07 Infant Mortality

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Information about 07 Infant Mortality

Published on January 15, 2008

Author: Saverio

Source: authorstream.com

Infant Mortality:  Infant Mortality Trends, causes, and responses in a changing world Megan Brown Children’s Defense Fund Minnesota Slide2:  “Children who get a healthy start in life are more likely to reach their full potential, with benefits for themselves, their families and society as a whole.” -State of the World’s Mothers Save the Children, 2007 Infant Mortality:  Infant Mortality Every day, 28,000 children under 5 die 10 million children annually 40% of those are newborns in their first month 2 million die on the day they are born “Using existing tools and knowledge, we could save more than 6 million of the 10 million children who die every year from easily preventable or treatable causes.” :  “Using existing tools and knowledge, we could save more than 6 million of the 10 million children who die every year from easily preventable or treatable causes.” Infant Mortality:  Infant Mortality Trends Historical Geographical Less Developed Countries Causes Responses More Developed Countries: U.S. Causes Responses Historical Trends:  Historical Trends Prior to 1900, infant mortality rates of two and three hundred per 1,000 births Fluctuated sharply Weather Harvest War Epidemic disease Anthropologists have found groups that do not name children until they have survived a year.  Historical Trends:  Historical Trends 1900 – Industrial Revolution New attitudes, behaviors and advancements brought shift in infant mortality rates Geographic, economic disparities persist Infant Mortality Rates, 1900:  Infant Mortality Rates, 1900 Infant Mortality Rates, 1930:  Infant Mortality Rates, 1930 Infant Mortality Rates, 1960:  Infant Mortality Rates, 1960 Infant Mortality Rates, 1996:  Infant Mortality Rates, 1996 Global Regional Variation:  Global Regional Variation Nine of the 10 countries with the highest IMR are in Sub-Saharan Africa Afghanistan is the tenth IMR sky-rocketing in the Middle East Iraq: 1990 (50); 2005 (125) Global Infant Mortality:  Global Infant Mortality 198 in 1960; 83 in 2001 Significant disparity between Less Developed Countries (LDC) and More Developed Countries (MDC) LDC (91); MDC (8) 10X higher for LDC than MDC 17X higher for Least Developed Countries than MDC Reductions overall, but more for MDC Per Capita Income and Infant Mortality:  Per Capita Income and Infant Mortality Two Sides of Infant Mortality:  Two Sides of Infant Mortality Less/Least Developed Countries v. More Developed Countries Our responses depend on the causes, and the causes depend on the nation… Infant Mortality in Less Developed Countries:  Infant Mortality in Less Developed Countries Violence:  Violence Due to armed conflicts over the past decade, two million children were killed, six million were seriously injured or permanently disabled, 12 million were left homeless, millions more orphaned. Refugee camps disrupt home life affect nutritional intake expose children to infections Poverty:  Poverty Children born in the developing world have a 4 in 10 chance of living in extreme poverty. In 1998 over half a billion children lived on less than $1 a day. Slide19:  Source: Economic and Social Research Council Family Size:  Family Size Children in larger families receive smaller share of family resources. More likely to be malnourished. Girls are often given fewer family resources, including medical care and food, than boys. Mother’s Educational Level:  Mother’s Educational Level Adult female literacy rate In countries where the adult female literacy rate is higher, the IMR is consistently lower. Mozambique: female literacy rate (23 percent), IMR (130) Tanzania: female literacy rate (57 percent), IMR (92) Delayed marriage and first birth Babies born to women in their 20s and 30s have a lower risk than those born to women younger than 20. Family planning and smaller families Reproductive health care for themselves Take better care of their children’s health needs. HIV/AIDS:  HIV/AIDS Increasing impact on children of all ages 4.3 million children under age 15 had died of AIDS (12/03) In 2000, 1.4 million children under 15 years of age were living with HIV/AIDS, up from 830,000 in 1996. One million live in sub-Saharan Africa 1,600 children infected each day. Mother-to-child transmission of HIV during pregnancy, birth, or breastfeeding accounts for more than 90 percent of all infections in children. One-third of infants born to HIV-infected mothers become infected. Children orphaned by AIDS More than 13 million children lost either their mother or both parents by the end of 1999. Ninety percent in sub-Saharan Africa Likely to be malnourished Illness & Disease:  Illness & Disease 70% caused by preventable, treatable diseases Respiratory infections Diarrhea Malaria Measles The physical environment is responsible for one-fourth of all preventable disease Water supply Sanitation Urban versus rural resources Physical Environment:  Physical Environment Safe drinking water and sanitation Over one billion people lacked access to safe drinking water in 2000 Inadequate sanitation, unsafe drinking water, air pollution and crowding malnutrition, diarrhea and acute respiratory infections Urban versus rural resources Urban residents have greater access to medical surveys and educational campaigns Large-scale campaigns have constituted the most