Perhaps our focus should be eliminating poverty.
18
We offer free birth control and free abortions to the poor, and yet we still read of women who murder their babies or leave them in garbage cans instead of a safe sanctuary. We also read too often of boy friends or family members who beat up a crying infant. Too many American women are ill prepared to be mothers, and too many American men are ill prepared, or just unwilling, to be nurturing fathers.
13
Give moms (and dads) time to focus their attention on their new babies! These are future citizens.
15
http://kff.org/other/state-indicator/infant-mortality-rate-by-race-ethni...
There is room for improvement in infant mortality. It is a tragedy for each family.
There is a great deal of variability by state. Per the link, for white babies, the rates vary from 3.2 in NJ to 7 in WV. For black babies, it varies from 6.9 in MA to 14.2 in KA, For American Indians or Alaska Natives it varies from 5.9 in NM to 13.2 in ND. For Asian or Pacific Islanders, it varies from 3.3 in MA to 7.6 in OK.
More study of best practices is needed. But there exists a possibility that there is a racial component, which means that racial parity may never be achieved. From the experience of women in the military, the fact that black women experience premature birth at twice the frequency may also be an indicator that a genetic difference may also tend to increase the risk of infant mortality. Perhaps white women are more likely to have a spontaneous abortion early in the pregnancy if the child is unlikely to survive his first year. so extremely fragile children do not survive long enough to be born alive.
There's room for better understanding. We should work toward identifying why some states do so much better than others.
There is room for improvement in infant mortality. It is a tragedy for each family.
There is a great deal of variability by state. Per the link, for white babies, the rates vary from 3.2 in NJ to 7 in WV. For black babies, it varies from 6.9 in MA to 14.2 in KA, For American Indians or Alaska Natives it varies from 5.9 in NM to 13.2 in ND. For Asian or Pacific Islanders, it varies from 3.3 in MA to 7.6 in OK.
More study of best practices is needed. But there exists a possibility that there is a racial component, which means that racial parity may never be achieved. From the experience of women in the military, the fact that black women experience premature birth at twice the frequency may also be an indicator that a genetic difference may also tend to increase the risk of infant mortality. Perhaps white women are more likely to have a spontaneous abortion early in the pregnancy if the child is unlikely to survive his first year. so extremely fragile children do not survive long enough to be born alive.
There's room for better understanding. We should work toward identifying why some states do so much better than others.
14
In the PC descriptions of many mothers and babies, two words are missing "unwanted" baby and "unplanned" pregnancy. How do our mortality rates compare to nations where all forms of birth control are readily available to all women of color bearing age?
15
There is no woman in the US who does not have access to birth control.
If you are interested in infant mortality, do you have any evidence to suggest that unwanted or unplanned babies have higher infant mortality rated than those who are wanted or planned? What about babies who are wanted and planned? Wanted and unplanned, unwanted and unplanned?
If you are interested in infant mortality, do you have any evidence to suggest that unwanted or unplanned babies have higher infant mortality rated than those who are wanted or planned? What about babies who are wanted and planned? Wanted and unplanned, unwanted and unplanned?
9
CHILDREN Are our future. It is a tragic loss that we place more value on giving corporate welfare to the 1%, the milionaires and billionaires, while we take resources away from expectant mothers, newborns, toddlers and children up till age 18 years. And for what purpose? To prove the GOP lies that government does not work. Of course programs will perform worse if funds are consistently being cut. Along with more tax cuts for the 1%. This is not the US I remember; it is not the US I identify with. If we are fortunate, we will come to our senses and rejoin the community of nations whose priorities include sharing resources so all can flourish and thrive.
19
It is mentioned that single mothers is a characteristic that predisposes infant death from one month to one year. If this is so, then it stands to reason that a baby born into a two parent household has a much better chance of survival and that the single best thing that our government can do is to discourage child bearing by single women instead of giving incentives. Why not give poor, young women of child bearing age ample access to birth control and money to not bear children? In the long, run it would be cheaper and a lot of children will be spared death.
32
It's not just the babies who die in America's "best health system in the world".
“the US has more than double the maternal mortality rate of Saudi Arabia and Canada, and more than triple the rate of the United Kingdom. The United States now ranks 60th for maternal deaths on a list of 180 countries.”
https://www.washingtonpost.com/local/maternal-deaths-in-childbirth-rise-...
“The United States was also one of only 13 countries to have worse rates of maternal mortality in 2015 than in 1990 - a group that also includes North Korea, Zimbabwe and Venezuela.
http://www.reuters.com/article/2015/11/12/us-health-pregnancy-idUSKCN0T1...
“the US has more than double the maternal mortality rate of Saudi Arabia and Canada, and more than triple the rate of the United Kingdom. The United States now ranks 60th for maternal deaths on a list of 180 countries.”
https://www.washingtonpost.com/local/maternal-deaths-in-childbirth-rise-...
“The United States was also one of only 13 countries to have worse rates of maternal mortality in 2015 than in 1990 - a group that also includes North Korea, Zimbabwe and Venezuela.
http://www.reuters.com/article/2015/11/12/us-health-pregnancy-idUSKCN0T1...
30
Poor women have poor options as to child care. They must return to work soon after giving birth. They cannot afford quality care for their babies. This leads to the unsafe conditions that cause SIDS, accidents -- and abuse. Spend that $7,000 per baby on quality child care and see what happens.
47
You are assuming the abuse is by someone other than the parent?
I think further clarifying research would be very helpful in describing the problem and directing potential interventions.
I think further clarifying research would be very helpful in describing the problem and directing potential interventions.
