Infant Mortality

1. Infant Mortality Trends, causes, and responses in a changing world Megan Brown Children’s Defense Fund Minnesota

2. “Children who get a healthy start in life are more likely to reach their full potential, with benefits for themselves, their families and society as a whole.” -State of the World’s Mothers Save the Children, 2007

3. Infant Mortality Every day, 28,000 children under 5 die 10 million children annually 40% of those are newborns in their first month 2 million die on the day they are born

4. “Using existing tools and knowledge, we could save more than 6 million of the 10 million children who die every year from easily preventable or treatable causes.”

5. Infant Mortality • Trends • Historical • Geographical • Less Developed Countries • Causes • Responses • More Developed Countries: U.S. • Causes • Responses

6. Historical Trends • Prior to 1900, infant mortality rates of two and three hundred per 1,000 births • Fluctuated sharply • Weather • Harvest • War • Epidemic disease • Anthropologists have found groups that do not name children until they have survived a year. 

7. Historical Trends • 1900 – Industrial Revolution • New attitudes, behaviors and advancements brought shift in infant mortality rates • Geographic, economic disparities persist

8. Infant Mortality Rates, 1900

9. Infant Mortality Rates, 1930

10. Infant Mortality Rates, 1960

11. Infant Mortality Rates, 1996

12. Global Regional Variation • Nine of the 10 countries with the highest IMR are in Sub-Saharan Africa • Afghanistan is the tenth • IMR sky-rocketing in the Middle East • Iraq: 1990 (50); 2005 (125)

13. Global Infant Mortality • 198 in 1960; 83 in 2001 • Significant disparity between Less Developed Countries (LDC) and More Developed Countries (MDC) • LDC (91); MDC (8) • 10X higher for LDC than MDC • 17X higher for Least Developed Countries than MDC • Reductions overall, but more for MDC

14. Per Capita Income and Infant Mortality

15. Two Sides of Infant Mortality Less/Least Developed Countries v. More Developed Countries Our responses depend on the causes, and the causes depend on the nation…

16. Infant Mortality in Less Developed Countries

17. Violence • Due to armed conflicts over the past decade, • two million children were killed, • six million were seriously injured or permanently disabled, • 12 million were left homeless, • millions more orphaned. • Refugee camps • disrupt home life • affect nutritional intake • expose children to infections

18. Poverty • Children born in the developing world have a 4 in 10 chance of living in extreme poverty. • In 1998 over half a billion children lived on less than $1 a day.

19. Source: Economic and Social Research Council

20. Family Size • Children in larger families receive smaller share of family resources. • More likely to be malnourished. • Girls are often given fewer family resources, including medical care and food, than boys.

21. Mother’s Educational Level • Adult female literacy rate • In countries where the adult female literacy rate is higher, the IMR is consistently lower. • Mozambique: female literacy rate (23 percent), IMR (130) • Tanzania: female literacy rate (57 percent), IMR (92) • Delayed marriage and first birth • Babies born to women in their 20s and 30s have a lower risk than those born to women younger than 20. • Family planning and smaller families • Reproductive health care for themselves • Take better care of their children’s health needs.

22. HIV/AIDS • Increasing impact on children of all ages • 4.3 million children under age 15 had died of AIDS (12/03) • In 2000, 1.4 million children under 15 years of age were living with HIV/AIDS, up from 830,000 in 1996. • One million live in sub-Saharan Africa • 1,600 children infected each day. • Mother-to-child transmission of HIV during pregnancy, birth, or breastfeeding accounts for more than 90 percent of all infections in children. • One-third of infants born to HIV-infected mothers become infected. • Children orphaned by AIDS • More than 13 million children lost either their mother or both parents by the end of 1999. • Ninety percent in sub-Saharan Africa • Likely to be malnourished

23. Illness & Disease • 70% caused by preventable, treatable diseases • Respiratory infections • Diarrhea • Malaria • Measles • The physical environment is responsible for one-fourth of all preventable disease • Water supply • Sanitation • Urban versus rural resources

24. Physical Environment • Safe drinking water and sanitation • Over one billion people lacked access to safe drinking water in 2000 • Inadequate sanitation, unsafe drinking water, air pollution and crowding • malnutrition, diarrhea and acute respiratory infections • Urban versus rural resources • Urban residents have greater access to medical surveys and educational campaigns • Large-scale campaigns have constituted the most recent child health initiatives • In Bolivia the child mortality rate in rural areas in 1998 was 134, versus 72 in urban areas.

25. Responses • Ensure the well-being of mothers • Invest in basic, low-cost solutions to save children’s lives • Expand the availability of health care • Increase the use of basic, lifesaving services • Increase government support for proven solutions -State of the World’s Mothers, Save the Children, 2007

26. Ensure the well-being of mothers • Nutrition • Stronger mothers • Fewer birth complications • Healthier babies • Skilled care during childbirth • Family planning

27. Family Planning • Could prevent one in four of the deaths in children under five by helping women to space births at least two years apart. • Can also improve the survival of the next sibling. • Helps women to have children during their healthiest reproductive years • Enables couples to have their desired number of children The United States, through the U.S. Agency for International Development (USAID), provides voluntary family planning and reproductive health services in over 60 developing countries.  According to USAID, 50 million couples in the developing world use family planning directly as a result of its efforts.

