Family planning issues relating to maternal and infant mortality in the United States.

Both maternal and infant death rates in the United States are much higher than in many developed countries. The interrelationships between abortions and maternal and infant mortality have been analyzed on the basis of data from the 1970s and 1980s. The legalization of abortions in 1973 resulted in a marked increase in legal abortions and marked reductions in maternal and infant mortality over the course of the 1970s. However, a wide variation in abortion rates and in the number of abortion facilities indicates that such facilities were not readily available to all segments of the population in some areas. This probably accounts in part for higher maternal and infant death rates in such areas. Smoking, small weight gain, use of alcohol and drugs in pregnancy, and excessive maternal youth or age affected the outcome of pregnancy and contributed to high rates of infant death. Infant death rates were especially high among newborns of teenagers and young adult mothers; relatively high proportions of these newborns had low birthweights; a large share of the pregnancies involved were unintended; and slightly over half of the unintended pregnancies in teenagers and young women resulted in abortion. Comparisons with findings in Sweden reveal that the rates of unplanned pregnancy, abortion, and infant mortality were all much higher in the United States than in Sweden. The differences are attributed to better contraceptive services, which were made available free or very inexpensively in Sweden. Also, the frequency of low weight births was much lower in Sweden.

PIP: Trends in maternal mortality, abortion, and infant mortality in the US are summarized and compared to findings in Sweden, and preventive strategies are offered for reducing maternal and infant mortality and the number of abortions through family planning (FP). The US has much higher rates of maternal and infant mortality than many developed countries. The US maternal death rate in 1983 was 8/100,000 compared to 4/100,000 in Denmark, Norway, and Sweden. Evidence is presented to show the extent of deaths attributed to illegal abortion in the US and in major cities worldwide. Selected investigations of reporting on death certificate forms showed higher maternal mortality than actually recorded on death certificates. The causes of maternal mortality center on unintentional or unwanted pregnancies, which frequently end in abortion. There are 500,000 maternal deaths annually in the world, of which 100,000-200,000 are attributed to poorly performed or illegal abortions. The availability of FP programs, educational programs, and provision of facilities for women with unwanted pregnancies would greatly reduce of facilities for women with unwanted pregnancies would greatly reduce the frequency of abortions and maternal death. After legalization of abortion in the US in 1973, there was a rapid rise in the number of abortions performed and a decline in the maternal death rate, which varied regionally. Data also revealed that teenagers accounted for 25.8% of reported legal abortion in 1987, and young women aged 30-34 accounted for 33.4%. These rates were considerably higher by age group than rates in Sweden. Data on pregnancy intention showed that unintended pregnancy was high among poverty groups and teenagers. Planned pregnancy was much higher in Sweden, where contraceptive services are widely available, confidential, and free or very inexpensive. Birthweight was also examined and found to vary with weight gain in pregnancy, prenatal care, and use of alcohol and drugs. The infant mortality rate was highest among teenagers and young adults. Information on FP practices in the US and Sweden revealed that FP needs to be extended to teenagers and young adults in the US, along with preventive and educational programs. The estimated per capita cost of a safe motherhood program would be $1.50/year or .5% of gross national product. Maternal mortality would be reduced by 65% and infant mortality by 80%.

[New approaches for epidemiologic studies of mortality statistics]. / Nuevos enfoques para los estudios epidemiológicos sobre estadísticas de mortalidad.

This report presents examples of studies done in the United States on multiple causes of death in adults in all age groups, in infants under one year, and in children. Some studies dealing with multiple factors related to infant mortality are also cited. The multiple cause approach is increasingly being applied to the analysis of mortality statistics, but more work is required to incorporate this new knowledge into the health planning process.

New approaches for epidemiologic studies of mortality statistics.