2
A neonatal nurse w 20 years experience shared some advice with a mutual friend struggling to conceive- get your health in order before going to the fertility specialist. She says she sees a trend with many of the women delieverying prematurely regardless of race or economics and that's obsesity, high blood pressure, metabolic syndrome/re-diabetes. Women get sent to fertility specialists instead of dietitians. In turn, maternity wards now need to have beds and stretchers for morbidly obese women having c-sections. One uncomfortable question to ask is if fertility specialists are helping too many women who are too unhealthy to conceive naturally.
48
Could it be related to lack of follow-up visits to doctors or nurses visiting in-home? I know that some countries do a lot of such in-home visits. Also, could it be that poorer women need to return to work around a month or so? I know that the time when both parents are working and the baby is still young is a very stressful time, maybe bad health outcomes can be one of the results? Just some thoughts.
23
Aaron.. this is a lot to tackle for a NYT piece. I think the important point here is the gap between neonatal mortality and post neonatal mortality. Once my patients leave the NICU, they are compromised on some way compared to their peers on other developed countries. It would not be a giant leap to say that we fail in terms of providing support to children in their first year of life compared to other developed countries... whether it's financial, social, or medical. Now it is our job to find out what those gaps are and how to fill them. In terms of neonatal care, we are always looking to improve, but it is disheartening to know that post neonatal mortality cuts into the progress we have made as neonatologists.
Regards,
Sunil
Regards,
Sunil
37
the US also has significantly higher rates of drug use than most developed nations. Significantly higher rates of illegal immigration. much higher illegitimacy and higher illiteracy rates. Yet we see none of these facts even mentioned in passing.
28
Try shipping them baby boxes as in Finland!
15
That is a sweet tradition in Finland. Maybe that's why they have an infant mortality rate of 3.4.
http://www.infoplease.com/ipa/A0934744.html
http://www.infoplease.com/ipa/A0934744.html
3
There are organizations working on this in the US!
https://storkandcompany.org/
https://www.facebook.com/babiesneedboxes/
https://storkandcompany.org/
https://www.facebook.com/babiesneedboxes/
3
Prenatal nutrition has never been a topic widely discussed but is essential for the health of an infant. Quite by accident, I discovered nutritionist Adele Davis' book on the topic when told by an OBGN "If you want to carry this baby-at the beginning of a second pregnancy after a miscarriage--go home and sit down." I quit my job, bought my first TV (at age 30) and read...the first was the book on nutrition. Five healthy babies---with healthy childhoods---and healthy adulthoods and children of their own--consider prenatal nutrition....including counting grams of protein and avoiding sugar when gestating.......
8
The fact is, many more children die in the United States than the author might think.
With respect to infant mortality, the prevalence of birth trauma is 0.58, higher than 19 other industrialized nations; the prevalence of low birth weight is 3.54, higher than 39 other industrialized nations, based on data from the World Heath Organization. Prevalence is the death rate per 100,000 population.
So it’s not surprising that USA child deaths (ages 1-14) per 100,000 is 16 overall, but varies from 26 in Louisiana to 9 in Connecticut.
With respect to infant mortality, the prevalence of birth trauma is 0.58, higher than 19 other industrialized nations; the prevalence of low birth weight is 3.54, higher than 39 other industrialized nations, based on data from the World Heath Organization. Prevalence is the death rate per 100,000 population.
So it’s not surprising that USA child deaths (ages 1-14) per 100,000 is 16 overall, but varies from 26 in Louisiana to 9 in Connecticut.
16
I wonder if the so called Welfare 'reform' in Bill Clinton's reign has anything to do with this. Poor mothers were forced to work and as another comment pointed out these mothers have no choice but to put their babies in very iffy and crowded day care centers. So that brings up our enormous and unprecedented economic inequality that both Democrats and Republicans have boosted in the last 40 years and now at an all time gigantic gap. I fear that these women might have serious depression since there is no way out of their dismal existence. These women have been abandoned by our government and the public. And there is no where to go.
19
Guess again.
http://www.hrsa.gov/healthit/images/mchb_infantmortality_pub.pdf
Infant mortality rate was 8.5 in 1992, and has declined steadily.
http://www.hrsa.gov/healthit/images/mchb_infantmortality_pub.pdf
Infant mortality rate was 8.5 in 1992, and has declined steadily.
3
A little surprised that the fact that mothers on military bases have the same theoretical access to care is presented as '*receive* the same prenatal care regardless of race. This may be wishful thinking - was analysis done to show that both access *and* care received were in fact comparable?
Also, one would like to know more about maternal (and paternal) health pre- and post- delivery. But as many have said, the unfortunate absence of paid maternity leave for, say, 3 months for most low-income groups in this country is unconscionable.
Also, one would like to know more about maternal (and paternal) health pre- and post- delivery. But as many have said, the unfortunate absence of paid maternity leave for, say, 3 months for most low-income groups in this country is unconscionable.
16
Not just low-income groups, but middle-income mothers also do not have paid maternity leave in most states.
6
"Deaths in the postneonatal period are due, in large part, to sudden infant death syndrome (SIDS), sudden death and accidents. Moreover, they seem to occur disproportionately in poor women."
1. What causes SIDS? We don't know. We have a list of risk factors plus a lot of mystery.
2. What is "sudden death"??? Sudden death from what? This is a giant I Don't Know?
3. "Accidents." What kind of accidents? Baby rolling off tables? Automobile accidents? Drowning? What?
Doesn't all this add up to either complete ignorance or inadequate analysis? I am disappointed in this article, which ends up mostly saying nothing.
1. What causes SIDS? We don't know. We have a list of risk factors plus a lot of mystery.
2. What is "sudden death"??? Sudden death from what? This is a giant I Don't Know?
3. "Accidents." What kind of accidents? Baby rolling off tables? Automobile accidents? Drowning? What?
Doesn't all this add up to either complete ignorance or inadequate analysis? I am disappointed in this article, which ends up mostly saying nothing.
