women, and yet, on average the white infants weigh more.
This innate characteristic is enhanced when combined with other risk
factors.
The California state committee trace the breach in white and black IMR
to "conditions present in the black community including poverty,
unemployment,
single-parent families, and lack of access to proper medical care (17,
p A35)," and an article in The New England Journal of Medicine states
that
more black women have short intervals between pregnancies (18, p
70).
Although many determinants contribute to infant death, the most
tell-tell
statement comes from Eberstadt. He states, "The District
[of
Columbia] may be one of black America’s most prosperous areas, but it
also
has one of its worst rates of prenatal care utilization...The portion
of
black mothers obtaining prenatal care for their babies only in the
third
trimester, or not at all, is over two-thirds higher in the District
than
in America as a whole (15, p 9-10)."
In contrast to Washington
D.C. and many southern states, certain New England states and western
states
have phenomenally low infant mortality rates. Rhode Island has a
substantially lower infant mortality rate than any other state (5.0).
Massachusetts
is second with an IMR of 6.0. Maine, New Hampshire, Utah, and
Washington
tie for third at 6.2. Nevada follows closely with an infant
mortality
rate of 6.5. Hawaii, West Virginia, and Wyoming all have the
fifth
lowest rate of 6.7. No records could be found to explain these
low
rates, nor to explain Rhode Island’s 31% decrease in infant deaths (13).
Return to Table of Contents
Every child
deserves
the chance to live. The number of premature births rises each year (19),
and although technology strives to curtail the infant death rate, it
cannot
save them all. In addition, simple, inexpensive (in comparison to
life support systems) practices are more effective. The National
Commission to Prevent Infant Mortality recommends five basic government
provisions:
1) guarantee universal
coverage and access to services for prenatal care, including outreach,
transportation, and translation;
2) increase
availability
of services by opening more school-based clinics and making better use
of nurse practitioners and nurse midwives;
3) organize services
to make everything available in one convenient place;
4) provide 100%
coverage
for all recommended well-baby examinations;
5) include more
specialists
in managed health care plans for at-risk pregnant women and infants
with
special needs (11, p 8).
The power of education
cannot
be over-stressed, nor the effects of money. Mothers must
understand
the importance of good nutrition and abstinence from alcohol, smoking,
drugs, and other risk factors; they need equal access to clinics,
technology,
and resources; and they deserve peace of mind that their baby will
receive
proper care.
However, the solution to
keeping Americas babies alive is not in technology, money, education,
nor
government intervention. Washington D.C. serves as a prime
example.
Eberstadt makes the following observation concerning Washington D.C.’s
high IMR. He states that according to the U.S. Census Bureau, the
poverty and unemployment rate for black Washingtonians is much lower
than
for the average nationwide African American. The "proportion of
adults
twenty-five or older with college degrees is distinctly higher for
blacks
in the District than for those in the country as a whole," and
Washington’s
ratio of population to medical doctors is nearly twice the national
average
(15, p 5-7). In addition, he notes that "higher food stamp
recipience
closely corresponds with lower usage of prenatal medical services (15,
p 14);" thus government aid is not promoting necessary maternal
practices.
In fact, 466 babies each year are born within the United States to
mothers
who either started prenatal care in the final trimester or did not
receive
any care at all (1).
The true determinant of
a babies chances of survival most often lie in the parents’
hands.
The most important factor is whether or not the baby is wanted.
Second,
the parents/parent must be educated, and actively participate in
prenatal
care programs and basic hygienic practices. Third, the
parents/parent
should consider whether raising and caring for their child is
financially
reasonable. The cure to babies dying is, therefore, a lifestyle
change.
Children who grow up in unhealthy environments "never understand what
is
necessary for healthy living (5, p 21)." Likewise, children who
grow
up in abusive, dysfunctional environments never understand what life is
like outside of those conditions. Thus the cycle continues.
Return to Table of Contents
Endnotes
1. "Quick Stats for the United States." Infant Health Statistics .
2. Ventura, Stephanie J.; Kimberley D. Peters; Joyce A. Martin; Jeffrey D. Maurer. Monthly Vital Statistics Report.
3. "Infant mortality rates, fetal deaths rates, and perinatal mortality rates, according to race: United States, selected years 1950-95." National Center for Health Statistics.
4. MacDorman, Mariam F. and Jonnae O. Atkinson, "Infant
Mortality
Statistics from the Linked Birth/Infant Death Data Set-1995 Period
Data."
Monthly Vital Statistics Report.
5. Cowley, G. "Children in Peril."
6. "Geography for Live, National Geography Standards."
National Geographic Research & Exploration.
7. "Ten Leading Causes of Infant Mortality," Infant Health
Statistics.
8. "Leading Causes of Infant Deaths, United States,
1994."
Infant Health Statistics.
9. Steinbrook, R. "Black Infant Deaths Tied to
Birthweight."
10. Bond, Christopher S. "Statements on Introduced Bills
an Joint Resolutions."
