While widely known for spending the most dollars per capita on health care in the world, the United States is lagging behind World Health Organization's (WHO) Millennium Development Goals (MDG) for women's health and child mortality, with Philadelphia, the nation's fifth largest city losing ground.
According to new research gathered by the University of Pennsylvania School of Nursing, infant mortality rates have been consistently higher than the U.S. and Pennsylvania from 2000 to 2005, with African American infants falling within a 2-3 times greater risk of dying in their first year of life than any other racial or ethnic group within the city. The WHO has established eight MDGs, two of which directly impact health for women and their children: Goal 5 -- Improve Maternal Health and Goal 4 -- Reduce Child Mortality.
"Philadelphia, if representative of the nation, shows us that there are major improvements that need to be made system-wide to provide the best healthcare to all of the city's residents," said William McCool, PhD, CNM, RN, FACNM, the Term Associate Professor in Women's Health and Nurse Midwifery at Penn Nursing and the study's lead investigator.
In a period where the number of Philadelphia hospitals available to laboring Moms to give birth were reduced from 19 to only six, the numbers of preterm babies born in the city continued at a rate almost a third higher when compared to Pennsylvania as a whole, and 40% higher than the national average. Because preterm deliveries are known to lead to possible long-term consequences both to the health of the infants and to the overburdening of the healthcare system, their impact extends well beyond the costs associated with longer hospital stays for these newborns at the beginning of their lives. Perhaps most alarming for the city is that the number of African-American babies born prematurely has continued at a rate at least 40% higher than that of white Philadelphians.
The new findings by University of Pennsylvania School of Nursing researchers found that birthrates for preterm babies were 40% higher in Philadelphia than in Pennsylvania and 32% higher than in the nation between 1997 and 2008, as reported in the October issue of the journal Midwifery. Between roughly the same period (1997 to 2010), the number of maternity wards dropped from 19 to six while the overall numbers of births in the city has increased.
"While we cannot know definitively if closing hospitals contributed to the continuing high numbers of preterm births, it stands to reason that families in Philadelphia, especially the poorest, have had increasing difficulty getting access to care," said Dr. McCool. "What is perhaps most troubling is that the remaining six hospitals offering labor and delivery care are located within six miles of each other, and are principally located in the Center City region. For a city that is over 135 square miles, and runs over 20 miles from its southern border to its northeastern border, this is a problem. Transportation for many pregnant women in Philadelphia for prenatal care is difficult, and this is especially the case for a woman in labor."
The authors noted that African-American preterm births were 37% higher than other ethnic groups between 2005 and 2007. The other groups nearly matched the goal of 11.4% set by Healthy People 2020, a U.S. government-based initiative to improve American healthcare.
While preterm birth is related to infant death, there has been increasing concern that it is linked to health conditions later in life, including respiratory, cardiovascular and renal diseases, the authors noted, concluding that "increased preterm births rates in Philadelphia may implicate greater stress on Philadelphia health care systems in the future."
In other findings, the authors found that mothers receiving no prenatal care in the first trimester increased for all ethnic groups but were at the highest rates for African-American mothers, noting that if current trends continue, "two-thirds of all women in Philadelphia and 72% of non-Hispanic Black women will have received no (prenatal) care in the first trimester by 2020."
Despite the common belief and statements by many politicians that the U.S. has the best healthcare system in the world, the authors noted that America is ranked 37th in the world in terms of health care system performance and does not meet the MDGs. Over the last 20 years, maternal deaths in the U.S. have actually increased from 12 to 21 deaths from 1990 to 2010 for every 100,000 live births, noted the authors.
"Although no causal relation can be made between the decreased availability of midwifery care [due, in part, to maternity ward closures] in Philadelphia over the last decade or more and the increasingly negative outcomes in maternal and newborn health, one is certainly left to wonder if greater access to midwifery care in the city would not make a positive difference in health care outcomes for women and their newborns," wrote Dr. McCool and his colleagues.
- William F. McCool, Mamie Guidera, Jaclyn Janis. ‘The Best Health Care Delivery System in the World’? Women's health and maternity/newborn care trends in Philadelphia, PA, United States—1997–2011: A case report. Midwifery, 2013; 29 (10): 1158 DOI: 10.1016/j.midw.2013.06.016
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