13
#s 1 and 2:
Sudden Infant Death Syndrome (SIDS) is basically when a baby goes to sleep perhaps offering no medical symptoms (or at most with some nasal congestion) and they don't wake up, and the cause seems medically undeterminable. It used to be called "crib death." It IS mysterious, and its causes can be random. It is heartbreaking.
#3 accidents: would be the other "categorical" cause of death as opposed to death from medical causes that would be specifically diagnosed. It would include automobile accidents, drowning, falling, and others not mentioned here that have no medical cause, but are the result of physical trauma that was accidental in nature. It would not include physical abuse such as shaking a baby. Accidents probably include death by heat exhaustion when a baby is left in the car... but that seems to actually be "not always accidental." Tragedy on tragedy.
Sudden Infant Death Syndrome (SIDS) is basically when a baby goes to sleep perhaps offering no medical symptoms (or at most with some nasal congestion) and they don't wake up, and the cause seems medically undeterminable. It used to be called "crib death." It IS mysterious, and its causes can be random. It is heartbreaking.
#3 accidents: would be the other "categorical" cause of death as opposed to death from medical causes that would be specifically diagnosed. It would include automobile accidents, drowning, falling, and others not mentioned here that have no medical cause, but are the result of physical trauma that was accidental in nature. It would not include physical abuse such as shaking a baby. Accidents probably include death by heat exhaustion when a baby is left in the car... but that seems to actually be "not always accidental." Tragedy on tragedy.
6
Did they ever figure put why, with equal prenatal care that the black military mothers had twice the preterm births?
16
Some time ago I read an extensive article showing that countries have very different CRITERIA for counting infant deaths. I cannot recall the details except that Canada and US are much more rigorous in counting infant deaths, beginning at birth. Some countries do not count those deaths for as much as one year after birth. So, the criteria should also be looked at and adjusted for. The article said that we in the US are not doing as poorly as un-adjusted statistics would indicate.
7
Here is an excellent article by the CDC on infant mortality statistics. It shows that counting mortality is a complex task. Thus, people with agendas can make statements that are "true" but not the whole story. This looks to be the whole story.
http://www.cdc.gov/nchs/products/databriefs/db23.htm
http://www.cdc.gov/nchs/products/databriefs/db23.htm
7
I had my first child in America. My labor was an exhausting 30 hours and I hadn't been all that successful in nursing when out 48 hours were up and we had to leave the hospital. The lactation consultant wasn't that helpful.
The first well baby visit was a week later. My baby was underweight because I hadn't gotten the hang of nursing, wasn't producing enough milk, but didn't recognize it. How the stress levels soared!
I had my second child in England. The day after I left the hospital, I got a visit at home from the family practitioner. Until I was completely recovered and my baby clearly thriving, I got regular visits from nurses or health visitors. No stress.
The NHS ran free well baby clinics once a month, which were encouraged and also a place to connect with resources, like free formula or food assistance, parenting help, mental health help, mother-baby groups, etc, etc.
In America, exhausted new mothers have to navigate a complex medical system to get help they may not even know they need. In England, they make sure you have a GP and a scheduled next day visit before they discharge you from the hospital.
The first well baby visit was a week later. My baby was underweight because I hadn't gotten the hang of nursing, wasn't producing enough milk, but didn't recognize it. How the stress levels soared!
I had my second child in England. The day after I left the hospital, I got a visit at home from the family practitioner. Until I was completely recovered and my baby clearly thriving, I got regular visits from nurses or health visitors. No stress.
The NHS ran free well baby clinics once a month, which were encouraged and also a place to connect with resources, like free formula or food assistance, parenting help, mental health help, mother-baby groups, etc, etc.
In America, exhausted new mothers have to navigate a complex medical system to get help they may not even know they need. In England, they make sure you have a GP and a scheduled next day visit before they discharge you from the hospital.
162
I think you have nailed the kind of services we would need to help mothers and babies - and lower the postneonatal death rate. And It has the potential for starting all children off on a better basis
23
You were also a second time mother by then. Of course, no stress!
There are support groups here in the USA as well. Usually mothers are given brochures at the time of discharge. La Leche League of Texas, Texas Tens Steps, etc. etc.
First visit to the pediatricians are typically made 48 hrs after discharge, not after a week.
There are support groups here in the USA as well. Usually mothers are given brochures at the time of discharge. La Leche League of Texas, Texas Tens Steps, etc. etc.
First visit to the pediatricians are typically made 48 hrs after discharge, not after a week.
5
My sister was born in Brooklyn Hospital, my mother's first child, in 1951. My mother stayed in the hospital for about a week, as was customary at the time. About a week after returning home with her baby, the visiting nurse from Brooklyn Hospital dropped by shortly after my mother had put the baby down for a nap. After talking to my mother for a few minutes, they went into the bedroom to check on my sister. She wasn't breathing and had turned blue. The nurse believed her lungs had collapsed and picked her up, which set her to screaming. They rushed her to the hospital where she stayed for a week or two, but they couldn't find anything wrong with her.
Family tradition holds that a guardian angel guided the nurse at just the right moment in time, or my sister would have been a SIDS baby.
It's ironic that something that was standard policy in the 1950's and 1960's is only recently being revised as a best practice. [I was seven when the visiting nurse cam to check on Mom and my baby brother in 1961.] If you think about it, the visiting nurse can evaluate the mother's physical and mental health, and answer her questions and reassure her. She can also weigh the baby and give the baby a mini physical. She can also evaluate if the baby has an appropriate crib to sleep in, if the house or apartment is appropriately heated and cooled and clean. And help find resources if the family needs help.
Family tradition holds that a guardian angel guided the nurse at just the right moment in time, or my sister would have been a SIDS baby.
