The effect of maternal demographic factors on 1nfant mortality rates Summary of the findings of the Louisiana Infant Mortality Study. Part I
AJ\DREW B. DOTT, M.D., M.P.H. ARTHUR T. FORT. M.D. New Or/rans, Louisiana
Birth and infant death certificatPs fur Louisiana in 1972 were matched and reviewed to identify groups particularly in need of close medical support and counselling during the life phases of preparation for reproduction, gestation, and parenthood. From all recorded birth and infant death certificates for 1972 (69,556 birth and 1,541 death certificates) infant. neonatal, and postneonatal mortality rates were computed for maternal demographic (intrinsic patient physical and life-style characteristics) factors including age, rare, parity by age cohort, education, and legitimacy. Excessive infant deaths were found among illegitimate offspring, except in mothers less than 15 years of age or rwnu•hites o1•er 35 years of age; the less educated; those having too many children too soon; those of low birth weight; and whites relying on Charity Hospitals. An increased mortality rate was seen with nonwhites and with the younger and older mothers.
INFANT mortality rates and their counterpart, pennatal mortality rates. are widely accepted indices of medical, socioeconomic, and cultural attainment within and between populations. Physicians and public health officials have used these rates to point out areas or groups in need of special attention. Social activists and politicians have often used these data unfairly against the medical and health establishments hy overemphasizing the contribution of medical management or its lack in infant deaths. Unfortunately. the array of factors that contribute to infant death are complex and overlapping and have tended to encourage a one- or t\\·o-factor view of the problem. Presently, however,
there is emergmg a desire among both the health professionals and the public to expand this liniitedfactor view and to acknowledge that a single factor, such as obstetric anesthesia, maternal age. or maternal weight gain, seldom operates in isolation in effecting perinatal outcome. Likewise, it is unfair and unscientific to criticize only the health-care delivery system, the health education curriculum, or tht' social st'rvict' system as the sole cause for maternal ill health and infant death. Rather, it is important to see how these multifaceted factors interact to bring about success or failure in reproduction and childrearing. As these factors and their interactions are better understood, we can develop a more realistic strategy for successfullv modifying them. Three broad categories of factors can be developed to facilitate systematic analysis: these are ( 1) intrinsic patient factors such as life-style in terms of maternal age, child spacing, legitimacy, educational attainment, socioeconomic status. and race: (2) health-care delivery factors such as the availability and utilization of prenatal clinics, hospitals, and medical personnel; and (3) the quality of medical care. Most analyses of morbidity and mortality rates of the infant have
From the Tulane University School of Public Health and THJpiudl'vfedit·ine, Division of l'vfaternal and Child Htalth. This research wa; funded in part by grant MCT-000123012, United States Public Health Service, and by the Loui,iana Family Planning Program. Rereived for publication August 12, 1974. Revised Noz•ember 15, 1974. Accepttd Derembrr 16, 1974. Reprint requests: Andrew B. Dott, M.D., 1521 Frrn St., _,Vrw Orlrans, Louisiana 70118.
concentrated on this third factor. ()ptirnal rnedica1 care
847
848
Dott and Fort
lk«·mlwr
.-\m.
Table I. Summan ol available data-btrthideath certificates. Louisiana. Jl)7~ Birth. Date Se'< Race PlatT
Parit1 Bin h 11cight Plcuralit1
\laternalcd. Paternal l'd. Lt·gitimac 1 Hospital
1'\.t""."'JUClllt"
Hu~pital
.-\gc
Race
Diagnosis
Plate
Residenn· l\laternal age Prenatal 1·isit Attendant status
IJtllih: 1"\ .. , __
lhlll.
Se'
AJ\DREW B. DOTT, M.D., M.P.H. ARTHUR T. FORT. M.D. New Or/rans, Louisiana
Birth and infant death certificatPs fur Louisiana in 1972 were matched and reviewed to identify groups particularly in need of close medical support and counselling during the life phases of preparation for reproduction, gestation, and parenthood. From all recorded birth and infant death certificates for 1972 (69,556 birth and 1,541 death certificates) infant. neonatal, and postneonatal mortality rates were computed for maternal demographic (intrinsic patient physical and life-style characteristics) factors including age, rare, parity by age cohort, education, and legitimacy. Excessive infant deaths were found among illegitimate offspring, except in mothers less than 15 years of age or rwnu•hites o1•er 35 years of age; the less educated; those having too many children too soon; those of low birth weight; and whites relying on Charity Hospitals. An increased mortality rate was seen with nonwhites and with the younger and older mothers.
INFANT mortality rates and their counterpart, pennatal mortality rates. are widely accepted indices of medical, socioeconomic, and cultural attainment within and between populations. Physicians and public health officials have used these rates to point out areas or groups in need of special attention. Social activists and politicians have often used these data unfairly against the medical and health establishments hy overemphasizing the contribution of medical management or its lack in infant deaths. Unfortunately. the array of factors that contribute to infant death are complex and overlapping and have tended to encourage a one- or t\\·o-factor view of the problem. Presently, however,
there is emergmg a desire among both the health professionals and the public to expand this liniitedfactor view and to acknowledge that a single factor, such as obstetric anesthesia, maternal age. or maternal weight gain, seldom operates in isolation in effecting perinatal outcome. Likewise, it is unfair and unscientific to criticize only the health-care delivery system, the health education curriculum, or tht' social st'rvict' system as the sole cause for maternal ill health and infant death. Rather, it is important to see how these multifaceted factors interact to bring about success or failure in reproduction and childrearing. As these factors and their interactions are better understood, we can develop a more realistic strategy for successfullv modifying them. Three broad categories of factors can be developed to facilitate systematic analysis: these are ( 1) intrinsic patient factors such as life-style in terms of maternal age, child spacing, legitimacy, educational attainment, socioeconomic status. and race: (2) health-care delivery factors such as the availability and utilization of prenatal clinics, hospitals, and medical personnel; and (3) the quality of medical care. Most analyses of morbidity and mortality rates of the infant have
From the Tulane University School of Public Health and THJpiudl'vfedit·ine, Division of l'vfaternal and Child Htalth. This research wa; funded in part by grant MCT-000123012, United States Public Health Service, and by the Loui,iana Family Planning Program. Rereived for publication August 12, 1974. Revised Noz•ember 15, 1974. Accepttd Derembrr 16, 1974. Reprint requests: Andrew B. Dott, M.D., 1521 Frrn St., _,Vrw Orlrans, Louisiana 70118.
concentrated on this third factor. ()ptirnal rnedica1 care
847
848
Dott and Fort
lk«·mlwr
.-\m.
Table I. Summan ol available data-btrthideath certificates. Louisiana. Jl)7~ Birth. Date Se'< Race PlatT
Parit1 Bin h 11cight Plcuralit1
\laternalcd. Paternal l'd. Lt·gitimac 1 Hospital
1'\.t""."'JUClllt"
Hu~pital
.-\gc
Race
Diagnosis
Plate
Residenn· l\laternal age Prenatal 1·isit Attendant status
IJtllih: 1"\ .. , __
lhlll.
Se'
