Infant mortality, though on the decline, is still a serious health concern in the United States and Philadelphia presents the worst-case scenario. Though government sponsored programs have helped mitigate the crisis there is still a lot to be done in terms of enabling easy access of quality maternity care to people from diverse economic, ethnic and cultural backgrounds.
Infant mortality is a serious concern worldwide and infant mortality rate is considered an indicator of the health standard of a nation. In the United States, over the last few decades there has been a steady drop in the infant mortality rates indicating a positive change in maternal health care facilities. The infant mortality rate, which was as high as 96.5 per 1000 live births in the early part of 20th century has now dropped considerably to 6.8 per 1,000 live births as projected by the 2001 statistics. However in some regions like Philadelphia the problem is acute. West Philadelphia for example, suffers the distinction of being the city with the highest infant mortality rate, one that is almost double the national average. There are many reasons, which contribute to this negative health picture in the region. Let us analyze the issue of infant mortality in a little detail so that we may gain better insight into the problem and try to find out remedial measures for the same.
Infant Mortality (An Overview)
Infant mortality by definition refers to the 'death of infants that occur within the first year of their life." The infant mortality rate is the "number of infant deaths within the first year of life per 1,000 live births per year." [UDOH]. Infant deaths fall under the following two categories namely perinatal deaths and neonatal deaths. Perinatal deaths include fetal deaths, those that occur after 20 or more weeks of gestation, and deaths that occur within the first 28 days after delivery of the baby. Neonatal deaths refer to infant deaths that occur after 28 days of birth and within one year. This classification serves to provide us with a better picture of the actual conditions that result in infant deaths. It has to be noted however, that, in general many conditions that originate in the perinatal period are responsible for the large proportion of deaths in the neonatal period.
Philadelphia (A Special Case)
Nationwide, the infant mortality rate has been steadily decreasing projecting a positive trend in pediatric health care. In Philadelphia, though infant mortality is showing a gradual decline over the last decade, the mortality rate is still very high compared to the national average. One reason for this poor scenario in Philadelphia is the clear contrast that exists in health care access between the rich and poor communities. For example the University City and Mantua, two neighborhood regions in Philadelphia present a good contrast of wealth and poverty side by side. Speaking of this disparity Ms. Whelan, a Senior nurse in Mantua says, "Here we are blocks away from major medical centers, and we had one of the worst infant mortality rates. We had high teen-age pregnancy, all of these health indicators like third-world countries,." [Jerry Janda]. A survey conducted in 1999 showed that more than 17% of families living in Philadelphia were well below the federal poverty level.
The problem is that, while the rich people can avail of the excellent services offered by the numerous private health clinics in the city the vast majority of the poor are literally dependent on the public hospitals. Economic disparity and the consequent hurdles in access to quality health care is identified to be the key factor contributing to the high infant death rate in the city.
General Causes for Infant Mortality (Literature review)
The 1999 study by Lorraine Halinka Malcoe, Gary M. Shaw, et.al, was pivotal in understanding the various causes of infant mortality. This was a comprehensive study, which analyzed the effect of congenital anomalies on the infant mortality on a whole. For the study the researchers took the available data on the California birth defects program and performed a comparative study with the available birth death records of 278646 children between 1983 and 1986. The children chosen for the study were all from black and white communities. From this huge pool of data the researchers compared malformed infants with nonmalformed infants so as to ascertain the effect of congenital abnormalities on infant death rates.
The study clearly revealed a positive link between the presence of congenital anomalies and infant deaths. The researchers identified that congenital anomalies increased the risk of infant mortality nine fold in the case of black children while the risk factor was even higher for white children...
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