It's ironic that something that was standard policy in the 1950's and 1960's is only recently being revised as a best practice. [I was seven when the visiting nurse cam to check on Mom and my baby brother in 1961.] If you think about it, the visiting nurse can evaluate the mother's physical and mental health, and answer her questions and reassure her. She can also weigh the baby and give the baby a mini physical. She can also evaluate if the baby has an appropriate crib to sleep in, if the house or apartment is appropriately heated and cooled and clean. And help find resources if the family needs help.
14
Anti-abortion zealots chortle at their success in passing legislation blocking access to abortion in Republican-controlled states. Poor women who don't have the financial and emotional resources to take good care of unwanted children are affected much more severely by those laws. Maybe forcing women to give birth against their will isn't as nifty an idea as the antichoicers believe. They should ask themselves: Is punishing women for having sex worth having a high infant mortality rate in our country?
Oh, that's right. Actual babies that have been born don't count. Just fetuses.
Oh, that's right. Actual babies that have been born don't count. Just fetuses.
74
The clinics the forced birth movement often succeed in closing are also those that offer prenatal care to women living in poverty.
30
Perhaps the increase in post natal care, assistance and recovery for mother plays into this. Healthier, more rested moms, assistance with the care of a newborn, parental leave, all contribute to a 1st year with a fully rested parent who is able to feed and nurture and not have to also maintain a work schedule and manage a home might contribute and change in these deaths.
19
It's all connected to having a fragmented, multi-payer, for-profit, insurance-company-driven healthcare system.
42
Why isn't the crime as a cause of death a consideration? I was at a nursing conference where a nurse from KY presented data showing infant death as a result of crime to be one of the top 5 reasons for postnatal death before 1 yr.
I am however glad to read that the US fares as well as 'Utopian Childbirth' countries such as Norway when it comes to neonatal mortality statistics.
I am however glad to read that the US fares as well as 'Utopian Childbirth' countries such as Norway when it comes to neonatal mortality statistics.
7
Why does the article not mention the fact that while the United States has a decent breastfeeding initiation rate, around 75%, by the end of the first week it is below 50%, and by the end of the first month it is below 30%? Human milk matters a great deal in infant mortality and morbidity, and the act of feeding at the breast matters when it comes to maternal wellbeing. We as a nation need to put money into breastfeeding education and support in the prenatal and postpartum periods, as well as supporting the licensure of the International Board Certified Lactation Consultant (IBCLC), the gold standard in lactation care. Several states, including NJ, have IBCLC licensing bills before the state government right now.
38
It's worth pointing out that many of the countries that do better than the U.S. in terms of infant mortality have significantly lower rates of breastfeeding than the U.S. (e.g. France and the U.K.). That's not to say that breastfeeding isn't a good thing, but it's unlikely to explain the difference in mortality.
22
In developed countries with good water supplies, human milk has no relevance to infant mortality. The only exception to that is in very premature infants, who have a lower incidence of NEC (necrotizing enterocolitis) if fed on breastmilk rather than formula.
If we were talking about a developing nation I would agree with you, because obviously tainted or inadequate public water supplies make formula dangerous. And heck, if we were just talking about Flint, Michigan, you might also have a point, although AFAIK lead doesn't kill healthy babies in their first year (it "just" causes brain damage).
I'm guessing that if you are remembering some study you read somewhere that you feel supports what you wrote, that study was about a developing nation or nations. But this article is only about infant mortality in America, where most public water supplies are just fine and on top of that, ready-to-drink formula (no water needed) is available everywhere.
If we were talking about a developing nation I would agree with you, because obviously tainted or inadequate public water supplies make formula dangerous. And heck, if we were just talking about Flint, Michigan, you might also have a point, although AFAIK lead doesn't kill healthy babies in their first year (it "just" causes brain damage).
I'm guessing that if you are remembering some study you read somewhere that you feel supports what you wrote, that study was about a developing nation or nations. But this article is only about infant mortality in America, where most public water supplies are just fine and on top of that, ready-to-drink formula (no water needed) is available everywhere.
11
Even in developed nations, there is increased morbidity and mortality due to not breastfeeding. The assertion that only countries with poor access to clean water have a problem assumes that the only issue is contamination. While that's an issue--and, I might add, quite a lot of America counts as a "poor country" with no access to clean, free water; read about Flint lately?--and all the other cities that turn out to have comparable issues?--there are other ineradicable differences between breastmilk and formula. They are well-documented and the burden of proof does not lie with breastfeeding advocates to demonstrate that human milk fights infection (at any age), promotes optimal growth and gut health, etc., but with anyone who wants to argue that the biologically normal feeding method can safely be replaced.
3
At the risk of being politically incorrect it would appear from the US child poverty statistics (40% school kids get free lunch and child poverty rate twice that of the average US household rate) that we are sourcing our child production and rearing to the poor contributing greatly to deficiencies in infant mortality rates and stagnant school performance. My state (Virginia) is one of the stingiest when rated by preschool and school subsidies for poor kids. Frankly so much of an individual's brain and subsequent life is determined by his or her environment by the age of 3 that even these programs at their best cannot rectify future deficits- they are hardwired by that age. As a society we need to consider tax and social policies that encourage better early childhood development with subsidized quality daycare, longer parental leaves (for both parents), deep tax cuts for parents, as well as school based subsidized Planned Parenthood type birth control availability to allow poor teenagers to delay pregnancy until they can parent better.
48
I totally agree with your comments, wish more people did. Then perhaps something could be done to address these issues.
1
The child's prenatal brain development is included in that "before age 3" statistic.
1
Or delay pregnancy forever.
