The Children's Defense Fund has issued a disturbing report showing that two decades of progress in combating infant mortality have "ground to a virtual halt." In 1983, 40,000 infants died in this country. The rate of death for infants 28 days old to 1 year rose 3 percent from 1982 to 1983. The death rate for black infants rose 5 percent in 1983 -- the first increase in 18 years.
These last two figures are particularly troubling. Since 1965, the infant mortality rate has dropped steadily and dramatically. According to the National Center for Health Statistics, which gets its data from all birth and death certificates, there were 26 deaths per 1,000 live births in 1960. In 1970, that figure dropped to 20 and in 1980 it was 12.6 for all races combined. Thus, in two decades the death rate was cut by more than half. By 1983, the death rate had dropped to 11.2 per thousand live births -- a drop, but at a slower rate.
The rates for races other than white also declined dramatically, but these babies continue to die at about double the rate of white children. Thus, the death rate for nonwhite children dropped from 43.2 per thousand live births in 1960 to 19.1 in 1980. By 1983, it was 16.8. This was progress that the nation could be truly proud of. But then something happened.
The rate of decline in infant deaths has slowed down, and the rate of deaths for older infants has slightly increased. "We really don't understand exactly what has happened," says Dr. Harry M. Rosenberg, chief of the mortality statistics branch at the National Center for Health Statistics. One suggestion, he says, is that we may have reached a plateau. "In fact, from a comparative international view, we should not. There are many nations that have lower rates and, indeed within the U.S., there is a range of infant mortality rates within the states and some are considerably lower than the national picture. There is room for improvement and we have to ask ourselves what are the factors associated with what we're seeing -- and we don't know what they are."
The Children's Defense Fund, in its report, makes a convincing connection between prenatal care and healthy babies. "The proportion of babies born at low birth weight increased in 1983 among both white and black babies. The prematurity rate also increased for the third consecutive year. While the increases were slight, no increases in low birth weight have been observed among either group for at least 14 years," the CDF found.
"In 1983, one in eight black infants and one in 17 white infants was born at low birth weight. Low birth weight babies are 20 times more likely to die in the first year of life and are at significantly greater risk of developing lifelong disabilities such as retardation, autism, and epilepsy.
"In 1983, for the third consecutive year, the percentage of babies born to women receiving late [during the last three months] or no prenatal care increased. Babies born to women who receive no prenatal care are three times more likely to die in infancy than those whose mothers received early care."
Good prenatal care, except in cases of problem pregnancies, is simple and preventive in nature, and therefore the kind of medicine that is the most cost effective. We are talking about 10 minutes at a doctor's office or clinic, maybe 10 to 12 times during a pregnancy.
They can be the most valuable 10 minutes a woman can ever spend, and the most valuable 10 minutes society can pay for. Yet, according to the National Center for Health Statistics, there are still a great many women not getting prenatal care. In 1970, 8 percent of the nation's mothers had no care at all or no care until the last trimester of pregnancy. From 1978 to 1982, that figure dropped to 5 percent. Then, in 1983 it crept back up to 6 percent. In real numbers, that means that in 1983, about 218,000 women did not get proper -- if any -- medical attention until they were more than six months pregnant. Teen-age mothers were the least likely to get care: 11.5 percent of mothers 15 to 19 years old received no care until the end of their pregnancies.
The CDF report points out that care for low birth weight babies averages $1,000 a day. For many, the cost of their care is borne either by hospital charity funds or by Medicaid.
The report is an argument for pragmatism. Doubters can look back at those 1960 infant mortality rates and see how far we've come. This is one area where education, Medicaid money and federal nutrition programs for pregnant women and their infants have truly paid their way. Expanding them to all who need them ultimately will save money.