Infant Death Rate Declines by 6% in U.S.

The rate at which babies die before reaching age 1 in the United States dropped further in 1990 than in any year in the last decade, according to statistics to be released Monday by the federal government.

Officials attribute the 6% decline largely to recent advances in the medical care of extremely premature babies. Some said improved access to prenatal care for poor women and a rise in the birth rate among the more affluent may also be playing a part.

However, they said that they see little evidence of improvement in the principal cause of the country’s relatively high rate of infant death--the rate at which babies are born seriously underweight, particularly among poor and black women.

“Even better treatment of these infants born prematurely does not really improve the overall situation,” said Joel Kleinman, director of the division of analysis at the National Center for Health Statistics, which prepared the data.

“The areas where we need progress are in reducing the incidence of prematurity and understanding why women go into preterm labor,” he said. “Until then, we will be fighting around the edges.”

The infant mortality rate often is considered a crucial barometer of a nation’s overall health. Even at the new level, the U. S. rate is worse than that of most other Western and developed countries. In 1988, the latest year international comparison figures were available, the United States ranked 20th among developed nations.

The rate in the United States is especially high among blacks: African-American babies are twice as likely as whites to die by age 1. The 1990 figures analyzed by race and state are unlikely to be available for another 18 months.

“We don’t know whether the (racial) gap has narrowed because of this,” Kleinman said of the decline in the infant death rate.

According to Kleinman, the infant death rate dropped from 9.7 deaths per 1,000 live births in 1989 to 9.1 in 1990. That is the biggest single-year decline since 1980-81, when the rate dropped from 12.6 to 11.9.

About half of that decline appears to be traceable to a drop in deaths from respiratory distress syndrome, a lung condition that afflicts severely premature babies. During the last 18 months, a new treatment for that condition has become widely available.

Kleinman said it is unclear what accounts for the rest of the decline. He said it may be traceable in part to an increase in births concentrated among so-called low-risk women, which would serve as a counterbalance to the higher death rate among the poor.

“It is very good news,” Kleinman said of the numbers. “The decade of the 1980s has generally been one of rather slow decline in infant mortality. This is beyond our expectations, and just above the national health objective for 1990.”

He added: “We still have a long way to go. The most salient thing is reducing the wide racial gap.”

Others were also cautious in interpreting the new data.

Joseph Liu, a policy specialist with the Center on Budget and Policy Priorities in Washington traced part of the drop to improvements during the last few years in poor women’s access to prenatal care under Medicaid.

Since 1989, state Medicaid programs have been required by federal law to pay for prenatal care for all women with incomes up to 133% of the poverty level. Some states have gone beyond that requirement, covering women with incomes up to 185%.

“American medical technology is the best there is,” Liu said. “Unfortunately, we still aren’t doing the low-cost things we could do, like expanding access to prenatal care even more and ensuring better quality prenatal care and family planning.”

“So we might be doing a little better than we have in the past, but we still haven’t caught up with Japan or England or France. The need to improve the status of mothers and infants is still there.”

Christine Layton of the Children’s Defense Fund said three further steps are needed--incentives for physicians to accept Medicaid patients, simplification of the Medicaid application procedure and improved outreach to bring high-risk women into prenatal care.

“Improving technology is an incredibly costly way (of reducing infant deaths),” said Layton. “For every one that dies, 10 more are born with permanently disabling conditions. So even when we’re saving these babies, they may have problems down the road.”

Layton and others warned against concluding that the problem has been licked.

“We’re still (nearly) double the rate of Japan,” said Rae Grad, executive director of the National Commission to Prevent Infant Mortality. “I worry that people will walk away from the issue, saying, ‘Oh, we stopped that one.’ ”