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years of age. CHAPTER 1 A Framework for Maternal and Child Health Nursing 13 1960 3 4 6 8 10 20 40 Rate per 1,000 women in specified group 60 80 100 300 200 1965 1970 1975 1980 1985 1990 1995 2000 2005 20–24 years 30–34 years 18–19 years 35–39 years 40–44 years 15–17 years 15–19 years 25–29 years NOTE: Rates are plotted on a log scale. FIGURE 1.2 Birth rates by age of mother: United States, 1960–2004. (National Center for Health Statistics. [2004]. Births, marriages, divorces and deaths. National Vital Statistics Report, 49(1), 6.) 1950 0 10 20 30 40 50 60 70 80 90 1960 1970 1980 Maternal deaths per 100,000 live births 1990 2000 2005 FIGURE 1.3 Maternal mortality rates, 2004. (National Center for Health Statistics. [2004]. National Vital Statistics Report, 50(1), 3.) mothers, unequal provision of health care, and the higher percentage of low-birthweight babies born to AfricanAmerican women: 12%, compared with approximately 5% for white and Asian women (NCHS, 2005). Despite this negative trend, the overall steady drop in total infant mortality is encouraging (Martin et al., 2005) (Fig. 1.4). The infant mortality rate also varies greatly from state to state within the United States (Table 1.4). For example, in the District of Columbia, the area with the highest infant mortality, the rate is more than two times that in Massachusetts, the state with the lowest rate. Table 1.5 shows the ranking of the United States compared with other developed countries. One would expect that a country such as the United States, which has one of the highest gross national products in the world and is known for its technological capabilities, would have the lowest infant mortality rate. However, in 2000, the U.S. infant mortality rate was higher than that of 27 other countries (United Nations, 2000). One factor that may contribute to national differences in infant mortality is the type of health care available. In Sweden, for example, a comprehensive health care program provides free maternal and child health care to all residents. Women who attend prenatal clinics early in pregnancy receive a monetary award; this almost guarantees that all women will come for prenatal care. Many people believe that a guaranteed health care system such as this would lead to lower infant mortality in the United States. 14 UNIT 1 Maternal and Child Health Nursing Practice 5 6 21. United Kingdom 5 6 22. Ireland 6 6 23. Israel 6 6 24. Luxembourg 6 6 25. New Zealand 6 6 26. Greece 6 7 27. Portugal 6 7 28. United States 7 7 United Nations Statistics Division. (2000). Infant mortality. The world’s women 2000: Trends and statistics. New York: Author. Fortunately, the proportion of pregnant women who receive prenatal care in the United States is increasing (about 80% now begin care in the first trimester). Early prenatal care is important, because it identifies potential risks and allows preventive strategies to help reduce complications of pregnancy. The United States also differs from other countries in the increased number of infants born to adolescent mothers (30% of infants are born to mothers younger than 20 years of age). Because teenage pregnancy leads to increased premature births, this may result in infants being born who are not as well prepared as others to face extrauterine life. The main causes of early infant death in the United States are problems that occur at birth or shortly thereafter. Prematurity, low birthweight, congenital anomalies, sudden infant death syndrome, and respiratory distress syndrome are major causes. Although other factors that contribute to sudden infant death syndrome are yet to be determined, the recommendation to place infants on their back or side to sleep, made by the American Academy of Pediatrics in 1992, has led to an almost 50% decrease in its incidence (Daley, 2004). Before antibiotics and formula sterilization practices became available, gastrointestinal disease was a leading cause of infant death. By advocating breast-feeding and Checkpoint Question 2 Nursing is changing because social change affects care. Which of the following is a trend that is occurring in nursing because of social change? a. So many children are treated in ambulatory units that nurses are hardly needed. b. Immunizations are no longer needed for infectious diseases. c. The use of skilled technology has made nursing care more complex. d. Pregnant women are so healthy today that they rarely need prenatal care. ✔ Childhood Mortality Rate Like the infant mortality rate, the childhood mortality rate in the United States is also declining. In 1980, for example, the mortality rate was about 6.4% for children aged 1 to 4 years and 3.1% for children aged 4 to 14 years; today, it is 3.0% and 1.8%, respectively (NCHS, 2005). The risk of death in the first year of life is higher than that in any other year before age 55. Children in the prepubescent period (age 5 to 14 years) have the lowest mortality rate of any child age group (NCHS, 2005). The most frequent causes of childhood death are shown in Box 1.7. Motor vehicle accidents remain the leading cause of death in children, although many of these accidents are largely preventable through education about the value of car seats and seat belt use, the dangers of drinking/ drug abuse and driving, and the importance of pedestrian safety. A particularly disturbing mortality statistic is the high
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