4
Emmanuel Todd attracted attention in 1976 when he predicted the fall of the Soviet Union, based on sevreral indicator, the most important of them was the increasing infant mortality rates: (The Final Fall: an Essay on the Disintegration of the Soviet Sphere). His other book about the deccine of U.S. was translated to English, around 2007, and can be checked. (It is good, as his views were definittely not translated and printed in the U.S.S.R. in time.)
8
How to sustain life in these United States? Don't be poor. The more stratified our society becomes the more working poor and their children die. It's alright. We've earned our riches. It isn't as if American prosperity was founded upon free labor. Ownership has no need for such middling classes as Americans when we can exploit the labor of developing states for corporate dividends. How else are our future job creators supposed to afford their private education?
9
The entire economy of the Southern states in the US was sustained by free imported labor, AKA slaves.
The Civil war was fought and the slaves were freed.
The South has resented the North ever since, over 100 years later, and have been convinced by the GOP to vote against their own interests. It is mind boggling.
The Civil war was fought and the slaves were freed.
The South has resented the North ever since, over 100 years later, and have been convinced by the GOP to vote against their own interests. It is mind boggling.
3
Breastfeeding is, believe it or not, a key factor in infant health. It is not a frill for those who can afford it. It makes a real difference--or rather, widespread formula feeding is a genuine cause of infant illness and death. It always astonishes me that medical practitioners and writers recognize the role of the mother's body in nourishing the baby before birth, but assume that the mother's body becomes irrelevant to infant health after delivery. That's like getting a good architect to design the house and then handing the construction over to a team that specializes in cheap ready-built structures and hasn't read the blueprints carefully. Why would you expect the same results that we see in countries where the architect is also the construction firm?
19
Nope, it's actually not. In developing nations with inadequate or tainted water supplies, formula is obviously potentially dangerous. Not the case in a developed nation (with the obvious exception of Flint, Michigan).
6
To call Flint the only exception is an error; it has turned out in recent months that there are many cities in the US with comparable water problems. As I mentioned already elsewhere, breastfeeding contributes significantly to infant health in other ways than avoidance of contaminated water.
5
Though SIDS disproportionately affects poor women, a closer inspection of the associated environmental factors is necessary. Doctors and other health providers should inquire about the mother's particular exposures, preferably even prior to becoming pregnant. Exposure to elevated levels of outdoor pollutants and indoor pollutants should be routine in prenatal and postnatal care. If the mother is cooking on an old or malfunctioning gas stove and warming the home with the like (gas, oil, kerosene heater, etc.), her exposure offspring is at higher risk of SIDS. Proximity to heavy traffic and time spent in heavy traffic should also be considered. Many SIDS risk factors have overlapping effects of exposure to carbon monoxide (CO) and elevated carbon dioxide (CO2) (i.e., smoking). Overheating, another risk factor, is exacerbated by the presence of higher levels of CO and CO2, and reducing CO2 buildup is the premise of the
Back to Sleep Campaign.
Consider the following:
http://www.ncbi.nlm.nih.gov/pubmed/22408586
http://www.ncbi.nlm.nih.gov/pubmed/27110690
Back to Sleep Campaign.
Consider the following:
http://www.ncbi.nlm.nih.gov/pubmed/22408586
http://www.ncbi.nlm.nih.gov/pubmed/27110690
6
I wonder if breast feeding or the lack of it is related to these results.
10
Nope. Full-term babies do equally well on formula and on breastmilk. The only babies who don't are extreme preemies, who have a lower rate of NEC (necrotizing enterocolitis) when fed on breastmilk.
5
Nope. It's about economic justice, not magic boobs. Babies who are breastfed for the first year have mothers who can afford to either be stay-at-home moms or pay for high-quality child care and pump breast milk at work.
As this article points out, the babies of women who can afford those things have lower rates of SIDS. The babies of women who get up at 5AM to take the bus to their office-cleaning job, in contrast, get warehoused in low-quality daycare and die in disproportionate numbers.
As this article points out, the babies of women who can afford those things have lower rates of SIDS. The babies of women who get up at 5AM to take the bus to their office-cleaning job, in contrast, get warehoused in low-quality daycare and die in disproportionate numbers.
12
If we're talking about why the US has poor infant health outcomes, it really doesn't make sense to toss aside the fact that the US has higher formula use than many other developed countries. Studies comparing the health of babies on formula vs. breastmilk tend to be compromised by inconsistent or flawed or fuzzy definitions of breastfeeding. However, there are plenty of strong, well-conducted studies that do show a difference, including in SIDS rates. For example: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/
3
Make America Great Again. Support expanding Medicare to all
17
There's one obvious difference between the US and Europe that jumped at me when I read this, and I think it could help explain the numbers - the US does not provide adequate paid maternity leave or affordable daycare. The little that it does provide is on the order of weeks, if that - not months or years. What happens to American babies in the critical 1-12 months range when they are dying at such rates? Their mothers return to work! And where do the babies go? Mothers are forced to scrap together some kind of alternative child care, which is especially difficult for poor mothers who can't afford the ridiculous rates of daycare centers. Note how the causes of death aren't medical - they're all various kinds of accidents. Overwhelmed caregivers in crammed daycares of various quality, incapable or elderly relatives, sketchy boyfriends, etc. etc. are caring for these babies, instead of the mothers. No wonder they're at a higher risk of dying! How is nobody bringing this up? This is the biggest way in which the US fails its children and families - maternity leave and child care. It's our biggest embarrassment and sin. But nobody wants to talk about it, because chipping in for the common good is not in the spirit of American selfishness. As long as "social" is equated with "communist" and children are viewed as a burden instead of the country's future, we'll have this disgraceful reputation, and our babies will keep dying.
205
More correctly we are much more diverse so our culture won't support that massive expenditure. The correct (for our culture) answer is those that can't afford to have and raise children properly refrain from having them.
