Infant Mortality: Policy Implications

Some of the leading causes of infant mortality are preventable, or their risks can be addressed through public policy. While California policy currently promotes newborn screenings for potentially fatal birth defects (1), not all women understand the screening options, what the results mean, and/or how to follow up on the results. Public and institutional policy also can affect the risk and protective factors for Sudden Infant Death Syndrome (SIDS) and for prematurity, which can lead to infant death. Risks of prematurity can be reduced by avoiding smoking and substance use while pregnant, forgoing non-medically indicated preterm induction of labor or cesarean birth, and participating in comprehensive prenatal care programs. (4, 5, 6) 

According to research and subject experts, policy options that could influence infant mortality include: 

• Increasing public education about newborn screenings and ensuring funding for those screenings, as screenings can prevent infant death, brain damage, and serious illness (1)
• Enhancing public education about how to reduce SIDS risk among a wide constellation of potential caregivers for infants; primary recommendations include avoiding sleeping on the stomach, overheating, overly soft and loose bedding, co-sleeping with an adult, and maternal smoking during pregnancy (2)
• Sustaining adequate funding for universal screening for substance use among pregnant women, and for treatment services specifically designed for pregnant women who use alcohol or illicit drugs (3, 4)
• Supporting public education and systems change to reduce the number of non-medically indicated induced preterm deliveries and cesareans (5, 6)
• Supporting expanded research, education and demonstration projects aimed at reducing the rates of preterm labor and delivery

For more policy ideas and research on this topic, see kidsdata.org’s Research & Links section, or visit the Centers for Disease Control and Prevention and the March of Dimes. Also see policy implications on kidsdata.org for Prenatal Care, Low Birthweight and Preterm Births, and Health Care. 

Sources for this narrative:

1. California Newborn Screening Program, http://www.cdph.ca.gov/programs/nbs/Pages/default.aspx
2. American Academy of Pediatrics. (2005). “Policy Statement: The Changing Concept of Sudden Infant Death Syndrome.” Pediatrics, 115 (5): 1245. http://pediatrics.aappublications.org/cgi/reprint/116/5/1245?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=SIDS+Risk+
   Reduction&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=
   relevance&resourcetype=HWCIT
3. Chasnoff, et al. (2008). Perinatal Substance Use Screening in California. (NTI Upstream). http://www.adp.cahwnet.gov/Alcohol/pdf/PerinatalSubstanceUseSR.pdf
4. Brady, et al. (2005). Women in Substance Abuse Treatment: Results from the Alcohol and Drug Services Study (ADSS). (US Department of Health and Human Services). http://oas.samhsa.gov/WomenTX/WomenTX.htm#2.4
5. March of Dimes. (2010). Elimination of Non-Medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age. (California Maternal Quality Care Collaborative, California Department of Public Health). http://www.cdph.ca.gov/programs/mcah/Documents/MCAH-EliminationOfNon-MedicallyIndicatedDeliveries.pdf
6. Fleischman. (2010). What Happens When Babies are Born Too Early? (March of Dimes Foundation, Testimony before the US House of Representatives: Prematurity and Infant Mortality). http://www.modimes.org/advocacy/prevention_indepth.html