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The Department of Health and Human Services (HHS) supports a wide range of programs designed to prevent infant mortality. These efforts include programs to improve access to prenatal and newborn care, including Healthy Start, Medicaid and the State Children's Health Insurance Program (SCHIP). HHS also supports public health campaigns to promote healthy habits among parents expecting a child or caring for an infant to prevent child malnutrition, as well as medical research to better understand and prevent birth defects, premature birth and Sudden Infant Death Syndrome (SIDS) and to promote healthier growth and development.

RECENT TRENDS

Due in part to medical research, public health and social services supported by HHS, infant mortality has declined considerably during the past three decades. Overall, the nation's infant mortality rate has fallen from 20 deaths per 1,000 live births in 1970 to 6.9 deaths in 2000 (provisional data). The 1999 rate of 7.1 deaths, based on complete data, is the same as the 1998 rate, but has fallen 4 percent since 1995 and 22 percent since 1990. In 1999, the leading causes of infant mortality were congenital anomalies, disorders related to immaturity (short gestation and unspecified low birthweight), SIDS, and maternal complications.

Between 1998 and 1999, the mortality rate for white infants decreased 3 percent to 5.8 deaths per 1,000 live births, while the rate for black infants was 14.6, not statistically different from the 1998 rate. Although the trend in infant mortality rates among blacks and whites has been on a continual decline, the proportional discrepancy between the black and white rates has increased. The total Hispanic infant mortality rate in 1999 was 5.8. The mortality rate among American Indians and Alaska Natives is 9.3 deaths per 1,000 live births, while the Asian/Pacific Islander rate is slightly lower than for white infants.

In 2000, 83.2 percent of mothers began prenatal care within the first trimester of pregnancy, continuing a positive trend dating back to 1989. Disparities in access to prenatal care between white mothers and black and Hispanic mothers have narrowed during this period. In 2000, the percentage of black mothers who initiated first trimester prenatal care was 74.3 percent, compared to 74.4 percent for Hispanic mothers and 88.5 percent for white mothers. For mothers in their teens, 33 percent received no early prenatal care in 2000.

The incidence of low birthweight babies (less than 5 pounds, 8 ounces) was unchanged from 1999 at 7.6 percent. Cigarette smoking during pregnancy has declined 37 percent since 1989, to 12.2 percent of mothers in 2000. Twelve percent of births to smokers were low birthweight, compared with 7.2 percent of such births to nonsmokers.

PROMOTING ACCESS TO PRENATAL AND INFANT CARE

Early and continuous prenatal care helps identify conditions and behavior that can result in low birthweight babies, such as smoking, drug and alcohol abuse, inadequate weight gain during pregnancy and repeat pregnancy in six months or less. HHS supports many programs to improve access to prenatal and infant care, including:

Healthy Start. The Healthy Start program, administered by the Health Resources and Services Administration (HRSA), works to expand the availability and accessibility of prenatal health care in more than 100 communities nationwide with higher-than-average infant mortality rates. Designed to meet community needs, the projects include outreach, case management, health education and community consortia. www.healthystart.net/. --->

Medicaid and SCHIP. Medicaid is a state and federal partnership that provides access to prenatal care for eligible mothers and health coverage for millions of infants from low-income families. States can expand eligibility and services for pregnant women and their infants. As part of such expansions, states have streamlined application procedures to encourage early and continuous access to prenatal care and added coverage for parenting education. Families are encouraged and offered assistance to obtain well-child screenings that can identify and treat health problems. In addition, about 4.6 million children who otherwise would not have access to health care were covered under the State Children's Health Insurance Program (SCHIP) during fiscal year 2001 - a 38 percent increase from the previous year. HHS also has proposed allowing states to provide SCHIP coverage for prenatal care.

Toll-free prenatal care hotline. HHS supports a toll-free hotline to assist pregnant women and others seeking information on prenatal care, including referrals to local clinics and physicians. Assistance is available in English at 1-800-311-BABY (2229) and in Spanish at 1-800-504-7081.

Childhood immunization initiative. HHS efforts to promote and provide childhood immunizations have helped to increase immunization rates among children, with 90 percent or more of America's toddlers receiving the most critical doses of vaccines for children by age 2. With childhood vaccination levels in the United States at or near an all-time high, disease and death from preventable diseases are at or near record lows.

