Health Progress Through a Baby's Face

Today a new addition to my family arrived as my niece gave birth to a healthy 7 lb girl.  This is a happy time for new parents and families, a time celebrated by poets and greeting card designers.  I won't try to add words to highlight the special joy of a new healthy life.  However, there is much to celebrate regarding the good health currently enjoyed by new mothers and babies.

In the public health world, issues related to pregnancy and the health of newborns and mothers is referred to as maternal and child health.  It has been a traditional emphasis area of public health because in the past there has been so much disease and death associated with pregnancy and childbirth.  The height of joy associated with having a healthy baby is mirrored by the lowest low when a mother dies in childbirth or a baby dies before birth or shortly after.

We have seen tremendous progress in this regard.  Though past statistics are somewhat uncertain, best estimates are that in 1900, 850 mothers would die for every 100,000 births.  These deaths would usually be from blood clots, hemorrhaging, infections, and extreme high blood pressure.  Given the state of the art of medical care at the time, there was not much to be done for women with these problems. Underlying factors were that nutritional practices were poor, and there was no reliable birth control to better space pregnancies and limit pregnancies at older ages when risks to the mother and child are greater.  Over the years since then, the rate has dropped to around 12.  This is an enormous accomplishment due to advances in medical care and public health primary and secondary prevention.

When babies die in the first year of life, the technical term is infant mortality.  In 1900, about 1 in 10 babies would not survive to the first birthday.  The rate in the U.S. is now about 7 deaths for every 1,000 births.  The following chart illustrates progress in infant mortality since 1940.  That sterile looking chart represents a triumph over suffering and misery of a special kind.  Though the rate of improvement is slowing, we have come a long way from the bad old days when the hope of childbirth was always tempered by a shadow of risk.

In spite of great progress, there is still some concern, because of disparity in two dimensions.  First, on an international perspective, the U.S. does not compare very well.  The graphic below shows infant mortality for a set of developed nations, and it indicates that U.S. babies die at twice the rate of Japanese and Swedish babies, and we are behind all of these and many more nations in this regard.

The other concern is the disparity between black and white babies.  The African-American infant mortality rate is double the rate for white infants.  These two disparities illustrate that though we have come a long way, there is still much progress to be made.  The following chart illustrates the racial divide with this measure.

The point I want to close on is the human face of suffering.  My niece and her family are ecstatic today because mom and baby are in excellent health and have every expectation to thrive in perfect health going forward to the first and many more birthdays.  Public health statistics sometimes are abstract and cold, illustrating something which didn't happen because it was prevented.  My great niece is the polar opposite of the mother and child suffering and misery which once was so everyday routine. For me, today, prevention and public health progress has a face.