Journal Issue: U.S. Health Care for Children Volume 2 Number 2 Winter 1992
The authors of this paper focus on the health care services received by pregnant women and infants, and consider the ways in which these services affect child health outcomes. They examine the impact of prenatal, obstetrical, and neonatal care on two measures of infant health: the rate of low birth weight births and the rate of infant mortality. There is strong evidence that these two outcomes respond favorably to the application of appropriate health services, particularly prenatal care and neonatal intensive care. The delivery of prenatal care in the United States needs improvement: slightly more than 76% of women received early care in 1989, and discrepancies in prompt receipt of care among different ethnic and economic groups are large and persistent. Improved distribution of prenatal care services could have a significant impact on the rate of low birth weight births and infant deaths. In addition, expanded regionalization of prenatal, obstetric, and neonatal care in a coordinated approach to the entire continuum of gestation, labor, delivery, and early development holds out the promise of continued improvement in infant health. Health care initiatives need to focus more on the needs of poor families and of mothers and infants with special problems, especially high-risk pregnancies resulting from maternal substance abuse and pregnancies complicated by HIV infection. The authors describe advances in obstetrical technology and neonatology, and conclude that efforts to identify programs and activities which offer the greatest potential for improving newborn survival with the least investment should have high priority.