2
That's an outright vulgar suggestion. My parents immigrated to this country from Germany and had five children. In the early sixties my father could support the family by working two jobs - one union job with secure benefits and one job with income completely under the table. Once we kids were in school Mom worked part time as waitress. Given the cost of housing alone today and the fact that wages in those jobs have barely moved, a family in the same circumstances could not afford to have Mom at home. And just try sending five kids to college on those salaries without each one graduating with a boatload of debt. Even back then getting all of us through college and a couple of professional degrees on their wages was a tall order but doable. Forget about that today. We don't take care of one another very well in this country. The primary reason why Bernie Sanders has garnered so much support.
7
"Correct for our culture?" What an incredibly warped idea! So the answer is to make abortion only available to rich women who can afford to travel to a clinic in another state, or another country, as they used to have to do, and deny birth control to women who want it?
Making birth control easily available is the answer. Why are so many people against it? Abortions would be infrequent and rare if birth control was routinely available, especially to poor women.
Making birth control easily available is the answer. Why are so many people against it? Abortions would be infrequent and rare if birth control was routinely available, especially to poor women.
4
"Deaths in the postneonatal period are due, in large part, to sudden infant death syndrome (SIDS), sudden death and accidents. Moreover, they seem to occur disproportionately in poor women."
So the answer is some difference in post neonatal care but no-one has done the analysis on what it is? Or is Carroll "saving" this information for a second article?
So the answer is some difference in post neonatal care but no-one has done the analysis on what it is? Or is Carroll "saving" this information for a second article?
1
I had my first child in Norway which is at the opposite end of the infant mortality spectrum. Then hd two more babies here in LA. One key difference to me is the over-medicalization of pregnancy and infancy here. I felt like doctors are understandably so afraid of being sued that they opt for most medical rather than best practice. In Norway, our local "health station" staffed by midwifed handled all normal pregnancies and infant/baby check ups. The care was very comprehensive yet basic compared to here. I felt like this caring and reasonable approach was the key to their success rate without overspending to deliver it.
7
you didn't read the article closely enough. the data indicates that the problem has nothing to do with pregnancy/prenatal care, and recommends *increased* medicalization of infant care.
11
*You* are not aware that Norway and other countries have regular mom/baby checkups by RN type personnel (not medical doctors) throughout the first year or two of a baby's life. Is baby growing, sleeping, hearing,... Outside the US, people don't necessarily go to the pediatrician with their children as a matter of course. They go to their family's primary doctor for everything urgent (General Practitioner is a thing), and for their youngest, they get regular invites for the mom-baby check-ups.
6
We have a powerful medical establishment that resents having nurse practitioners, midwifes or any other non MDs cutting into their business.
2
Unfortunately this article seems to find that research has shown that more medical care during pregnancy will not change outcomes after birth after one month. That is the mystery which needs to be solved for all races.
10
Great article.
But I think there is one aspect of the postnatal life, of both the mother and the baby, that is not considered: The United States are the only western country (and one of the 5 countries all over the world) that does not have, by low, any maternity leave.
Each and every European country guarantees, by low, 5mo to 1yr of maternity/paternity leave.
This might play an important role in postnatal sudden death and accidents.
But I think there is one aspect of the postnatal life, of both the mother and the baby, that is not considered: The United States are the only western country (and one of the 5 countries all over the world) that does not have, by low, any maternity leave.
Each and every European country guarantees, by low, 5mo to 1yr of maternity/paternity leave.
This might play an important role in postnatal sudden death and accidents.
110
Surprised that they haven't tried to factor in differences in family leave policies. I have to imagine that parents who are able to stay home for the first 3-6 months (or first year!) take better care of their young infants than parents who have to go back to work nearly immediately after birth. 12 weeks of unpaid leave is not supportive of poor or even middle class families that depend on any and all income to survive.
113
Certain groups of people do everything they can to meddle prior to conception and prior to birth and immediately lose interest and ignore any support after birth.
97
Exactly. Thank you!
8
Great article, such an important public health issue to shine a spotlight on. I'd be really interested to see a study linking perinatal death rates with weeks of maternity leave allowed/taken. But certainly poor housing and neighborhood conditions must also play a role given the stark effect on low-income families.
10
What about care prior to being pregnant? I don't see that listed or mentioned here as a possible cause of differences in infant mortality.
20
Well, they did refer to maternal health, not just health during pregnancy. But you make an interesting & valid point. It would be interesting to know if women with health problems such as diabetes, epilepsy, hypertension, obesity, etc. were part of the study or if they were screened out.
4
Too many medical interventions during pregnancy, labor and then vaccines at less than 24 hours of life, not too mention the unsafe vaccine schedule that follows...SIDS is just another vaccine side effect that results in death...stop over treating women and babies and our numbers will rise. You can turn it and twisted but it's simple, nature knows best!
2
That must be why the US infant mortality rate for 1-12 month olds was 8.7/1000 in 1950, but it nosedived to 2.1/1000 in 2010. They had no epidurals and very few c-sections then, as well as hardly any vaccines, although they did have modern hygiene and excellent antibiotics. Yet somehow babies were more than 400% more likely to die between age 1 and 12 months.
And that also must be why the US neonatal mortality rate (0-28 days) was 20.5/1000 in 1950--think about that: more than 2 out of every 100 babies, 2%!!!--but it has plummeted to 4/1000 today. With the rise of epidurals, c-sections and vaccines at birth, we've seen a more than five-fold drop in neonatal mortality. Interesting, no?
This is a mathematical way of saying that you're dead wrong.
And that also must be why the US neonatal mortality rate (0-28 days) was 20.5/1000 in 1950--think about that: more than 2 out of every 100 babies, 2%!!!--but it has plummeted to 4/1000 today. With the rise of epidurals, c-sections and vaccines at birth, we've seen a more than five-fold drop in neonatal mortality. Interesting, no?
