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pubmed:otherAbstract |
PIP: The solution to the problem of infant mortality in the U.S. is not medical but social, economic and environmental. In the U.S., 70% of infant mortality is neonatal, death in the 1st month of life, due to factors in pregnancy and delivery. The remainder of mortality is primarily related to socio-economic factors such as poverty, poor housing, lack of supervision. The 1st aspect of pregnancy is prenatal care. All European countries mandate from 4 to 30 visits of prenatal care. Women not attending are followed up by home visits. There is no evidence that the quantity of care affects mortality: WHO suggests the minimal number of medical appointments combined with other forms of social support. The 2nd aspect is maternity protection, meaning child allotments, transfer to a less strenuous job during pregnancy, parental leave, assured re-employment, time off for breastfeeding, day care, and even more liberal benefits for single parents. It might be cost-effective for the U.S. to give maternity protection a higher priority than costly prenatal care. The 3rd aspect of pregnancy and birth is operative intervention in delivery. The U.S. has several times the cesarean section rate of European countries with low infant mortality: 2 times that of Sweden and 3 times that of Holland. Surgical intervention does not contribute any demonstrable benefit to infant survival. The excess cesarean sections in the U.S., compared to Sweden and Holland, amount to $2-3 billion yearly. Furthermore, in Europe 70% of all births are attended by professional midwives, who assist the woman with a social, non-interventionist clinical approach. Without a strong, independent midwifery profession, the U.S. suffers from excess intervention, its attendant risks, and serious malpractice suits. Clearly what is needed is not more dollars spent on medically-oriented prenatal and obstetric care, but a shift in priorities toward social and financial support for pregnant women. The U.S. needs far less money spent on surgical obstetrics, and more resources invested in a large, strong, independent midwifery profession.
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