10 Lecture 5-Great Achievements - Infant _ Maternal Health

10 Lecture 5-Great Achievements - Infant _ Maternal Health...

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Weekly October 01, 1999 / 48(38);849-858 Achievements in Public Health, 1900-1999: Healthier Mothers and Babies At the beginning of the 20th century, for every 1000 live births, six to nine women in the United States died of pregnancy-related complications, and approximately 100 infants died before age 1 year (1,2). From 1915 through 1997, the infant mortality rate declined greater than 90% to 7.2 per 1000 live births, and from 1900 through 1997, the maternal mortality rate declined almost 99% to less than 0.1 reported death per 1000 live births (7.7 deaths per 100,000 live births in 1997) (3) ( Figure 1 and Figure 2 ). Environmental interventions, improvements in nutrition, advances in clinical medicine, improvements in access to health care, improvements in surveillance and monitoring of disease, increases in education levels, and improvements in standards of living contributed to this remarkable decline (1). Despite these improvements in maternal and infant mortality rates, significant disparities by race and ethnicity persist. This report summarizes trends in reducing infant and maternal mortality in the United States, factors contributing to these trends, challenges in reducing infant and maternal mortality, and provides suggestions for public health action for the 21st century. Infant Mortality The decline in infant mortality is unparalleled by other mortality reduction this century. If turn- of-the-century infant death rates had continued, then an estimated 500,000 live-born infants during 1997 would have died before age 1 year; instead, 28,045 infants died (3). In 1900 in some U.S. cities, up to 30% of infants died before reaching their first birthday (1). Efforts to reduce infant mortality focused on improving environmental and living conditions in urban areas (1). Urban environmental interventions (e.g., sewage and refuse disposal and safe drinking water) played key roles in reducing infant mortality. Rising standards of living, including improvements in economic and education levels of families, helped to promote health. Declining fertility rates also contributed to reductions in infant mortality through longer spacing of children, smaller family size, and better nutritional status of mothers and infants (1). Milk pasteurization, first adopted in Chicago in 1908, contributed to the control of milkborne diseases (e.g., gastrointestinal infections) from contaminated milk supplies. During the first three decades of the century, public health, social welfare, and clinical medicine (pediatrics and obstetrics) collaborated to combat infant mortality (1). This partnership began with milk hygiene but later included other public health issues. In 1912, the Children's Bureau was formed and became the primary government agency to work toward improving maternal and infant welfare until 1946, when its role in maternal and child health diminished; the bureau was eliminated in 1969 (1). A proponent of the Children's Bureau was Martha May Eliot ( see box
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10 Lecture 5-Great Achievements - Infant _ Maternal Health...

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