This is a mathematical way of saying that you're dead wrong.
48
Sure, feel free to return to nature. Infant mortality of 20%. Maternal mortality at 5-10%. No herd immunity to anything, so epidemics would be rampant. A good way to rid our species of anti-vaxxers and other special cases for Darwinism.
Seriously, during my medical training 40 years ago, it was pretty apparent that the young women who resisted prenatal advice and smoked and drank and did all manner of recreational drugs were the ones with increased fetal wastage and poor neonatal outcomes.
Seriously, during my medical training 40 years ago, it was pretty apparent that the young women who resisted prenatal advice and smoked and drank and did all manner of recreational drugs were the ones with increased fetal wastage and poor neonatal outcomes.
46
European countries give as many or more vaccines as we do. It has absolutely nothing to do with vaccines.
47
There's a darker side to this; poor women without access to abortion may not be as vigilant when it comes to taking the steps to prevent SIDS- especially when the infant is a real challenge to provide for.
16
There are no "Steps to prevent SIDS" per se... It is, by definition, Sudden Infant Death Syndrome, in which babies die for no apparent reason. Statistically they are more commonly males that are about 6 months old during the winter months. This was the case when my son had apnea. If I'd not been woken by my daughter (I thought it quite a nuisance at the time), and if I'd not had the habit of listening to my babies breathe in their sleep, I'd have lost my son.
It is unfair to mother-blame for SIDS.
While I must admit that neglect would certainly contribute to the loss of a child, it should not be assumed that a parent has been neglectful when SIDS occurs. Heart monitors would help alert for problems while infants sleep. Widespread use of heart monitors could theoretically help reduce SIDS deaths.
It is unfair to mother-blame for SIDS.
While I must admit that neglect would certainly contribute to the loss of a child, it should not be assumed that a parent has been neglectful when SIDS occurs. Heart monitors would help alert for problems while infants sleep. Widespread use of heart monitors could theoretically help reduce SIDS deaths.
6
Widespread use of human milk for feeding would also prevent SIDS in many cases. Breastfed babies die at half the rate of formula fed babies in the first year.
7
@ Margaret: SIDS occurs significantly more frequently in babies which are placed to sleep on their tummies rather than their backs, also in babies exposed to tobacco smoke in the home. So, yes, there are things which can be done to lower the risk.
13
What about drug use by the mothers? I have a good friend who works in a hospital in a somewhat rural area. 75% of the mothers who come in for birth have drugs in their system. I was astounded. All of them are tested.
20
Anita: The vast majority of drug screens in the hospital shows that a lot of people smoke marijuana. Other drugs are a very small fraction of the total. It's women who are pregnant smoking cigarettes that makes me cringe.
7
Providing heart monitors for the first year would go a long way. A simple audible alarm can help revive a child that is experiencing apnea, whose heart hasn't beat for a specific time, say 20 seconds AND it alerts the caregiver that the child needs attention and possible immediate medical intervention. I havea son who experienced apnea as an infant, related to the flu, and he is now 27. He was "almost" a SIDS death. There is a lot of talk about position in which a baby sleeps and its relation to SIDS, but I don't think that information is trustworthy. When my children were infants we were supposed to put them on their tummy or on their sides for sleeping, so everyone did. So, of course more SIDS deaths were related to sleeping on their tummy or their sides, since that was the prevailing habit. What is linked to SIDS is a baby SLEEPING. Thus a heart monitor to alert when an infant's heart doesn't beat might eliminate SIDS to a large degree.
4
We used a Snuza alarm. It doesn't take the place of a heart monitor, and it doesn't work if the baby is moving (in a bouncer, a carseat in a moving car, etc.), but it tells you if the baby's belly stops moving--in other words, if the baby stops breathing. There were a few annoying false alarms when the monitor slipped out of position, but not many, and I couldn't care less about that since one night it went off and my baby not only wasn't breathing but took several seconds to start breathing again after I frantically picked him up.
3
A heart monitor would be a terrible idea. If you are waiting for the heart rate to go to zero, you now already have a dead child who you are now trying to revive. It isn't that the child suddenly stops breathing and then instantaneously the heart rate goes to zero. Typically, with lack of breathing in a child, oxygen levels start to drop, and the heart rate may start going down, but not necessarily to zero. Typically then over time the perfusion of blood to the rest of the body will then slow down, and this includes the brain and all the other vital organs. The child's heart will likely still be beating, and may be detectable electrically on a monitor, but it is weak and not pushing blood to the whole body (no pulse would be felt) and the child is becoming brain damaged and damaging, perhaps irreversibly, other vital organs. This process typically occurs over many minutes, at times, even longer. This is why in the hospital, we don't only watch heart monitors on the sickest children, because in healthy children the heart rhythm is the last thing to go. We pay much more attention to oxygen level and perfusion (pulses). In fact, the guidelines are to start CPR still with a beat seen on a monitor, if no pulse is felt, even for adults.
There are commercial apnea alarms out there. However, they do have many false alarms, which can cause alarm fatigue (ie the boy who cried wolf) and just plain fatigue (ie so exhausted by false alarms you sleep through the real ones).
There are commercial apnea alarms out there. However, they do have many false alarms, which can cause alarm fatigue (ie the boy who cried wolf) and just plain fatigue (ie so exhausted by false alarms you sleep through the real ones).
1
Are you really a doctor? I was not indicating a heartbeat of "zero" (beats per minute?) but setting it at 20 seconds without a heartbeat (or 23 seconds if it keeps tripping the monitor, as it did in my son's case).
