Infant Mortality: The Shared Concern

130 Presentation INFANT MORTALITY: THE SHARED CONCERN MARGARET C HEAGARTY, M.D. Director of Pediatrics Harlem Hospital College of Physicians and Surgeons Columbia University I have been asked to discuss a special problem—namely, that poor infants are more likely than their more affluent contemporaries to die during the first year of their lives. I have to admit that as I began to prepare this paper, I had little, if any, enthusiasm for the task. That is not to say that I don't consider the problem important, indeed critical, to children living in poverty in this nation. As the director of pediatrics in a public general hospital in an urban, poor community, I face daily the reality, of which the rather dry statistic, infant mortality, is but a symbol. My ennui, my boredom with the issue, has more to do with my ever-increasing amount of gray hair, with my middle age. For I am old enough by now to know and to have participated with the regularity of seasons for the past two decades in an endless series of reports and policy statements from such disparate groups as the National Academy of Sciences; federal, state and local governmental commissions ; or child advocacy groups that have cried with alarm about our infant mortality rates. And like many at this conference, I am frequently seduced into giving sermons, usually to the already converted, calling for solutions to the problem. In short, over the past 20 years or so, many of us—professionals, policy makers, journalists, and politicians—have spent considerable time and effort researching, conferring, and writing about the nation's infant mortality rate. Unfortunately, despite all of this spinning of our collective wheels, little seems to me to have been accomplished. I am going to try to give you a highly personal, "once more with feeling" account of what I think about the nation's infant mortality rate and the effects of poverty and racism upon that rate. But I have warned you: I can say little that has not already been said, and probably better. I will be mercifully brief, for I want to address only three things: the implications of the infant mortality rate itself; its more pertinent causes; and finally some thoughts about solutions. Journal of Health Care for the Poor and Underserved, Vol. 1, No. 1, Summer 1990 ___________________________Heagarty_________________________131 First, some statistics. The infant mortality rate is defined as the number of infants per thousand live births who die in the first year of life. Though the national rates have fallen steadily since the turn of the century, the discrepancy between the rates for poor and minority children, as compared with more affluent majority groups, continues to be very wide. In 1986, the national infant mortality rate stood at 10.4 per 1000, but the rate for black infants (18 per 1000) remained as it has for years, almost twice the rate for white infants (8.9 per 1000). In major urban areas of the country—Washington, D.C, Chicago, El Paso, and even Nashville—the mortality rates for black infants range from 22 to 29 per 1000.1 Moreover, in recent years the rate of the decline in the nation's infant mortality rate has decreased. We are no longer making progress on this problem at the rate we were ten or more years ago. In addition, though no significant amounts of data are available yet, there are rumors that in some cities or in specific areas of some cities, the mortality rates may be increasing, perhaps because of the current "crack" epidemic, but more on that later. Implications In many ways, the mortality of the infant mortality rate is less important than what it signifies. Most of these infants die within the first month of life and they die from complications associated with low birthweight. Now, in the past twenty or more years, advances in the technology of medical care for small, immature newborns have been little short of astonishing. Indeed, there is considerable evidence that the decline in infant mortality rates experienced in this country has more to do with this technology than with prevention of the problems causing the low birthweight...