MCMS Physician Winter 2017 - 9

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The Issue of Infant Mortality
In 2014, over 23,000 infants under one died in the
United States. Trends in infant mortality are analyzed at
the local, state and national level. Overall, there appears
to have been a decline in the infant mortality rate (IMR),
but racial disparities continue to exist.
Infant mortality is the term used to describe the
death of a baby before his or her first birthday. The IMR
is the number of infant deaths out of every 1,000 live
births. In addition to being a key indicator to measure
maternal and child health status, IMR has also been
labelled as the most sensitive indicator of overall societal
health.i The factors that affect the health of a community
or population can also impact the infant mortality in
that community.ii Whereas significant improvement
in IMR has transpired in the U.S. since its peak in
1960 (reduction from 26/1000 in 1960 to 10/1000 in
2010), any further lowering of IMR continues to pose
challenges to stakeholders at all levels.iii The Healthy
People 2020 (a national health promotion and disease
prevention initiative) target for IMR is set at 6.0/1000.
This progress attained in IMR reduction over the
past five decades, however, masks the protracted racial
and geographic disparities. IMR for African-American
infants continues to be twice the rate of non-Hispanic
white infants. Furthermore, preterm-related deaths
in black infants occur at a rate three times higher
than white infants. The infant mortality racial gap has
continued to widen between births of black women
compared to births of white women.iv Racial and ethnic
differences in the U.S. infant mortality rate are complex,
and the differences in education, socioeconomic status,
prenatal care usage, and behavioral characteristics fail to
explain the disparities between black infant deaths and
white infant deaths.v
IMR is divided into two main age periods: neonatal
(birth-27 days) and post neonatal (28-364 days). Deaths
in the neonatal period are caused by complications
stemming from preterm births, birth defects, maternal
health conditions, complication in labor and delivery,
and inadequate/inappropriate healthcare at the time of
delivery. Post neonatal deaths are associated with Sudden
Unexpected Infant Deaths (SUID), injury, and infection.
Nationally, approximately 2/3 of all infant deaths occur
in neonatal period while 1/3 occurs in the post neonatal
period.

Main Causes and Associations
The majority of newborns are healthy and thrive
but almost six out of every 1,000 babies that are born
in the United States die during their first year. Most of
these babies die as a result of birth defects, preterm birth
(birth before 37 weeks gestation) and low birth weight,
maternal complications of pregnancy, Sudden Infant

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Death Syndrome (SIDS), and unintentional injuries (e.g.,
suffocation). A major contributor to the decline in IMR in
the U.S. over the past five decades has been the reduction in
neonatal deaths associated with low birth weight, helped by
improving medical technology.vi
While these are the diagnosed causes of infant deaths,
there are more complex social, behavioral, and health risk
factors that contribute to infant mortality and affect birth
outcomes. Interventions aimed at increasing access to early
prenatal care and to address high-risk behaviors (smoking,
teen-age pregnancy, etc.) have had little success in addressing
the ongoing poor pregnancy outcomes in the United States.vii
Researchers have actually postulated that poor birth outcomes
such as high IMR among women of different social classes
and ethnicities indicate deeper disparities than just poor
healthcare and health behaviors.viii
New paradigms are being proposed with focus on the
health of reproductive age women before they become
pregnant.ix Supported by theoretical knowledge and empirical
evidence, programs are now being put into practice that
address pre-conception, life course, and social determinants
of health. A growing body of evidence affirms linkages
between social class and stress and poor birth outcomes,x-xi
linkages between socio-economic status, including education,
income, and occupation, and pre-conception experiences

MCMS PHYSICIAN 9 WINTER 2017

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Table of Contents for the Digital Edition of MCMS Physician Winter 2017

MCMS Physician Winter 2017 - 1
MCMS Physician Winter 2017 - 2
MCMS Physician Winter 2017 - 3
MCMS Physician Winter 2017 - 4
MCMS Physician Winter 2017 - 5
MCMS Physician Winter 2017 - 6
MCMS Physician Winter 2017 - 7
MCMS Physician Winter 2017 - 8
MCMS Physician Winter 2017 - 9
MCMS Physician Winter 2017 - 10
MCMS Physician Winter 2017 - 11
MCMS Physician Winter 2017 - 12
MCMS Physician Winter 2017 - 13
MCMS Physician Winter 2017 - 14
MCMS Physician Winter 2017 - 15
MCMS Physician Winter 2017 - 16
MCMS Physician Winter 2017 - 17
MCMS Physician Winter 2017 - 18
MCMS Physician Winter 2017 - 19
MCMS Physician Winter 2017 - 20
MCMS Physician Winter 2017 - 21
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MCMS Physician Winter 2017 - 24
MCMS Physician Winter 2017 - 25
MCMS Physician Winter 2017 - 26
MCMS Physician Winter 2017 - 27
MCMS Physician Winter 2017 - 28
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MCMS Physician Winter 2017 - 30
MCMS Physician Winter 2017 - 31
MCMS Physician Winter 2017 - 32
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