Finding and analyzing multiple causes of death-rather than single causes-has major epidemiologic advantages. Besides helping to reveal the magnitude of the causes or morbid conditions leading to death, it also demonstrates that deaths are usually the result of several simultaneous or sequential causes. This article reviews ways that multiple cause of death data have been analyzed in order to improve our knowledge of these causes and other relevant health factors.

Results of the Inter-American Investigations of Mortality relating to reproduction.

Maternal age and parity, according to the findings of the Inter-American Investigation of Mortality in Childhood, have a direct relationship to the health and survival of the infant. Among the results of this broad undertaking are data suggesting that babies born close in succession, especially within large families and as birth order ascends, are at greater risk of dying. Also, the offspring's future is increasingly threatened as the mother's age tends toward the extremes of the childbearing years. Compromise of the mother's health, in turn, was indicated in the earlier Investigation, a study of deaths in adults, which revealed unexpectedly high maternal mortality in the Latin American cities that it covered. Immaturity, or low birthweight, and malnutrition emerged as the two major underlying or associated causes of death in the Latin American projects of the Inter-American Investigation of Mortality in Childhood. Despite the marked variations in the data available from the different areas, there appeared to be some correlation between these two indicators of deficits in growth and development. Mortality due to immaturity was especially high for babies of young mothers, with increases occurring as the birth order rose. Not only are the risks greater for mothers having low-weight babies when they are young (under 20), but they increase even more with the second, third, and fourth products when the birth intervals become shorter. Maternal age, birth order, and birthweight are factors that must be considered in combination in the programming of protective health measures.

Results of the Inter-American Investigations of Mortality relating to reproduction

Maternal age and parity, according to the findings of the Inter-American Investigation of Mortality in Childhood, have a direct relationship to the health and survival of the infant. Among the results of this broad undertaking are data suggesting that babies born close in succession, especially within large families and as birth order ascends, are at greater risk of dying. Also, the offspring's future is increasingly threatened as the mother's age tends toward the extremes of the childbearing years. Compromise of the mother's health, in turn, was indicated in the earlier Investigation, a study of deaths in adults, which revealed unexpectedly high maternal mortality in the Latin American cities that it covered. Immaturity, or low birthweight, and malnutrition emerged as the two major underlying or associated causes of death in the Latin American projects of the Inter-American Investigation of Mortality in Childhood. Despite the marked variations in the data available from the different areas, there appeared to be some correlation between these two indicators of deficits in growth and development. Mortality due to immaturity was especially high for babies of young mothers, with increases occurring as the birth order rose. Not only are the risks greater for mothers having low-weight babies when they are young (under 20), but they increase even more with the second, third, and fourth products when the birth intervals become shorter. Maternal age, birth order, and birthweight are factors that must be considered in combination in the programming of protective health measures (Au)

Results of the Inter-American Investigations of Mortality relating to reproduction

Maternal age and parity, according to the findings of the Inter-American Investigation of Mortality in Childhood, have a direct relationship to the health and survival of the infant. Among the results of this broad undertaking are data suggesting that babies born close in succession, especially within large families and as birth order ascends, are at greater risk of dying. Also, the offspring's future is increasingly threatened as the mother's age tends toward the extremes of the childbearing years. Compromise of the mother's health, in turn, was indicated in the earlier Investigation, a study of deaths in adults, which revealed unexpectedly high maternal mortality in the Latin American cities that it covered. Immaturity, or low birthweight, and malnutrition emerged as the two major underlying or associated causes of death in the Latin American projects of the Inter-American Investigation of Mortality in Childhood. Despite the marked variations in the data available from the different areas, there appeared to be some correlation between these two indicators of deficits in growth and development. Mortality due to immaturity was especially high for babies of young mothers, with increases occurring as the birth order rose. Not only are the risks greater for mothers having low-weight babies when they are young (under 20), but they increase even more with the second, third, and fourth products when the birth intervals become shorter. Maternal age, birth order, and birthweight are factors that must be considered in combination in the programming of protective health measures (Au)