A Century of Progress: Infant & Maternal Mortality in the US - Research Paper

Introduction

In the past century (1900-1999), the world has witnessed significant improvements in morbidity and mortality. These important milestones can be appreciated by looking at infant mortality and maternal mortality data in the United States over the past century. To understand this crucial milestone, it is worth noting that at the start of the 20th century, approximately six to nine mothers out of 1000 lost their lives to pregnancy-associated complications (CDC, 2001). Additionally, about 100 newborns for every 1000 live births lost their lives before attaining the age of one year (CDC, 2001).

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It is worth noting that from 1915-1997, the United States achieved a significant milestone as manifested by a decline in infant mortality by more than 90% (from 100 deaths per 1000 live births to 7.2 per 1000 live births) (CDC, 2001). Similarly, there was a significant improvement in maternal mortality rates as shown by 99% decrease in maternal death from 6-9 deaths per 1000 live births in 1900 to 0.1 deaths per 1000 live births (CDC, 2001). Declined mortality rates was attributed to improved standards of living, improved educational attainment, enhanced surveillance and monitoring of disease, better access to healthcare, advances in clinal medicine, improved nutrition, and environmental interventions.

CDC (2001) further reported that in 1900, some of the cities in the United States registered about 30% infant mortality rates before attaining the age of one year. To decrease infant mortality rates, efforts were made to improve both living and environmental conditions in towns and cities. Some of the environmental strategies that were used to reduce infant mortality include the provision of safe drinking water and better garbage, sewage, and refuse disposal (CDC, 2001). Declined infant mortality rates were also linked to decreased fertility rates via child spacing, improved nutrition, smaller family size (CDC, 2001).

Declined infant mortality rates are also attributed to the discovery and extensive use of antimicrobial agents (such as penicillin and sulfonamide). Additionally, the discovery of intravenous fluid therapy and safe blood transfusions led to a rapid decrease in infant-related deaths. Following these discoveries, infant mortality decreased by 52% between 1930 and 1949. The highest decline in infant mortality was captured in infants aged one month (28 days) and 364 days- whose mortality rates declined by 66%. However, infants aged 0 days and 27 days had a lower decline in mortality rates at 40%. In the next 15 years (1950-1964), infant mortality underwent a slow decline compared to the previous period (1930-1949). Increased prevalence of infant deaths was linked to perinatal causes such as premature birth and low birthweight.

Following the implementation of health-related federal programs, such as Medicaid in the late 1960s, there was a rapid decline in infant mortality rates. For instance, there was a 41% reduction in infant mortality between 1970 and 1979 (Chen, Munnell, & Sanzenbacher, 2017). The decline was linked to technological advancement in newborn infants' medicine and increased access to perinatal services attributed to the establishment of hospital and clinics that handle infant health matters in many regions. Between 1980 and 1985, there was a slow down in infant mortality rates, followed by a rapid decline between 1989 and 1991. The rapid decline witnessed between 1989 and 1991 was attributable to the discovery of artificial pulmonary surfactant used in the prevention and treatment of respiratory-related diseases in preterm infants (Erwin & Brownson, 2016; Goldsmith & Karotkin, 2016; Liu, Sorantin, & Cao, 2018; Mason, Murray, Nadel, & Gotway, 2015). Lastly, between 1991 and 1997, rapid decline in infant mortality was linked to a decline in sudden infant death syndrome which accounted for 39% of all infant mortality (Cowgill, 2018; Graham & Sanchez-Lara, 2016).

Contribution of Community Health Education Theories to Decreased Morbidity and Mortality

Community health education theories might have played a crucial role in the reduction of infant morbidity and mortality. For instance, community health workers and other healthcare professionals utilize oral and pictorial forms of teaching to impart mothers with knowledge and skills related to infant care- approaches which are consistent with social cognitive theory (Mendhi, Cartmell, Newman, Premji, & Pope, 2019). Healthcare professionals utilize role-play and skill demonstration in assisting mothers to adopt the best infant healthcare strategies.

The socio-ecological models have also been found to be useful in reducing infant mortality rates (Sobiech, 2014). The interpersonal dimension of the socio-ecological model explains the relationship between an individual and his or her health. For instance, mothers who are victims of abuse are at high risk for adverse birth outcomes. If a mothers social group believe that prenatal care is crucial during pregnancy, there is an increased likelihood that she will be actively involved in prenatal care (Sobiech, 2014). Other ecological contexts associated with infant mortality include income inequality, employment status, and female literacy (Ladusingh, Gupta, & Yadav, 2016). It can be argued that decreased infant mortality in the past century is associated with declined infant mortality rate.

References

Chen, A., Munnell, A. H., & Sanzenbacher, G. T. (2017). What's Happening to U.S. Mortality Rates? Retrieved from https://crr.bc.edu/wp-content/uploads/2017/09/IB_17-17.pdf

Cowgill, B. (2018). Rest uneasy: Sudden infant death syndrome in twentieth-century America. New Brunswick, NJ: Rutgers University Press.

Erwin, P. C., & Brownson, R. C. (2016). Scutchfield and keck's principles of public health practice. Boston, MA: Cengage Learning.

Goldsmith, J. P., & Karotkin, E. (2016). Assisted ventilation of the neonate. New York, NY: Elsevier Health Sciences.

Graham, J. M., & Sanchez-Lara, P. A. (2016). Smith's recognizable patterns of human deformation (Edition 4). Philadelphia, PA: Elsevier.

Ladusingh, L., Gupta, A. K., & Yadav, A. (2016). Ecological context of infant mortality in high-focus states of India. Epidemiology and Health, 38. https://doi.org/10.4178/epih.e2016006

Liu, J., Sorantin, E., & Cao, H.-Y. (2018). Neonatal lung ultrasonography. Springer.

Mason, R. C., Murray, J. F., Nadel, J. A., & Gotway, M. (2015). Murray & nadel's textbook of respiratory medicine e-book. New York, NY: Elsevier Health Sciences.

Mendhi, M. M., Cartmell, K. B., Newman, S. D., Premji, S., & Pope, C. (2019). Review of educational interventions to increase traditional birth attendants' neonatal resuscitation self-efficacy. Women and Birth: Journal of the Australian College of Midwives, 32(1), 16-27. https://doi.org/10.1016/j.wombi.2018.04.016

Sobiech, N. M. (2014). State-level analysis of variation in infant mortality rate: A socio-ecological approach. Retrieved from https://docs.lib.purdue.edu/open_access_theses/687/