Family planning issues relating to maternal and infant mortality in the United States

Abstract

Both maternal and infant death rates in the United States are much higher than in many developed countries. The interrelationships between abortions and maternal and infant mortality have been analyzed on the basis of data from the 1970s and 1980s. The legalization of abortions in 1973 resulted in a marked increase in legal abortions and marked reductions in maternal and infant mortality over the course of the 1970s. However, a wide variation in abortion rates and in the number of abortion facilities indicates that such facilities were not readily available to all segments of the population in some areas. This probably accounts in part for higher maternal and infant death rates in such areas. Smoking, small weight gain, use of alcohol and drugs in pregnancy, and excessive maternal youth or age affected the outcome of pregnancy and contributed to high rates of infant death. Infant death rates were especially high among newborns of teenagers and young adult mothers; relatively high proportions of these newborns had low birthweights; a large share of the pregnancies involved were unintended; and slightly over half of the unintended pregnancies in teenagers and young women resulted in abortion. Comparisons with findings in Sweden reveal that the rates of unplanned pregnancy, abortion, and infant mortality were all much higher in the United States than in Sweden. The differences are attributed to better contraceptive services, which were made available free or very inexpensively in Sweden. Also, the frequency of low weight births was much lower in Sweden.

PIP: Trends in maternal mortality, abortion, and infant mortality in the US are summarized and compared to findings in Sweden, and preventive strategies are offered for reducing maternal and infant mortality and the number of abortions through family planning (FP). The US has much higher rates of maternal and infant mortality than many developed countries. The US maternal death rate in 1983 was 8/100,000 compared to 4/100,000 in Denmark, Norway, and Sweden. Evidence is presented to show the extent of deaths attributed to illegal abortion in the US and in major cities worldwide. Selected investigations of reporting on death certificate forms showed higher maternal mortality than actually recorded on death certificates. The causes of maternal mortality center on unintentional or unwanted pregnancies, which frequently end in abortion. There are 500,000 maternal deaths annually in the world, of which 100,000-200,000 are attributed to poorly performed or illegal abortions. The availability of FP programs, educational programs, and provision of facilities for women with unwanted pregnancies would greatly reduce of facilities for women with unwanted pregnancies would greatly reduce the frequency of abortions and maternal death. After legalization of abortion in the US in 1973, there was a rapid rise in the number of abortions performed and a decline in the maternal death rate, which varied regionally. Data also revealed that teenagers accounted for 25.8% of reported legal abortion in 1987, and young women aged 30-34 accounted for 33.4%. These rates were considerably higher by age group than rates in Sweden. Data on pregnancy intention showed that unintended pregnancy was high among poverty groups and teenagers. Planned pregnancy was much higher in Sweden, where contraceptive services are widely available, confidential, and free or very inexpensive. Birthweight was also examined and found to vary with weight gain in pregnancy, prenatal care, and use of alcohol and drugs. The infant mortality rate was highest among teenagers and young adults. Information on FP practices in the US and Sweden revealed that FP needs to be extended to teenagers and young adults in the US, along with preventive and educational programs. The estimated per capita cost of a safe motherhood program would be $1.50/year or .5% of gross national product. Maternal mortality would be reduced by 65% and infant mortality by 80%.