Infant Mortality: A National Disgrace : Each Child Has a Right to Adequate Prenatal Care

Despite the reputation the United States enjoys as a country that loves its babies, we may not love them enough. More than 40,000 American babies die every year, most of them needlessly. Where once our infant-mortality ranking was a respectable sixth among the 20 comparable industrialized nations, we have slipped almost to last place. These statistics are a national disgrace in light of the quality of medical care we could be offering.

These babies are not dying of incurable diseases. They are dying of poverty, ignorance and neglect. They are dying because they are born too small, to mothers too poor to afford the prenatal care that should be every child’s birthright.

Although we have made great progress in fighting disease and prolonging the lives of the sick, we have shamefully overlooked the issue of maintaining life at its beginning. Imagine these fragile babies, small enough to fit in the palm of your hand, fighting for their lives. These newborns are 40 times more likely to die in their first year, and three times more likely to be permanently impaired than are normal-weight babies. No one should come into this world so disadvantaged from the first moment of life.

The reasons for low-birth-weight babies are many: Inadequate nutrition, substance abuse, teen-age pregnancy and medical conditions such as diabetes have all compounded the problem. Although the primary cause of low birth weight is often unclear, there is no doubt that professional medical intervention during pregnancy can help prevent the death and disabilitiesof these babies.

Despite the proven effectiveness of early and continuous prenatal care, almost one-third of all pregnant women do not receive adequate care. The cost of our neglect is high. In cold, harsh terms, each year it costs us about $1.5 billion to pay the hospital bills for low-birth-weight babies. Instead of spending billions of dollars trying to keep them alive with high-technology medical care, we could be preventing the tragedy and suffering by spending a fraction of that amount on prenatal services. For every $1 spent on this preventive care, we could save $3 in other health-care costs. Thus, prenatal care is an investment that can benefit everyone.

Congress turned the corner in the current crisis in 1987 when it established the National Commission to Prevent Infant Mortality. The commission’s mandate was to design a comprehensive national strategy for reducing the incidence of infant mortality and sickness in the United States. As a member of the commission, I am proud of our efforts to make the health of mothers and children a national priority.

One of the commission’s most important findings was that our maternal and child health policy is plagued by a glaring irony: The United States has the most sophisticated medical care in the world, yet, of all the industrialized countries, we offer the most inequitable access to our services. Millions of pregnant women and children cannot take advantage of our highly advanced prenatal and pediatric care. These women must have access to information and services if we are to begin to eliminate the inexcusable scourge of infant mortality.

In recent years, Rep. Henry Waxman (D-Los Angeles) and I have initiated legislation to help eliminate the financial barriers that poor and near-poor pregnant women must overcome in order to receive health care. As a result of these new laws, more poor women and children will have access to care than ever before. But there is still more that can be done, and we will continue to advocate further expansion of coverage for pregnant women and children.

A mere expansion of Medicaid coverage, however, will not suffice. The commission also has identified several complementary measures that will improve access to prenatal and pediatric services. Legislation introduced by the congressional members of the commission recently establishes some greatly needed services: a maternal and pediatric health handbook; home-visiting health programs for high-risk pregnant women and new mothers; “one-stop shopping” health-care systems designed to consolidate health and social services for pregnant women and young children, and a toll-free information service to provide basic information and referrals for maternal and child health services.

A child born today already has no choice but to face a host of problems. Poverty, crime, drug use and AIDS are too frequently a part of their lives. When modest action by government can have such a profound effect, we have an obligation to intensify our efforts. In a society as sophisticated and diverse as ours, adequate prenatal care should not be a privilege. No one deserves to be born without a future.