U.S. Infant Mortality Rates Show Racial Gulf

THURSDAY, July 11, 2002 (HealthDayNews) -- When it comes to infant mortality, America is a nation divided.

Black babies are about 2.5 times as likely as whites ones to die during their first year of life, according to a new report today from the Centers for Disease Control and Prevention.

Contributing to this gap, black children are roughly two-to-three times more likely to be born dangerously underweight, reflecting a similarly increased risk of prematurity compared to white babies. Premature birth is the leading cause of infant death in this country.

The reasons for the split aren't entirely clear, officials say, but include unequal access to good prenatal care for black mothers and reduced access to top-notch care for their newborns.

Ironically, 20 years ago, severely underweight black infants -- those born under 5.5 pounds -- were more likely than white ones to survive, officials says. Now, despite major advances in the treatment of the most vulnerable babies, that's changed, says Dr. Wanda Barfield, a medical epidemiologist at the CDC and a co-author of the new report.

"These are very tiny babies. Their chances of survival are enhanced by access to effective neonatal and obstetrical technologies," Barfield says.

Barfield says researchers need to better understand the causes of prematurity. They should also design "culturally sensitive interventions," such as those that help bring minority women into the health-care system earlier in their pregnancies.

The nation's overall infant mortality rate was 7 per 1,000 live births in 2000, down 44 percent from the 1980 mark of 12.6. But the rate was 5.7 per 1,000 for white babies and 14 per 1,000 for black babies, according to the report.

In 1997, when the nation's infant mortality rate was 7.2 per 1,000, the United States ranked 27th among the world's developed countries, Barfield says.

The percentage of babies of both races born underweight or very underweight has climbed since 1980, researchers say. However, the rate has risen more for whites, reflecting, in part, an increase in twins, triplets and even larger numbers of babies per pregnancy. A surge in the use of fertility treatments among white couples is probably behind this trend, experts say.

Still, white infants are roughly twice as likely to survive as blacks ones across all weight ranges. And while both groups have seen significant gains since the early 1980s, the progress for whites has been greater.

"In general, we really don't know why there has been this persistent gap" between the races, says Cynthia Ferre, a CDC epidemiologist who studies infant health.

Researchers have attempted a variety of measures to reduce premature births among minority women and others at high risk, but with little success, Ferre says.

"People have been doing that for two decades and it really hasn't made much of an impact," she says. "We need to begin to improve women's health very early in pregnancy as well as before they get pregnant."

Dr. Robert Goldenberg, an obstetrician at the University of Alabama in Birmingham, led a major study of premature births called PORT. He found that "virtually nothing that physicians do or that the public health community does has reduced [the problem] in the United States" or abroad.

Doctors know a great deal about the risk factors associated with premature births, from smoking to vaginal infections. "But we've not been terribly successful in reducing those risk factors, and in preventing or stopping premature labor once it starts," he says.

The numbers of labors that come early -- defined as before week 37 of gestation -- is now at about 12 percent, Goldenberg says. That's higher than in previous decades, and it's due, partly, to the increase in multiple births and possibly vaginal infections.

But, another explanation is that doctors feel more comfortable today inducing labor early because they can care for under-developed babies better than they once could, he says.

The Bush administration set aside $99 million this year to reduce infant mortality through its Healthy Start program.

What To Do

For more on infant mortality in the United States, try the National Center for Health Statistics. And for more on the global problem of low birth weight, visit UNICEF.