In the United States, an estimated 11,300 babies die each year on the day they are born, according to a new report from Save the Children. The United States has the highest first-day death rate in the industrialized world and, combining that rate with its large population, it has 50% more first-day deaths than all other industrialized countries combined. The alarming report has clear implications for U.S. policy, particularly the importance of investing in and expanding the reach of programs like Medicaid and Title X that make affordable pregnancy-related care and family planning services available to millions of women otherwise unable to obtain such care.
First-day deaths have many contributing factors, according to the report, including preterm, unplanned and teen births. One in eight U.S. babies—a total of over half a million births each year—are born prematurely and U.S. preterm births rank second only to Cyprus in the industrialized world. The report also notes that half of all U.S. pregnancies are unintended and that the U.S. adolescent birth rate is the highest among industrialized countries—with teenage mothers tending to be poorer, less educated and receiving less prenatal care than older mothers.
Clearly, a complex problem like the high rate of U.S. infant deaths—as well as the closely related challenge of the high U.S. maternal death rate—requires comprehensive efforts to reduce pervasive economic, social and health disparities. Improving access to high-quality, affordable maternity care for all women regardless of income or background has to be a major national priority. Another key component of a broad-based approach is making effective family planning available to every woman who needs it—a proven intervention that offers direct and positive effects on newborns' and mothers' health. According to U.S. and international studies, there is a causal link between proper birth spacing and three major measures of birth outcomes: low birth weight, preterm birth and small size for gestational age.
In addition, according to a 2008 literature review, numerous U.S. and European studies have found an association between pregnancy intention and delayed initiation of prenatal care. This is partly because women are less likely to recognize a pregnancy early if it is unplanned. Early recognition of pregnancy also affects the frequency of prenatal care visits. Furthermore, compared with children born from intended pregnancies, those born from unintended pregnancies are less likely to be breast-fed at all or for a long duration. Breast-feeding, in turn, has been linked with numerous positive outcomes throughout a child's life.
Contraception has also been the main driver behind declines in the U.S. teen birth rate, which reached a record low in 2010. The U.S. teen birth rate—while still the highest among industrialized countries—has declined for nearly two decades and the 2010 rate represents a 44% drop from the 1991 rate. Likewise, contraception's impact on unintended pregnancy may also be seen in the significant benefits of publicly funded family planning services. Together, the services supported by Medicaid, Title X and other public programs help women avoid 1.94 million unintended pregnancies each year, which would otherwise result in 860,000 unplanned births and 810,000 abortions. In the absence of this public effort, levels of unintended pregnancy would be nearly two-thirds higher among U.S. women overall and among teens—and close to twice as high among poor women.
As the Save the Children report underscores once more, it is crucial to protect and invest in the programs that are needed to ensure that all women, regardless of income or background, can access the affordable care they need to have healthier pregnancies and births. Ideological and fiscal attacks against these programs are not only counterproductive, but threaten to worsen what is already a severe crisis for U.S. women and newborns.
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