Declining Decline in Infant Deaths

For all its wealth and scientific progress, the U.S. ranks below at least eleven other nations in its ability to help infants survive their first year of life. During that first twelve months, 23.8 out of every 1,000 U.S. babies die, compared with 12.6 in Sweden, 14.7 in The Netherlands. Among other nations ranking ahead of the U.S.: Denmark with 17 deaths per 1,000, Switzerland with 17.2, Japan with 18.3, and France with 21.7. Among the worst: Guatemala with 91.5.

It wasn't always that way. From 1936 through 1950, the infant-mortality rate in the U.S. dropped from 57.1 to 29.2 per 1,000, an improvement of 49% that placed it sixth. Then the descending curve leveled off. By 1955, the U.S. had slipped to eighth place on the list. Since then, while other nations have achieved dramatic reductions, the U.S. rate has declined at an average of only .83% per year, pushing the nation even farther down the list.

Trouble in the Cities. A principal reason is poverty--and since poverty afflicts a disproportionate number of Negroes, the problem also involves race. Where money and medical care are available, infant mortality drops far below the national average, according to a county-by-county survey released this year by the Department of Health, Education and Welfare's Children's Bureau. Fiftysix, or less than 2% of all the counties studied, HEW pointed out, account for an unusually significant proportion of the nation's infant deaths. Included in the 56 are all but one of the U.S. cities with more than 500,000 population and the country's largest Negro and white ghettos.

Behind the statistics is an obvious shift in U.S. population. Poor nonwhites have been migrating to the cities. Middle-class whites have moved to the suburbs, leaving behind degenerating medical facilities in deteriorating communities. Under such conditions, families tend to disintegrate and unwanted children get ignored and neglected. The result has been a decline in prenatal and postnatal care in areas where it is needed most.

Explaining the Gap. Chief among the direct causes of infant death are respiratory malfunction, low birth weight, premature birth, and congenital malformations of the circulatory, digestive and central nervous systems. Some of these factors are genetic, and irreversible. Thus there is a limit beyond which infant mortality cannot be reduced. Nonetheless, 320 U.S. counties have achieved a lower rate of 18.3 deaths per 1,000 births. Poor maternal health, malnutrition, inadequate sanitation and illegitimacy, predictably most prevalent in low-income communities, are also important factors. In Holland and Denmark, which have had a virtually uninterrupted decline in infant mortality since 1950, comprehensive mother and infant care has become a tradition. Some medical experts attribute part of the gap between U.S. and Scandinavian rates of decline to a greater European use of legal abortion and family planning.

To help more U.S. infants survive, Congress has authorized $35 million for maternity and infant care in fiscal 1968. And HEW hopes to set up and train a corps of physicians' assistants to provide more thorough care to mothers and infants in low-income areas.

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