After my son had apnea the doctors put him on a heart monitor for a month. They informed me that often the alarm itself would often be enough stimulus for the baby's heart to resume, and (during that month) while the alarm would occasionally beep once or twice, it did then stop beeping and "by the time I got to his crib" he was breathing normally.
This was the practice 27 years ago. I'm sure technology will have improved methods for infant monitoring, and the price of that technology should have also dropped accordingly -- making it more practical to be used more widely. If you are a doctor, I think you are not a pediatrician; nor are you a parent who has dealt with apnea.
After my son had apnea the doctors put him on a heart monitor for a month. They informed me that often the alarm itself would often be enough stimulus for the baby's heart to resume, and (during that month) while the alarm would occasionally beep once or twice, it did then stop beeping and "by the time I got to his crib" he was breathing normally.
This was the practice 27 years ago. I'm sure technology will have improved methods for infant monitoring, and the price of that technology should have also dropped accordingly -- making it more practical to be used more widely. If you are a doctor, I think you are not a pediatrician; nor are you a parent who has dealt with apnea.
3
USA is number one in God/religion. But US is lower than other countries with lower GDP in compassion for those who are not in our family/church/group. As others get further away from my home group, the less I am willing to share with them anything of mine. The more wealth I have the better I am able to control exactly what I choose to share, and with whom I choose to share it. The rich and friends get medical they need. Many of the rest of us loose most if not all of our savings trying to get medical care the wealthy take for granted.
31
A huge omission in prenatal care-- that disproportionately affects black women-- is that US doctors do not emphasize prenatal nutrition. When you live in a food desert, it's very hard to get the right diet, and a crap diet plus a prenatal vitamin pill is NOT the answer.
Dr Robert Bradley, founder of the Bradley Method, noticed that in well nourished women eating 80-100 grams of protein a day from a wide variety of nutritious whole foods, eclampsia (a prime risk of childbirth) simply did not occur.
SIDS rises with smoking and not breastfeeding-- two 'health care' factors that can be addressed. Maternal leave can be extended to encourage breastfeeding.
Visiting nurses are an enormous value-add re breastfeeding, parenting practices, empathy, attachment, and child development.
If we want to build healthier babies we need to begin with excellent nutrition including extended breastfeeding!
Dr Robert Bradley, founder of the Bradley Method, noticed that in well nourished women eating 80-100 grams of protein a day from a wide variety of nutritious whole foods, eclampsia (a prime risk of childbirth) simply did not occur.
SIDS rises with smoking and not breastfeeding-- two 'health care' factors that can be addressed. Maternal leave can be extended to encourage breastfeeding.
Visiting nurses are an enormous value-add re breastfeeding, parenting practices, empathy, attachment, and child development.
If we want to build healthier babies we need to begin with excellent nutrition including extended breastfeeding!
30
I completely agree that prenatal nutrition is important and that the best standards are hard for moms in some neighborhoods to meet. That said, Bradley is wrong. His method has no evidentiary support--studies have failed to show the effect he claims. On a personal note, I consumed that quantity of protein during my pregnancy, from very high quality sources (wild salmon, organic yogurt etc.), and I still got preeclampsia.
8
Norway and Finland, which have better outcomes, have lower population density than US. True, US is big, but much of its "big" part is nearly uninhibited, and the areas where people actually live have high densities.
1
Dr Bradley found that some patients indeed got pre-eclampsia but none progressed to eclampsia.
1
Before we go into the whole white/black divide: even if we take US "white" infant mortality rate at 5, it will be only marginally lower than the mortality in the report, and twice as high as in Europe. At the same time, it will be at about the same level as Canada's, which means there's no obvious way to improve it.
Which begs for a question: why is it still so much higher than in continental Europe? Different doctor practices? Different gene pool? Different parenting techniques? For me, the most obvious reason is the willingness of doctors to be on call 24/7: if in Europe you routinely take your young kid to a hospital if he has high fever, then in US it is considered a waste of resources.
Which begs for a question: why is it still so much higher than in continental Europe? Different doctor practices? Different gene pool? Different parenting techniques? For me, the most obvious reason is the willingness of doctors to be on call 24/7: if in Europe you routinely take your young kid to a hospital if he has high fever, then in US it is considered a waste of resources.
9
The USA and Canada are much larger than the other countries having better prenatal care. I guess having socialized medicine alone does not account for the difference.
3
Diet and exercise habits?
1
You need to re-read. These are percentages, not overall. This also does not appear to be related to quality or kind of health care, but is multi-factorial. Poverty and life-style are highly correlated in these and other studies: http://jama.jamanetwork.com/article.aspx?articleid=2513561.
The reality is that despair and poverty have a detrimental affect on life-span. Unless there are serious policy changes in this country, the numbers will continue to deteriorate.
The reality is that despair and poverty have a detrimental affect on life-span. Unless there are serious policy changes in this country, the numbers will continue to deteriorate.
4
An absolutely critical piece of information is lacking in these studies: What about the placentas? The placenta reflects the pregnancy's history and may show pathology even after an apparently normal pregnancy. A retrospective comparison of any placenta examinations from the two groups is in order.
8
If a placenta study still shows no significant differences I would recommend a research design that attempts to look systematically at a few key demographic and associated life style behaviors, e.g., exposure to multiple, possibly violent partners, parents' birthplace. I read anecdotally about lots of baby shaking in Boston Globe by poor caretakers. I would investigate whether this and other demographic, high-poverty environments, and correlating parenting patterns could be a factor.
6
Was there no breakdown between SIDS, "sudden death" (whatever that is) and accidents in the lit. that this author reviewed? This would get to your questions about violent partners, living situation, etc. And obviously, it also addresses the consistent report of the higher % of disadvantaged/poor mothers of these children.
1
Thus, we have a huge oversupply of less-trainable social dependents while your young energetic types have fewer offspring.