Year: 2001
Type: article
Abstract: Among industrialized countries, the United States continues to have a dismal record with regard to infant mortality, generally ranking about 22nd (Guyer, Hoyert, Martin, et al. 1999) and below much poorer countries. Most infant deaths can be attributed to infants born at low birth weight (LBW, <2,500 grams), especially those born at very low birth weights (VLBW, <1,500 grams), and to those born with congenital malformations. While, indeed, our infant mortality has decreased dramatically, much of this decline reflects increased survival of smaller and smaller infants, since the incidence of LBW births has not declined. In fact, the rate ofLBW births has recently increased. That of VLBW births has remained virtually constant for 30 years among whites and has increased to almost 3 percent of African American infants (Guyer, Hoyert, Martin, et al. 1999). Thus, most observers agree that making substantial progress in improving our reproductive outcomes requires reducing the rates of these high-risk births. Repeated reviews of the situation have focused on interventions in the prenatal period as part of expanded prenatal care (Preventing Low Birth Weight 1985; Prenatal Care 1988). In response, between 1985 and 1989, Congress expanded eligibility for Medicaid coverage for pregnant women up to 185 percent of the poverty level and also enacted a variety of strategies to improve and hasten enrollment (Gold, Singh, and Frost 1993). As a result, about one-third of U. S. births are covered by Medicaid (Singh, Gold, and Frost 1994). Associated with these changes has been an increase in the early initiation of prenatal care (NCHS 2000). As Dubay and colleagues (Dubay et al. 2001) note in this issue of Health Services Research, the results of studies in the effect of these programmatic changes are mixed for the several reasons that they cite. To address this issue, they have performed a before and after analysis using the national natality files
Source: PubMed Central
Author: M C McCormick
Institution: Harvard University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W191952027