PROMOTING HEALTHY CHOICES TO REDUCE MORTALITY RISKS

As part of its broader efforts to reduce infant mortality, HHS agencies support a wide range of outreach and education efforts aimed at reducing behavior that increases the risks of infant mortality. These efforts include:

Folic acid campaign. HHS participates in the National Folic Acid Campaign to promote the use of folic acid to prevent serious birth defects such as spina bifida and anencephaly. The goal of the campaign is to educate all women who could possibly become pregnant to consume 400 micrograms (400 mcg) of folic acid daily from vitamin supplements and/or fortified foods, in addition to eating certain foods with folic acid. The campaign involves the Centers for Disease Control and Prevention (CDC), the March of Dimes and the National Council on Folic Acid. More information is available at www.cdc.gov/ncbddd/folicacid.

"Back to Sleep" campaign. The public-private "Back to Sleep" campaign educates parents and caregivers that babies who sleep on their backs have a lower risk of SIDS. The 1999 National Institute of Child Health and Human Development (NICHD) household survey found that 85 percent of infants were sleeping either on their sides or backs. The number of SIDS deaths has decreased from 4,891 in 1992 to 2,648 in 1999, a 46 percent decrease. The campaign is led by HHS and co-sponsored by other organizations, including the American Academy of Pediatrics, the SIDS Alliance and the Association of SIDS and Infant Mortality Programs. Information about the campaign is available at www.nichd.nih.gov.

Reducing mother-to-child HIV transmission. HHS provides information to women and their physicians on HIV testing and treatment with zidovudine (AZT) and other anti-viral drugs, as well as obstetrical approaches, to reduce transmission of HIV from mother to child. HHS guidelines and educational materials are available at www.aidsinfo.nih.gov/.

Maternal and Child Health Services Block Grant (Title V). HRSA provides block grants to states to develop service systems to meet critical challenges in maternal and child health, including reducing infant mortality. These state efforts are developed with careful attention to Health Status Indicators and National Performance Measures, among them those that emphasize the importance of adequate prenatal care in improving the health of pregnant women and reducing infant mortality.

Reducing teen pregnancy. Infants born to teenage mothers are at higher risk of being born low birthweight babies and have a higher mortality rate. HHS directly funds teen pregnancy prevention programs in more than 2,200 communities - about 47 percent of all communities nationwide. By focusing on abstinence and personal responsibility, HHS hopes to help young people make the choices that will lead to a successful future. More information on HHS' teen pregnancy prevention efforts is available at www.hhs.gov/news/press/2002pres/teenpreg.html .

Healthy People 2010. Reducing infant mortality is one of the major goals of Healthy People 2010, the nation's prevention initiative developed by HHS in partnership with the private sector, universities, state and local health departments and community groups. Healthy People's framework relies on science and consensus to guide efforts to promote health and prevent disease. The initiative includes 22 measurable health objectives specific to risk factors for infant mortality and more than 100 related objectives on issues such as cigarette smoking. More information on Healthy People 2010 is available at www.health.gov/healthypeople.

PROMOTING RESEARCH TO REDUCE INFANT MORTALITY

HHS supports a wide range of medical research to prevent and treat birth defects, premature birth, SIDS and other life-threatening conditions. For example:

• The wider use of antenatal corticosteroid treatments to prevent premature labor and promote lung maturation -- clinical practice endorsed by the National Institutes of Health (NIH) Consensus Development Conference -- as reduced deaths of premature infants and lowered the incidence of respiratory distress syndrome and internal hemorrhage in the infant.

• Treatment with surfactant, discovered and developed through research supported by the National Institute of Child Health and Human Development (NICHD) and the National Heart, Lung and Blood Institute (NHLBI), has also reduced deaths of premature infants from respiratory distress syndrome.

• NICHD-supported research has shown that treatment of a common condition known as bacterial vaginosis with specific antibiotics can reduce the risk of a premature delivery. Clinical trials are in progress to determine which precise treatment would be most effective.

• NHLBI, with input from NICHD, is developing an enhanced research agenda to address key issues regarding hypertensive disorders of pregnancy, such as preclampsia -- an abnormal increase in blood pressure during pregnancy that affects 5 percent to 8 percent of pregnancies and contributes to maternal, fetal and infant morbidity and mortality.

• The CDC is examining sociocultural, behavioral and environmental factors, including stress and social support, related to preterm births among African-American women in Harlem, N.Y., and Los Angeles, Calif.

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