Improving maternal-child health & infant mortality

This video was recently posted to the Bill & Melinda Gates Foundation about the improvements in maternal, newborn and child health in Malawi. Through education and community support, Malawi has greatly reduced the number of deaths in mothers and babies. Improving maternal-child health is one of the World Health Organization Millenium Development Goals.


A recent New York Times article Global Death Rates Drop for Children 5 or Younger describes some of the progress made in this area in more detail.

One thing to note from the article as well as other surveys: The United States has one of the highest infant mortality rates in the developed world! I did however find it interesting that Washington state has one of the lowest rates within the United States – ranked 49th with a 5.1 infant deaths per 1,000 live births – but that would still be around 26-27th in the world rankings, falling far short of countries such as Singapore (2.30 deaths/1000 live births), Sweden (2.76), or Japan (2.80).

So what can we do about this? Among the causes of infant mortality in the United States, a leading cause is prematurity and low birth weight. Many premature babies die. Of the premature babies who survive, despite the advanced care they receive, many face a lifetime of learning and medical problems, including increased risk for hypertension, diabetes, and coronary artery disease. The March of Dimes Prematurity Campaign is working hard to increase awareness and funding to help reduce prematurity and its risks. Through March of Dimes funding, a number of risk factors have been identified, but one of the most interesting – and easy to reduce – factors is c-sections. From the March of Dimes website:

The Relationship Between Cesarean Delivery and Gestational Age Among U.S. Singleton Births, Clinics in Perinatology: This study found that cesarean sections account for nearly all of the increase in U.S. singleton preterm births between 1996 and 2004.

The c-section research suggests that more scrutiny is needed to ensure that cesarean sections are medically indicated. C-sections performed before 39 weeks for the convenience of the mother or the physician do not comply with guidance from the American College of Obstetricians and Gynecologists (ACOG); they may significantly contribute to the growth of premature birth in the United States.

Based on the study’s findings, the March of Dimes has called for hospitals and providers to voluntarily assess c-sections performed before 39 weeks to ensure that professional guidelines are being followed. This message supports the quality improvement initiatives now under way in many hospitals and has the potential to reduce the prematurity rate within those institutions.

In an earlier post, I discussed the success that Swedish Medical Center is having in reducing inductions before 39 weeks. This kind of work is essential if we’re to improve the health of moms and infants in the United States.

Of course, another cause of prematurity is premature labor – something that we at Open Arms are helping mothers to address. By teaching the signs and symptoms of premature labor, doulas are able to help moms to identify premature labor early, before it progresses to a point that is difficult to stop, and to seek help from care providers. This education around premature labor is now a regular part of our prenatal visits and since January has already helped several moms to avoid early births.

But is the infant mortality rate constant, meaning is it distributed evenly in our population? One might think so, but it’s not – African Americans in particular have a shockingly higher infant mortality rate, and overall the non-white rate of infant mortality is higher than that of non-Hispanic whites even when adjusting for socioeconomic, income, and education levels. Why is that?

If the health of a society is measured by its infant mortality rates, then the United States is not a particularly healthy population. Compared to the rest of the industrialized world, the United States is vastly underachieving in this very important area – certainly nothing to be proud of, despite touting its excellent health care. It would benefit us to really understand why this inequity exists and do something about it.

If you want to explore this problem in greater depth, this report Racial Differences in the Relationship Between Infant Mortality and Socioeconomic Status is a good summary of the problem. This report finds that over time, even when factoring in socioeconomic status and income, these differences persist.

There have been many reasons put forth on why these differences exist: health care disparities including prenatal care, cumulative and chronic stress from racism and discrimination, nutritional differences not only currently but in past generations, and behavioral differences.

We at Open Arms are deeply concerned with the question of infant mortality. We believe social factors play a part in the discrepancies in infant mortality as well and are working to reduce them. For example, providing bilingual and bicultural doulas can help reduce communication barriers between care provider and mother to improve health outcomes, and connection to lactation services that fit within a cultural context can promote breastfeeding when before it might have been dropped. Information on health care and healthy parenting and nutrition must be available in a way that can be understood and followed – one way does not fit all communities.

Just in Melinda Gates’ video, volunteers from the community were trained and went back the community to support women and give them the information they needed. When you have support coming from within communities rather than externally, it suddenly works.

If that model can drastically improve maternal-child health in countries such as Malawi, it can work here in the United States. For evidence of this, see some of the research from Chicago HealthConnect One on their community-based doula model, which is the basis for the Open Arms programs.

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