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infants during the first month of life. The leading causes of infant mortality during the first 4 weeks of life are prematurity (early gestational age), low birthweight (less than 2,500 g), and congenital anomalies. Approximately 80% of infants who die within 48 hours after birth weigh less than 2,500 g (5.5 lb). The proportion of infants born with low birthweight is about 7% of all births. This number rises slightly each year as better prenatal care allows infants who would have died in utero (fetal death) to be born and survive (Martin et al., 2005). Perinatal Death Rate The perinatal period is defined in a number of ways. Statistically, the period is defined as the time beginning when the fetus reaches 500 g (about week 20 of pregnancy) and ending about 4 to 6 weeks after birth. The perinatal death rate is the sum of the fetal and neonatal rates. Maternal Mortality Rate The maternal mortality rate is the number of maternal deaths that occur as a direct result of the reproductive process per 100,00 live births. Early in the 20th century, this rate in the United States reached levels as high as 600 10 UNIT 1 Maternal and Child Health Nursing Practice BOX 1.5 FOCUS ON . . . 11 NATIONAL HEALTH GOALS NATIONAL HEALTH GOALS Leading Health Indicators Physical Activity Regular physical activity throughout life is important for maintaining a healthy body, enhancing psychologic wellbeing, and preventing premature death. The objectives selected to measure progress in this area are: • Increase the proportion of adolescents who engage in vigorous physical activity that promotes cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion. • Increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per day. Overweight and Obesity Overweight and obesity are major contributors to many preventable causes of death. The objectives selected to measure progress in this area are: • Reduce the proportion of children and adolescents who are overweight or obese. • Reduce the proportion of adults who are obese. Tobacco Use Cigarette smoking is the single most preventable cause of disease and death in the United States. Smoking results in more deaths each year in the United States than AIDS, alcohol, cocaine, heroin, homicide, suicide, motor vehicle crashes, and fires—combined. The objectives selected to measure progress in this area are: • Reduce cigarette smoking by adolescents. • Reduce cigarette smoking by adults. Substance Abuse Alcohol and illicit drug use are associated with many of this country’s most serious problems, including violence, injury, and HIV infection. The objectives selected to measure progress in this area are: • Increase the proportion of adolescents not using alcohol or any illicit drugs during the past 30 days. • Reduce the proportion of adults using any illicit drug during the past 30 days. • Reduce the proportion of adults engaging in binge drinking of alcoholic beverages during the past month. Responsible Sexual Behavior Unintended pregnancies and sexually transmitted diseases (STDs), including infection with the human immunodeficiency virus that causes AIDS, can result from unprotected sexual behavior. The objectives selected to measure progress in this area are: • Increase the proportion of adolescents who abstain from sexual intercourse or use condoms if currently sexually active. • Increase the proportion of sexually active persons who use condoms. Mental Health Approximately 20% of the U.S. population is affected by mental illness during a given year; no one is immune. Of all mental illnesses, depression is the most common disorder. More than 19 million adults in the United States suffer from depression. Major depression is the leading cause of disability and is the cause of more than two thirds of suicides each year. The objective selected to measure progress in this area is: • Increase the proportion of adults with recognized depression who receive treatment. Injury and Violence More than 400 Americans die each day from injuries, due primarily to motor vehicle crashes, firearms, poisonings, suffocation, falls, fires, and drowning. The risk of injury is so great that most persons sustain a significant injury at some time during their lives. The objectives selected to measure progress in this area are: • Reduce deaths caused by motor vehicle crashes. • Reduce homicides. Environmental Quality An estimated 25% of preventable illnesses worldwide can be attributed to poor environmental quality. In the United States, air pollution alone is estimated to be associated with 50,000 premature deaths and an estimated $40 billion to $50 billion in health-related costs annually. The objectives selected to measure progress in this area are: • Reduce the proportion of persons exposed to air that does not meet the U.S. Environmental Protection Agency’s health-based standards for ozone. • Reduce the proportion of nonsmokers exposed to environmental tobacco smoke. Immunization Vaccines are among the greatest public health achievements of the 20th century. Immunizations can prevent disability and death from infectious diseases for individuals and can help control the spread of infections within communities. The objectives selected to measure progress in this area are: • Increase the proportion of young children who receive all

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