11. Evans, S. "Prenatal Care to Combat Infant Mortality."
12. Herman, R. "Reducing Alabama’s Infant Death Rate."
13. "Live Birth, Infant Deaths and Infant Mortality Rates, By
State, United States, 1994." Infant Health Statistics.
14. Casey, Annie E. "Infant Mortality Rate (Deaths per
1,000 Live Births) 1994." Kids Count.
15. Eberstadt, Nicholas. "Why Babies Die in D.C."
16. Goldenberg, Robert L; Suzanne P. Cliver; Francis X.
Mulvihill;
Carol A. Hickey; Howard J. Hoffman; Lorraine V.
Klerman; Marilyn J. Johnson.
"Medical, Phsychosocial, and Behavioral Risk Factors Do Not Explain the
Increased Risk
for Low Birth Weight among Black
Women."
17. Scott, J. "Black Infant Death Rate 2 ½ Times
That of Whites."
18. Rawlings, James S.; Rawlings, Virginia B.; Read, John
A.
"Prevalence of low Birthweight and Preterm Delivery in
Relation to the Interval between
Pregnancies among White and Black Women."
19. "Preterm Births, United States 1984-1994." Infant
Health
Statistics.
Return to Table of Contents
Bond, Christopher S. "Statements on Introduced Bills an Joint Resolutions." Congressional Record. Daily ed., Vol. 143 No. 86, 19 Jun, 1997, p S6000-6005.
Cowley, G. "Children in Peril," Newsweek, 117 (26), May 1991, p 18-21.
Eberstadt, Nicholas. "Why Babies Die in D.C." The Public Interest, No. 115, Spring 1994, p 4.
Evans, S. "Prenatal Care to Combat Infant Mortality." Washington Post Health, 21-28 Dec 1993, 9 (51), p 8
Goldenberg, Robert L; Suzanne P. Cliver; Francis X. Mulvihill; Carol A. Hickey; Howard J. Hoffman; Lorraine V. Klerman; Marilyn J. Johnson. "Medical, Phsychosocial, and Behavioral Risk Factors Do Not Explain the Increased Risk for Low Birth Weight among Black Women." American Journal of Obstetrics and Gynecology, Vol. 175, No. 5, 1996, p 1317-1325.
Herman, R. "Reducing Alabama’s Infant Death Rate." Washington Post Health, 6 Aug 1991, 7 (32), p 8-9.
"Infant mortality rates, fetal deaths rates, and perinatal mortality rates, according to race: United States, selected years 1950-95." National Center for Health Statistics 1997. http://www.cdc.gov/nchswww/datawh/statab/pubd/hus97t23.htm (11 April 1998).
"Leading Causes of Infant Deaths, United States, 1994." Infant
Health Statistics. 1998.
http:www.modimes.org/stats/percent.htm
(11 April 1998).
"Live Birth, Infant Deaths and Infant Mortality Rates, By State,
United
States, 1994." Infant Health Statistics. 1998.
http://www.modimes.org//stats/states/htm
(11 April 1998)
MacDorman, Mariam F. and Jonnae O. Atkinson, "Infant Mortality
Statistics
from the Linked Birth/Infant Death Data Set-1995 Period Data."
Monthly
Vital Statistics Report, Vol. 46, No. 6 Supplement 2, 26 Feb 1998, p
1-24
http://www.cdc.gov/nchswww/products/pubs/pubd/mvsr/supp/46-45/46-45htm
(11 April 1998).
"Preterm Births, United States 1984-1994." Infant Health Statistics. 1997 http://www.modimes.org/stats/preterm.htm (12 April 1998).
"Quick Stats for the United States." Infant Health Statistics 1998. http://www.modimes.org/stats/quick.htm (11 April 1998).
Rawlings, James S.; Rawlings, Virginia B.; Read, John A. "Prevalence of Low Birthweight and Preterm Delivery in Relation to the Interval between Pregnancies among White and Black Women." The New England Journal of Medicine, Vol 332, No 2, 1995, p 69-75.
Scott, J. "Black Infant Death Rate 2 ½ Times That of Whites." Los Angeles Times, 1991 Nov 15, 110 (347), A35.
Steinbrook, R. "Black Infant Deaths Tied to Birthweight." Los Angeles Times, 111 (184), 4 Jun 1992, A26.
"Ten Leading Causes of Infant Mortality," Infant Health Statistics. 1997. http://www.mofimes.org/stats/ten.htm (11 April 1998).
Ventura, Stephanie J.; Kimberley D. Peters; Joyce A. Martin;
Jeffrey
D. Maurer. Monthly Vital Statistics Report, Vol.46, No. 1
Supplement
2, 11 Sept. 1997, p 6.
http://www.cdc.gov/nchswww/products/pubs/pubd/mvsr/supp/46-45/46-45.htm
(11 April 1998).
Return to Table of Contents
Return to the Top of the Page
Created April 16, 1998
Return to http://ejw.i8.com/geog/98/plans98.html