28. Invest in basic, low-cost solutions • Antibiotics • Newborn sepsis • Pneumonia • Insecticide-treated mosquito nets • Oral rehydration therapy • Breastfeeding “Recent analysis has shown that nearly 3 million of…newborn deaths could be prevented annually by improving access to basic, cost-effective interventions that are not yet reaching those who need them most.” -State of the World’s Mothers Save the Children, 2007

29. Oral rehydration Therapy (ORT) • Low-cost, low-technology method to control diarrhea • Prepackaged mixture of salts and sugars combined with water • Replaces fluid and salts lost through diarrhea • Throughout the 1990s, it was used in 80 percent of all episodes.

30. Increased Breastfeeding • One of the most cost-effective interventions • Saves the lives of six million infants every year

31. Increased Breastfeeding • If a child is breastfed for six months, she is significantly less likely to contract or die from diarrhea and acute respiratory infections. • Beyond 6 months, breastfed alongside age-appropriate feeding • Almost one-fifth of all child deaths • Save an additional two million children each year

32. Expand the availability of health care • Trained health workers • Urban and rural • Basic newborn care • Home visits • Mass media, public education campaigns • Promote healthy behaviors • Raise awareness

33. Increase use of basic, lifesaving services • Community case management linked to local health facilities • Community education and mobilization Encourage family members to use lifesaving, home-based practices to care for their infant.

34. Increase government support for proven solutions • Basic education • HIV/AIDS awareness • Family planning • Funding • Policies

35. U.S. Cuts in International Family Planning • Funding • Level- funded since 2001 • President Bush’s 2007 budget: 18 percent reduction • $357 million, well below the 2006 level of $440 million • Highest levels in 1995 ($541 million) • With inflation, 30 percent reduction • Funding should be $865 million • "Mexico City Policy" / “Global gag rule” • Denies USAID funds to overseas clinics that perform abortions, provide abortion counseling and referral, or lobby to make abortion legal. • Clinics have closed or cut staff and services, including HIV screening, voluntary counseling and education. • USAID has stopped shipment of condoms to 16 countries because the sole recipients – local family planning organizations – have refused to sign on to the gag rule.

36. More Developed Countries

37. IMR and the Industrial Revolution • Rates have been steadily decreasing • Major decline in 20th century • Attributed to • Cleanliness • Sewage systems • Central heating • Clean drinking water • More food • Cheaper clothing • Use of hospitals • Antibiotics and vaccines

38. Infant Mortality in the U.S. • 2004 • 27,936 infant deaths • More than all child/teen deaths combined (25,325) • 42nd in the world (2005) • 36th (2002) • 28th (1998) The U.S. spends more on health care than any other country, but our infant survival rate is lower than that of most other industrialized nations.

39. The United States has the second worst newborn mortality rate in the developed world.

40. U.S. Infant Mortality Rates, 2004

41. Racial Disparities: U.S. 2004 Rates • Non-Hispanic white: 5.7 • Non-Hispanic black: 13.8 • Hispanic: 5.6 • American Indian: 8.9 • Asian/Pacific Islander: 3.6 At any age, and at any income, education or socioeconomic level, an African American mother is twice as likely to lose her infant than a white woman.

42. Causes: U.S. Each year, well over half of infant deaths from all causes involve LBW babies.

43. Low Birth Weight Babies, 2004

44. Contributing Factors • Health of Baby • LBW • Birth Defects • Disease/Illness • Health of Mother • High-risk pregnancy • Poor nutrition • Obesity • Poverty • Health Insurance • Reduced access to care • Lack of insurance

45. Responses • Address Disparities in Infant Mortality • Provide Pre-Pregnancy Education and Counseling • Ensure Timely Prenatal Care for All Women • Expand Access to Medical Care for Infants in the First Month of Life (Neonatal) • Expand Access to Well-baby Care and Parenting Education • Expand Programs for the Prevention of Child Abuse and Neglect -Annie E. Casey Foundation

46. Address Disparities • Support research on the medical, socioeconomic and behavior factors that affect infant mortality, esp. low birth weight • African American and Puerto Rican babies most severely affected • Medical advances increase survival • Incidences of LBW are the same The cost of a premature baby's hospital care can reach over a quarter-of-a-million dollars. A full-term healthy newborn costs a few thousand dollars.

47. Address Disparities • Promote breastfeeding, with an emphasis on African American mothers • African American mothers only 40% as likely to breastfeed as other mothers • Accounts for higher rates of infant mortality • Campaign • Research • Improve education • Workplace policies

48. Pre-Pregnancy Counseling and Education • Health education and preconception counseling • Expectant mothers • Unplanned pregnancies • Education about positive and negative behaviors that impact health of baby • Effective monitoring and treatment of chronic diseases • Hypertension, diabetes, renal disease, urogenital infactions • Addresses disparities (African American women)

49. Prenatal Care • Infant mortality is 50 percent higher for children born into families in poverty • Decreased access to prenatal care • Low-income women • Segregated rural and urban areas • Racial/ethnic minorities • First trimester

50. Prenatal Care • Address barriers to prenatal care • Medically underserved areas • Regular source of care (Outpatient, ER) • Culturally competent providers • Ensure that all eligible individuals receive Medicaid and SCHIP services • Covering All Families (www.coveringallfamilies.org)