Did you know that the U.S. has the second worst newborn mortality rate in the developed world? According to Save the Children, out of 1,000 live births, 5 infants will die in their first 24 hours. The only industrialized nation with a higher rate is Latvia, with 6 deaths per 1,000 live births. CNN reports that the U.S. has more neonatologists (specialists in newborn care) and neonatal intensive care beds per capita than fellow English-speaking countries Australia, Canada, and the United Kingdom, yet its newborn death rate exceeds those countries. What is causing this disparity, and what can be done about it?
In my opinion, the first factor is lack of access to quality health care. What good is it to have well-trained newborn specialists or NICU (newborn intensive care unit) beds if the infants who need them cannot get to them? Most hospitals with those facilities are in large cities such as Dallas, New York, or Atlanta. Rural areas and small towns usually have adequate care for uncomplicated pregnancies, but some individuals cannot get even that much due to transportation or financial issues. Money is also a major consideration for those who do live in cities with specialized care available.
Lack of education is my second factor. There is no organized system nationwide that educates women of childbearing age (puberty and up) about risk factors, habits to avoid during pregnancy, prenatal nutrition, or even how to locate social services designed for pregnant women. Any girl who is menstruating is capable of becoming pregnant. While I believe strongly in abstinence before marriage, in reality that often doesn’t happen, for a variety of reasons (perhaps if girls were fully educated about the responsibilities of bearing and raising a child they would think twice about getting intimate! Teenage pregnancy is in itself a risk factor for newborn mortality). In any case, all women who can become pregnant need to know the facts.
For example, how many women are aware of the dangers of fetal alcohol syndrome? It is one of the leading causes of low-birth-weight babies, and low-birth-weight substantially increases the risk of newborn death. Other dangers exist if the mother smokes or uses illegal drugs. Even prescription drugs can be harmful to the developing infant; this is one reason early prenatal care is so important.
Many women do not seek prenatal care because they cannot afford it. They are unaware that Medicaid generally covers pregnant women, even when they do not qualify otherwise. Again, this reflects lack of education. Better information about nutritional programs for pregnant women, infants, and young children is also needed. In addition to Food Stamps, the Federal Government (through the states) offers the Women, Infants, and Children (WIC) program that pays for certain types of foods that fulfill the needs of these populations.
Lack of education is not always the cause of problems such as fetal alcohol syndrome. A woman may realize that her substance abuse will affect her baby, but be unable to let go of her addiction without help. She may not even be motivated to quit. Social support and formal rehab services, if easily available to the pregnant woman, can provide the necessary help.
Finally, and perhaps most importantly, most developed countries (including Australia, Canada, and the U.K.) have a system of universal health care. In the United States there is a “Medicaid gap” – a level of income that is too high to qualify the person for Medicaid, yet too low to allow the person to purchase health insurance or pay deductibles and co-payments and still pay other bills. Universal health care would solve this problem since there would no longer be eligibility requirements (such as income) to participate in health care programs.
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