U.S. Slips Badly in Infant Mortality Fight, Panel Says

TIMES MEDICAL WRITER

Progress in reducing the infant mortality rate in the United States has ground nearly to a halt, a national panel reported Wednesday. And it said the "mortality gap" between black and white babies is the widest it has been since the country began keeping track in 1940.

The National Commission to Prevent Infant Mortality found that the United States has fallen to 20th place among developed countries in the race to cut infant deaths. Japan has leaped from 17th to first place, with only half the U.S. rate of 10.1 deaths per 1,000 live births.

Cities such as Washington, D.C., with a rate of 19.3 deaths per 1,000 live births, and Philadelphia, with a rate of 17.3, have become "infant mortality disaster areas" with rates rivaling those of the Third World, according to the report. Babies born in Jamaica and Costa Rica are more likely to live to see their first birthday than babies born in those cities. (Los Angeles' rate is 10.5 deaths per 1,000 births.)

"These trends provide a strong indicator that infant mortality will worsen in the years ahead, especially as more communities feel the impact of increased poverty among children, drugs and fewer health-care providers serving high-risk families," the commission said.

The discouraging trends in infant mortality are widely attributed to shrinking access for lower-income women to prenatal and pediatric care, as well as the rising numbers of women using drugs and alcohol during pregnancy or carrying infectious diseases.

The Commission to Prevent Infant Mortality, formed by Congress three years ago, called upon the government and private industry to guarantee universal access to early maternity and pediatric care, just as the United States acted in 1965 to guarantee medical care for the elderly through the Medicare program.

The commission also urged the country to "make the health and well-being of mothers and infants a national priority," not simply making services available but aggressively reaching out to make sure they are known and used.

"This is not an area in which we don't know what to do," said former U.S. Sen. Lawton Chiles, the commission chairman, in a telephone interview. "Prenatal care, early developmental care--these things work. And they're cost-effective."

Last year, Congress passed legislation that would have set up demonstration projects to explore innovative ways of encouraging prenatal and pediatric care. But, faced with a tight budget, it opted not to allocate money for the program.

"That was a lesson to us that when push comes to shove, the Congress will go only so far," said Rae Grad, executive director of the commission.

"We still have not been able to get it clearly across . . . that the money we're talking about spending will promote savings," said Chiles. "We're paying for all this now--in increased prisons, welfare payments, dropout numbers and babies having babies."

A nation's infant mortality rate--the rate at which children die in the first year of life--is considered significant not only in itself, but as a sensitive measure of the health and well-being of the population at large.

In the United States, 105 infants die each day. Nearly 39,000 of the 3.8 million babies born each year die by age 1. The U.S. infant death rate of 10.1 per 1,000 live births is worse than that of Ireland, Spain, East Germany and 16 other countries.

In its report to Congress, the commission compiled the latest national, international, state and local figures on infant mortality. It also examined related trends in so-called low birth-weight births--babies born weighing under 5 1/2 pounds.

The commission's findings dramatically illustrate the slowing of progress in combatting infant deaths made in the United States during the 1950s, '60s and '70s, and the growth of what the commission calls "the unconscionable gap" between rates for blacks and whites.

The findings include:

- The rate of decline in the infant mortality rate in the United States slowed from 4.7% a year in the 1970s to 2.7% a year in the 1980s. Since the 1950s, the United States has dropped from sixth to 20th place in the quest to cut the infant death rate.

- The percentage of infants born at low birth weight stalled at 6.8% throughout the 1980s after dropping steadily from 8% to 7% during the 1970s. In 1987, the most recent year for which national figures exist, the rate crept ominously upward to 6.9%.

Low birth weight contributes to infant death and disability. Low birth-weight infants are 40 times more likely to die during the first month of life, and two to three times as likely to be disabled by such conditions as blindness, deafness and mental retardation.

- Black babies are now more than twice as likely as whites to die, and more than three times as likely to be born at less than 3 1/4 pounds. The gap between white and black infant mortality rates has expanded steadily and is now the widest ever recorded.

"The reasons for the large and growing disparity between the health of black and white infants are not entirely understood," the report said. "Researchers cite many factors such as access to preventive health services, economic considerations and unhealthy life styles."

- The incidence of newborns exposed to drugs in the uterus quadrupled between 1985 and 1989, the commission found. The number of babies born to unmarried women in 1987--933,013 infants--was 40% higher than in 1980.

- Between 1980 and 1987, the percentage of women getting late or no prenatal care increased 26% for blacks and 17% for whites. In 1987, more than 74,000 pregnant women received no prenatal care at all. That represented a 50% rise over the 1980 rate.

Nearly 800 U.S. counties have no clinics offering prenatal care. States report that up to 75% of family physicians have stopped delivering babies since 1980. "In sum, the maternity care delivery system is failing those pregnant women most at risk," the report found.

Sen. Bill Bradley (D-N.J.) responded to the report by introducing legislation Wednesday that would require states by 1993 to provide Medicaid coverage for pregnant women and infants in families with an annual income of up to 185% of the poverty level.

The current level is 133%. (California already covers women and children in families with incomes of up to 200% of the poverty level under the state's Medi-Cal program for the poor.)

"It is unacceptable that in America today, infant mortality is higher than in all other industrialized nations," Bradley said. ". . . A country that can put men on the moon and can dream of sending men to Mars can surely find ways to add ounces to the birth weight of newborns."

Infant Mortality Rates

Chart shows infant mortality rates in developed countries, based on 1987 figures, the latest available.

Infant deaths per 1,000 live births.

Japan: 5.0 Sweden: 5.7 Finland: 5.8* Switzerland: 6.8 Canada: 7.3 Ireland: 7.4 Netherlands: 7.6 France: 7.6 Denmark: 8.3 Federal Republic of Germany: 8.3 Norway: 8.4 German Democratic Republic: 8.5 Spain: 8.5** Australia: 8.8* United Kingdom: 9.1 Belgium: 9.7 Italy: 9.8* Austria: 9.9 New Zealand: 10.0 United States: 10.1 Israel: 11.4* Greece: 12.6 * Rate is for 1986. ** Rate is for 1985. Source: United Nations Statistical Office, Population and Vital Statistics Report, April 1989.

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