recent child health initiatives In Bolivia the child mortality rate in rural areas in 1998 was 134, versus 72 in urban areas. Responses:  Responses Ensure the well-being of mothers Invest in basic, low-cost solutions to save children’s lives Expand the availability of health care Increase the use of basic, lifesaving services Increase government support for proven solutions -State of the World’s Mothers, Save the Children, 2007 Ensure the well-being of mothers:  Ensure the well-being of mothers Nutrition Stronger mothers Fewer birth complications Healthier babies Skilled care during childbirth Family planning Family Planning:  Family Planning Could prevent one in four of the deaths in children under five by helping women to space births at least two years apart. Can also improve the survival of the next sibling. Helps women to have children during their healthiest reproductive years Enables couples to have their desired number of children The United States, through the U.S. Agency for International Development (USAID), provides voluntary family planning and reproductive health services in over 60 developing countries.  According to USAID, 50 million couples in the developing world use family planning directly as a result of its efforts. Invest in basic, low-cost solutions:  Invest in basic, low-cost solutions Antibiotics Newborn sepsis Pneumonia Insecticide-treated mosquito nets Oral rehydration therapy Breastfeeding “Recent analysis has shown that nearly 3 million of…newborn deaths could be prevented annually by improving access to basic, cost-effective interventions that are not yet reaching those who need them most.” -State of the World’s Mothers Save the Children, 2007 Oral rehydration Therapy (ORT):  Oral rehydration Therapy (ORT) Low-cost, low-technology method to control diarrhea Prepackaged mixture of salts and sugars combined with water Replaces fluid and salts lost through diarrhea Throughout the 1990s, it was used in 80 percent of all episodes. Increased Breastfeeding:  Increased Breastfeeding One of the most cost-effective interventions Saves the lives of six million infants every year Increased Breastfeeding:  Increased Breastfeeding If a child is breastfed for six months, she is significantly less likely to contract or die from diarrhea and acute respiratory infections. Beyond 6 months, breastfed alongside age-appropriate feeding Almost one-fifth of all child deaths Save an additional two million children each year Expand the availability of health care:  Expand the availability of health care Trained health workers Urban and rural Basic newborn care Home visits Mass media, public education campaigns Promote healthy behaviors Raise awareness Increase use of basic, lifesaving services:  Increase use of basic, lifesaving services Community case management linked to local health facilities Community education and mobilization Encourage family members to use lifesaving, home-based practices to care for their infant. Increase government support for proven solutions:  Increase government support for proven solutions Basic education HIV/AIDS awareness Family planning Funding Policies U.S. Cuts in International Family Planning:  U.S. Cuts in International Family Planning Funding Level- funded since 2001 President Bush’s 2007 budget: 18 percent reduction $357 million, well below the 2006 level of $440 million Highest levels in 1995 ($541 million) With inflation, 30 percent reduction Funding should be $865 million "Mexico City Policy" / “Global gag rule” Denies USAID funds to overseas clinics that perform abortions, provide abortion counseling and referral, or lobby to make abortion legal. Clinics have closed or cut staff and services, including HIV screening, voluntary counseling and education. USAID has stopped shipment of condoms to 16 countries because the sole recipients – local family planning organizations – have refused to sign on to the gag rule. More Developed Countries:  More Developed Countries IMR and the Industrial Revolution:  IMR and the Industrial Revolution Rates have been steadily decreasing Major decline in 20th century Attributed to Cleanliness Sewage systems Central heating Clean drinking water More food Cheaper clothing Use of hospitals Antibiotics and vaccines Infant Mortality in the U.S.:  Infant Mortality in the U.S. 2004 27,936 infant deaths More than all child/teen deaths combined (25,325) 42nd in the world (2005) 36th (2002) 28th (1998) The U.S. spends more on health care than any other country, but our infant survival rate is lower than that of most other industrialized nations. Slide39:  The United States has the second worst newborn mortality rate in the developed world. U.S. Infant Mortality Rates, 2004:  U.S. Infant Mortality Rates, 2004 Racial Disparities: U.S.:  Racial Disparities: U.S. 2004 Rates Non-Hispanic white: 5.7 Non-Hispanic black: 13.8 Hispanic: 5.6 American Indian: 8.9 Asian/Pacific Islander: 3.6 At any age, and at any income, education or socioeconomic level, an African American mother is twice as likely to lose her infant than a white woman. Causes: U.S.:  Causes: U.S. Each year, well over half of infant deaths from all causes involve LBW babies. Low Birth Weight Babies, 2004:  Low Birth Weight Babies, 2004 Contributing Factors:  Contributing Factors Health of Baby LBW Birth Defects Disease/Illness Health of Mother High-risk pregnancy Poor nutrition Obesity Poverty Health Insurance Reduced access to care Lack of insurance Responses:  