By the end of 1989, a very important report card on children's health will be available to parents worldwide. In 1979, the International Year of the Child, the U.S. surgeon general set health objectives for Americans of all age groups to achieve by 1990. Sadly, the report card recounts that we failed to meet most of these key health objectives for children.
The disturbing paradox is that while medical technology thrives, basic health objectives like reducing infant mortality, reducing injuries, and improving nutrition, have languished. How has this happened? According to some recent national reports, the state of U.S. children's health reflects an ongoing story of "haves and have-nots." More serious health problems are seen in poor non-white children, often dictated by who has access to adequate, and costly, health care. Still, the majority of health problems, from drug and alcohol abuse to teenage pregnancy, cut across social and economic lines.
Making Healthy Babies
The infant mortality rate--a measure of the number of babies who do not reach their first birthday for every thousand infants who do--is a clear reflection of a nation's health. Over the last fifty years, the infant mortality rate dropped sharply in developed countries; but decreases halted during the 1980s. Several developed countries have achieved the lowest possible infant mortality rate, but the United States ranks eighteenth worldwide, lagging behind countries like Ireland, Spain, and Singapore. The U.S. infant mortality rate tells the story of a nation divided: By 1986, the mortality rate for white infants was less than nine deaths per thousand, but the rate for nonwhites stagnated at eighteen deaths per one thousand.
Prenatal Care For All
That more nonwhite babies die is the outcome of many factors: a higher number of babies born to teenage mothers; a higher number of babies born prematurely or with lower average birth weight (birth weights of less than 5.5 pounds are associated with poor survival rates). According to a recent report by the Children's Defense Fund, a nonprofit research and advocacy organization, black infants are more likely to die from preventable causes than are white infants. Reducing infant deaths depends on good prenatal care--monitoring the mother's diet, treating medical problems, and eliminating exposure to harmful chemicals, including drugs, cigarette smoke, and alcohol.
Many states have tried to make prenatal care more affordable for low-income mothers. But despite these efforts, the percentage of pregnant women who receive prenatal care has not budged over the last decade, according to a report from the National Association of Children's Hospitals and Related Institutions (NACHRI). In some states, the program simply cannot afford to serve any but the poorest of the poor, leaving the near-poor uncovered. The situation in Massachusetts, the only state that provides free prenatal care to women whose income is up to 200 percent of the poverty line, only emphasizes the growing problem in large cities. While the infant mortality rate for babies of all races inched downward nationwide during the 1980s, here, in the backyard of one of the most medically enriched neighborhoods in the world, mortality among black infants was still on the rise. According to the Children's Defense Fund, a black infant born in
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