Perspectives in Disease Prevention and Health Promotion Progress Toward Achieving the 1990 Objectives for Pregnancy and Infant Health

The 1990 Health Objectives for the Nation, published by the Public Health Service (PHS) in 1979, included 19 objectives related to pregnancy and infant health (1). PHS identified 13 of these as "priority objectives" for federal programs and activities (Table 1). These objectives concern improving the health status, reducing risk factors, increasing public and professional awareness, and improving health services and protection for mothers and infants. The Office of Maternal and Child Health (OMCH), Bureau of Maternal and Child Health and Resources Development, Health Resources and Services Administration (HRSA), is responsible for monitoring federal efforts to reach these objectives. Progress is assessed by monitoring national vital statistics and, when national data sets are not available, by selected studies.

Despite numerous public and private efforts, current projections for 1990 indicate that the majority of objectives for improving health status and reducing risk factors for pregnant women and infants will not be met (Table 2). The decline in the infant mortality rate (IMR) has slowed since the preceding decade, and no progress has been made in reducing low birthweight (LBW)-- less than 2,500 grams (2,3). Between 1970 and 1981, the IMR in the United States declined by nearly 5% per year. Between 1981 and 1985, the decline slowed to less than 3% per year. Based on estimates of the National Center for Health Statistics (NCHS), recent rates now exceed the confidence limits estimated from the 1970-1981 trend. The 1970-1981 trend projected the 1990 IMR to be 7.8 per 1,000 live births. The 1981-1985 trend projects a 1990 IMR of 9.1 per 1,000 live births. In addition, the 1970-1981 trend analysis projected that 41 states would meet the 1990 objective of no more than nine deaths per 1,000 live births. The 1981-1985 analysis projects that 25 states will meet this objective.

Between 1970 and 1985, IMR has decreased by 50% and LBW rate by 15%. Thus, most of the progress in reducing infant mortality over the past 15 years has resulted from a decline in birthweight-specific mortality; that decline, in turn, is likely due to technologic improvements in perinatal care. The LBW rate (6.8%) was the same in 1980 and 1985. The incidence of very LBW infants (less than 1,500 grams at birth) has been increasing in recent years. The 1990 LBW projection of 6.7% is 35% higher than the objective.

Programs to promote the use of infant safety seats in automobiles have been successful. The objective for such use has been met, according to survey data. In June 1987, in a sample study involving 19 cities, more than 75% of toddlers and infants were observed to be in safety seats (4).

National data are available for only part of the objective related to increased public and professional awareness of nutritional needs and of the hazards caused by smoking and by using alcohol and drugs during pregnancy. National survey results indicate that pregnant women and women who have recently been pregnant are more knowledgeable about smoking and alcohol risks than are members of the general population 18 to 44 years of age (5).

Progress has been made in one of the four priority objectives for improving services and protection: all states have screening programs for newborns (6). Progress has been limited or cannot be assessed for the other three objectives in this category. In 1980, 73.3% of pregnant women received first-trimester prenatal care, and in 1985, 76.2% received such care. Recent studies confirm that access to care remains inadequate for many women (7). No data are available for assessing the progress being made in providing regionalized systems of perinatal care or for estimating the availability of primary care services for infants. Reported by: Office of Maternal and Child Health, Bureau of Maternal and Child Health and Resources Development, Health Resources and Services Administration. Office of Disease Prevention and Health Promotion. National Institute of Child Health and Human Development, National Institutes of Health. National Center for Health Statistics; Div of Reproductive Health, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: Efforts to achieve the objectives for pregnancy and infant health must be sustained and strengthened. The Low Birthweight Prevention Work Group, formed in 1984 with representation of experts on maternal and infant health from organizations within the Department of Health and Human Services, has served as the focus and coordinating body within the federal government for service, research, and information efforts to address LBW and other causes of infant mortality in the United States. This group has worked to develop a broad national strategy to understand and effect improvements in LBW and IMR. Highlights of recent initiatives follow.

Efforts to improve coordination and effectiveness of health services have intensified. The National Governors' Association and HRSA are collaborating to assist states in implementing the current expanded Medicaid eligibility and coverage options. In a related activity, the Health Care Financing Administration and OMCH are working with the Medicaid/Maternal and Child Health Technical Advisory Group in promoting best practices for Medicaid and Title V programs at the state level. In a private/public partnership, the Robert Wood Johnson Foundation and OMCH are collaborating on grant initiatives in states with high infant mortality to support improved health care for pregnant women and their infants.

The prevention of LBW has been identified by the National Institute of Child Health and Human Development as a major research initiative. Research is focusing on mechanisms involved in premature labor and intrauterine growth retardation, evaluation of methods for preventing and treating disorders affecting LBW, and racial and ethnic differences in mortality and LBW.

A national system that links infant death and birth records is essential to the effective monitoring of trends and identification of high-risk populations. Therefore, a system for matching birth and death certificates has been implemented by NCHS. Also, a survey will be conducted by NCHS to collect data on births, fetal and infant deaths, national population estimates of maternal smoking and drinking, and access to prenatal care. Surveys on the nutritional status and on behaviors of mothers are being planned by some states in collaboration with CDC.

References

1. Public Health Service. Promoting health/preventing disease: objectives for the nation. Washington, DC: US Department of Health and Human Services, Public Health Service, 1980.

2. National Center for Health Statistics. Advance report of final natality statistics, 1985. Hyattsville, Maryland: National Center for Health Statistics, 1987; DHHS publication no. (PHS)87-1120. (Monthly vital statistics report; vol 36, no. 4, supplement).

3. National Center for Health Statistics. Advance report of final mortality statistics, 1985. Hyattsville, Maryland: National Center for Health Statistics, 1987; DHHS publication no. (PHS)87-1120. (Monthly vital statistics report; vol 36, no. 5, supplement).

4. National Highway Traffic Safety Administration. Restraint system usage in the traffic population: interim progress report. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1987; DOT contract no. DTNH2287-C-07081.

5. Fox SH, Koontz AM, Kessel SS. Smoking and heavy drinking during pregnancy: perceptions of risk and actual behavior reported in the 1985 NHIS. Presented at the 115th annual meeting of the American Public Health Association, New Orleans, Louisiana, October 18-22, 1987.

6. Infant Metabolic Diagnostic Laboratory. National screening status report. Infant Screening 1987;10:4-5.

7. US General Accounting Office. Prenatal care: Medicaid recipients and uninsured women obtain insufficient care. Washington, DC: US General Accounting Office, 1987; GAO document no. GAO/HRD-87-137.

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