This lack of progress is absolutely unacceptable. It’s time to reenergize our efforts to reduce infant mortality. And this should start with improving the Republican-led plan to repeal and replace the Affordable Care Act.
For far too long, the United States has lagged behind the rest of the developed world in terms of infant mortality. We have one of the highest infant mortality rates among developed nations, with nearly six deaths per 1,000 births — more than twice the rate of Japan, Norway, Sweden, Finland and much of continental Europe.
Worse, the outcome of American babies shows stark racial inequalities. The preterm birth rate — which is associated with health complications for infants — is nearly 50 percent higher for black infants than white ones. And black babies are nearly four times as likely to die from short gestation and low birthweight.
Researchers have had a difficult time pinning down exactly what’s behind infant mortality trends, partly because it’s impossible to conduct random trials to see the outcome of babies in different environmental settings. There’s also a frustrating lack of understanding behind sudden infant death syndrome — the unexplained death of a baby, usually during sleep — which claimed the lives of 1,600 babies in 2015.
But experts generally agree that the relatively high infant mortality rates in the United States have to do with poor nutrition among mothers, stress from poverty and smoking habits. Access to prenatal care, especially early ultrasounds, as well as family planning are also crucial elements in the mix.
Theoretically, this should be the sort of data informing policy from Republican lawmakers as they cobble together health-care legislation. But in reality, Republicans have proposed massive cuts to federal spending for Medicaid — which has long provided health care to low-income women and their children. As more Medicaid costs fall upon cash-strapped state budgets, the future of prenatal care to the nation’s most vulnerable becomes fuzzy.
It would be one thing for Congress to propose such cuts if they simultaneously make efforts to preserve access to care for low-income mothers and children. But both the House and Senate have proposed halting federal spending to Planned Parenthood, the nation’s largest provider of reproductive health services and family planning, for a one year.
This would only hurt our efforts to reduce infant mortality. Jay Kaufman, a co-author of the JAMA study and a professor at McGill University, put it simply: “Wanted pregnancies are healthier than unwanted pregnancies.”
Researchers rightfully warn that infant mortality is not something that can be easily solved by policymakers in Washington, as there are deeper social and environmental issues at play. That’s true, but our plateaued progress — especially our inequalities for babies of color — should startle everyone and must inform our debate on health care.
Health care is, and always has been, an issue fraught with political controversy. But infant mortality is an issue that should spark little disagreement: Protecting and caring for our most vulnerable — particularly, babies and pregnant women — should be among our highest priorities. Let’s not give up on the progress we’ve made so far.