Woman and Child Health

The health of a nation is often reflected in the health of its mothers and newborns. The World Health Organization (WHO) often uses a nation's maternity and neonatal morbidity and mortality statistics as a proxy for the health status of its population. It is an important summary reflecting social, political, health care delivery, and medical outcomes in a geographic area. The United States, despite its economic wealth and medical resources, consistently ranks poorly in such measures as maternal and infant mortality rates. In 2005 in the United States, 28,384 infants died before reaching their first birthdays, an infant mortality rate (IMR) of 6.9 per 1000 live births. Despite a more than 9% reduction in IMR between 1995 and 2005, the United States ranks 30th, after such select countries as Japan, the Scandinavian countries, and Canada (Box 21-1). In 2005, the U.S. IMR was more than three times as high as that in Singapore (2.1 per 1000 live births), the country with the lowest reported IMR. This number reflects in part the continuing disparities in health access and delivery for U.S. citizens (National Center for Health Statistics [NCHS], 2009).

Box 21-1 International Infant Mortality Rate (IMR)*

16. Switzerland (4.2)

20. Netherlands (4.9)

28. Northern Ireland (6.3)

35. Russian Federation (11.0)

From National Center for Health Statistics. http://www.cdc.gov/nchs/hus.htm. *Under 1 year of age; rankings are from lowest to highest IMR (per 1000 live births). Countries with the same IMR receive the same rank. Some of the variation in IMRs is caused by differences among countries in distinguishing between fetal and infant deaths.

Note: U.S. data used in this table is final mortality data. After 1994, Peristats uses period-linked birth/infant death data to calculate IMRs. Rates in table may vary slightly from other rates on PeriStats: www.marchofdimes.com/peristats.

The causes of infant mortality are multiple, with birth defects being the leading cause, with a 2005 rate of 134.6 per 100,000 live births. Preterm birth (birth at <37 completed weeks of gestation) or low birth weight (LBW) is the second leading cause of infant mortality in the United States. Preterm birth rates differ by race; during 2003-2005 (average), IMR (per 1000 live births) in the United States was highest for black infants (13.3), followed by Native Americans (8.4), whites (5.7), and Asians (4.8) (NCHS, 2010). This persistent disparity contributes to the relative high IMR in the United States compared with similarly developed countries. Other causes of infant mortality include sudden infant death syndrome, respiratory distress syndrome, and maternal pregnancy complications. These five causes accounted for more than half of all infant deaths in 2005 (Fig. 21-1). Despite gains, the rate of preterm birth, birth defects, and LBW remain relatively constant. This indicates a need for further health initiatives to address the health needs of the pregnant woman and the unborn.

Pregnancy And Childbirth

Pregnancy And Childbirth

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