US among worst in world for infant death

[Einhander Sn0m4n]

US among worst in world for infant death

By The Associated Press Sat Nov 10, 4:50 PM ET

The rate at which infants die in the United States has dropped substantially over the past half-century, but broad disparities remain among racial groups, and the country stacks up poorly next to other industrialized nations.

In 2004, the most recent year for which statistics are available, roughly seven babies died for every 1,000 live births before reaching their first birthday, the Centers for Disease Control and Prevention says. That was down from about 26 in 1960.

Babies born to black mothers died at two and a half times the rate of those born to white mothers, according to the CDC figures.

The United States ranks near the bottom for infant survival rates among modernized nations. A Save the Children report last year placed the United States ahead of only Latvia, and tied with Hungary, Malta, Poland and Slovakia.

The same report noted the United States had more neonatologists and newborn intensive care beds per person than Australia, Canada and the United Kingdom — but still had a higher rate of infant mortality than any of those nations.

Doctors and analysts blame broad disparities in access to health care among racial and income groups in the United States.

Not surprisingly, the picture is far bleaker in poorer countries, particularly in Africa. A 2005 World Health Organization report found infant mortality rates as high as 144 per 1,000 births — more than 20 times the U.S. rate — in Liberia.

We need more of this hard-hitting bluntness in our media. This is sad and sickening.

[Sikon]

One of the main contributing factors is a relatively high abuse rate of cocaine and similar drugs, among parts of the U.S. population in inner cities, contributing to low birth weight babies. European countries don't have such to nearly the same degree. Here's an example, a random article back from 1991:

Cocaine Use and Infant Mortality Decline Together in New York City
By CELIA W. DUGGER
Published: April 20, 1991

A decline in the use of cocaine by pregnant women and improved prenatal care last year helped significantly reduce infant mortality in New York City for the first time in four years, city and state health officials said yesterday.

The decline in the infant death rate for 1990, based on preliminary tallies by the State Health Department, is a relief to health officials, who had watched two decades of progress erode as crack, homelessness, AIDS and deepening poverty devastated poor families.

But the city's preliminary infant mortality rate for last year is still 25 percent higher than the national rate, which continued to fall in the years that New York City's rate climbed. On average, five babies a day died in the city before their first birthdays in 1990. In Poor Areas, High Death Rates

Infant mortality also continues to be a stark measue of the chasm between economic classes and racial groups in the city, according to a report released this week by the Greater New York March of Dimes and the United Hospital Fund of New York.

Infants in the 10 poorest neighborhoods of the city died at twice the rate of babies in the 10 wealthiest areas, the study found. Black babies died at two-and-a-half times the rate of white babies. The conclusions were based on city data from 1987 through 1989, the most recent information available by race and neighborhood.

The city's infant mortality rate worsened in 1987 and 1988 and leveled off in 1989. Last year, it declined to 12.1 deaths in 1,000 live births, from 13.1 in 1989, according to projections by the State Health Department.

Karla Damus, the research director for family health services in the city Health Department, said a study of more than 120,000 of the 142,000 birth certificates in 1990 found that the rate of cocaine use among pregnant women also fell significantly, part of what she said was the larger trend of lower cocaine use in the city. The city collects information about drug use on the confidential portion of birth certificates.

"Crack exposure is beginning to turn the corner," Mrs. Damus said.

Babies whose mothers used cocaine during pregnancy in 1989 had a mortality rate more than three times the average rate. The babies were at higher risk not only because their mothers used cocaine, but also because the women were likelier to be poor, homeless, malnourished, sick and battered by their spouses, and less likely to receive prenatal care, said Stephen Kandall, the chief of neonatology at Beth Israel Medical Center. Signs of Decreasing Crack Use

Though experts say crack is still ravaging many families, there are other statistical signs that its use in the city is decreasing.

Child abuse reports, which rose to 59,353 in 1989, from 41,454 in 1986, dropped to 55,158 in 1990 and are expected to decline further this year, according to city child welfare statistics.

"There is anecdotal evidence that crack use is down among women having children," said Sheila Jack, the spokeswoman for the city's Human Resources Administration.

Cocaine-related emergency room admissions in the city were also down in 1990, as were cocaine-related drug arrests, according to the State Division of Substance Abuse Services. Crack 'Peaked in 1988'

"You've run the course of the epidemic," said Dr. David A. Bateman, chief of newborn services at Harlem Hospital. "Initially, there were a lot of new recruits to crack. It was fashionable. It peaked in 1988. There haven't been as many new people attracted to the drug. We see the same people over and over."

Tim Smith, senior biostatistician in the State Health Department, cautioned that the city's infant mortality rate for 1990 would probably be somewhat higher when the final tally of births and deaths was completed. "But I'm sure it will be down," he said. "It dropped quite a bit."

Another factor cited by Federal Government statisticians in the decline of infant mortality nationally last year was the introduction of a new drug that helps prevent deaths of premature babies from sudden respiratory failures.

But Dr. Bateman and Dr. Leonard Glass, a neonatologist at Kings County Hospital Center, minimized the role of that medical advance. The Difference of Prenatal Care

"Possibly that helped me save a couple of babies. But it wouldn't account for a major drop. It's a little blip," Dr. Glass said.

Improved prenatal care helped save the lives of some infants, Mrs. Damus said. In 1990, the state extended Medicaid coverage to more poor pregnant women. The city's infant mortality initiative, which began in 1988 by serving fewer than 1,000 women, is now in full swing, she said. More than 4,000 women received comprehensive prenatal care and follow-up care for the first year of their babies' lives through the program in 1990.

Prenatal care makes a big difference, according to the March of Dimes analysis of city data. The babies of addicted women who received prenatal care were a third less likely to die in infancy than drug-exposed babies whose mothers received late care or no care. One in seven pregnant women in New York City received late or no prenatal care in 1989, the March of Dimes report found. Similar information is not yet available for 1990.

An obstetrician and gynecologist at New York University Medical Center, Dr. Machelle Harris Allen, tried to explain the importance of prenatal care to 30 philanthropic organizations who gathered on Thursday for the presentation of the March of Dimes-United Hospital Fund report, Infants at Risk: Solutions Within Our Reach.

Dr. Allen treated 45 pregnant addicted women in 1989 and 1990 at Bellevue Hospital Center. All but one gave birth to healthy full-term babies, she said. Drugs, Alcohol and AIDS

One woman she treated smoked crack, sipped rum and tested positive for the AIDS virus. About halfway through her pregnancy, she stopped using drugs and was admitted to the hospital for 10 days when Dr. Allen discovered she had syphilis, a disease that a woman can pass on to her fetus.

"She gave birth to a healthy baby at term. She got a two-bedroom apartment and went home with her baby," Dr. Allen said.

But the story has a sad ending. The intensive attention that Dr. Allen gave the pregnant woman did not continue when she became a new mother. The woman returned to drugs and drink and lost her baby to foster care.

There are still only a handful of residential drug-treatment programs in the city that allow women to keep their children, said David Condliffe, director of the Mayor's Office of Drug Abuse Policy. The city is reviewing 32 proposals for new treatment programs intended to help pregnant women and mothers of young children get off drugs, and will award $5.5 million in contracts for such programs, unless the fiscal crisis results in cuts in financing, he said.

Improved drug treatment and better prenatal care are essential elements in reducing infant deaths, Mr. Condliffe said. "The problem isn't that these women don't know about Piaget's theories of child development," he said. "It's that the refrigerator was empty because the mother was feeding her addiction, not her kid."

From here.

Like the article illustrates, sometimes there is some progress in combating the problems, but there is a long ways to go.