Responses Address Disparities in Infant Mortality Provide Pre-Pregnancy Education and Counseling Ensure Timely Prenatal Care for All Women Expand Access to Medical Care for Infants in the First Month of Life (Neonatal) Expand Access to Well-baby Care and Parenting Education Expand Programs for the Prevention of Child Abuse and Neglect -Annie E. Casey Foundation Address Disparities:  Address Disparities Support research on the medical, socioeconomic and behavior factors that affect infant mortality, esp. low birth weight African American and Puerto Rican babies most severely affected Medical advances increase survival Incidences of LBW are the same The cost of a premature baby's hospital care can reach over a quarter-of-a-million dollars. A full-term healthy newborn costs a few thousand dollars. Address Disparities:  Address Disparities African American mothers only 40% as likely to breastfeed as other mothers Accounts for higher rates of infant mortality Campaign Research Improve education Workplace policies Promote breastfeeding, with an emphasis on African American mothers Pre-Pregnancy Counseling and Education:  Pre-Pregnancy Counseling and Education Health education and preconception counseling Expectant mothers Unplanned pregnancies Education about positive and negative behaviors that impact health of baby Effective monitoring and treatment of chronic diseases Hypertension, diabetes, renal disease, urogenital infactions Addresses disparities (African American women) Prenatal Care:  Prenatal Care Infant mortality is 50 percent higher for children born into families in poverty Decreased access to prenatal care Low-income women Segregated rural and urban areas Racial/ethnic minorities First trimester Prenatal Care:  Prenatal Care Address barriers to prenatal care Medically underserved areas Regular source of care (Outpatient, ER) Culturally competent providers Ensure that all eligible individuals receive Medicaid and SCHIP services Covering All Families (www.coveringallfamilies.org) Infant Mortality in the 1990s:  Infant Mortality in the 1990s Infant Medical Care:  Infant Medical Care Expand access to neonatal intensive care Timely, appropriate treatment for congenital anomalies Birth defects cause 1 in 4 deaths 1 in 3 are heart defects Improvements in surgical treatment Reduce the incidence of respiratory distress syndrome Preterm babies (less than 3 1/3 lbs, earlier than 32 wks) 40,000 develop it each year; 1,400 die Surfactant treatment Reduce LBW incidence Well-baby Care and Parenting Education:  Well-baby Care and Parenting Education SIDS public education campaign “Back to Sleep” campaign Target communities American Indian 2X higher than whites African American also higher than whites Well-baby and sick-baby care Early detection and treatment of influenza and pneumonia Access through SCHIP or Medicaid Accessing Health Insurance:  Accessing Health Insurance Covering All Families SCHIP Reauthorization Bush - $5 million Kick off 1 to 2 million currently covered kids Senate - $35 million Cover 3 to 4 million uninsured kids Slide55:  “In 2004, Gov. Haley Barbour came to office promising not to raise taxes and to cut Medicaid. Face-to-face meetings were required for annual re-enrollment in Medicaid and CHIP, the children’s health insurance program; locations and hours for enrollment changed, and documentation requirements became more stringent. As a result, the number of non-elderly people, mainly children, covered by the Medicaid and CHIP programs declined by 54,000 in the 2005 and 2006 fiscal years. According to the Mississippi Health Advocacy Program in Jackson, some eligible pregnant women were deterred by the new procedures from enrolling. “ -Erik Eckholm New York Times Accessing Health Insurance:  Accessing Health Insurance Legislation Children’s Health Security Act Cover 80,000 uninsured in MN, option for all kids All Healthy Children Act Cover 9 million uninsured kids, option for all kids “The CHSA…[would] change the way we provide health care coverage for children to a system analogous to public education – all children would have access to health care coverage just as all children are guaranteed a public education.” -Carole Specktor CDF-MN Expand Programs for the Prevention of Child Abuse and Neglect:  Expand Programs for the Prevention of Child Abuse and Neglect SIDS decreasing, deaths from abuse increasing 1% to 5% of SIDS cases as infanticide Provide services to parents at risk for child abuse and neglect Emergency services for distraught parents Education for teen parents and single mothers on babies’ needs and vulnerabilities Legal alternatives to desperate parents Abandonment Laws that allow parents to avoid prosecution for child abandonment by leaving their babies in safe places such as hospital emergency rooms Summary:  Summary 10 million children under 5 die annually, 40% are newborns IMR decreasing through time Geographic, economic disparities persist Less developed countries Easily preventable causes Health care, education, family planning More developed countries (U.S.) Worst outcomes for MDC Racial/ethnic disparities Low birth weight, maternal health Bottom line: This is a solvable problem! `:  ` “We should expect more and we should do better, and we need to look at every aspect that we can influence, that we can control, that could help improve the chance that a baby who is born can live.” Thank you for coming…

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