this is a great idea, but impossible to implement. How much care is not getting done in a population is next to impossible to tell, but we can come up with generalities and follow these - the point is that the monies are already there, and BTW the working class PA is paying MORE then their share either through their employer paying tens of thousands of dollars for insurance, or the employee portion
I just about lost my coffee
How dare you throw such vitriol and hate towards a medical Dx of addiction - as well it is absolutely unbelievable to think that people think the USA doing well in the 20th century and this was only a problem in the last 15 years. This is a long standing problem, please go look at WHO rankings... News flash, we have been trailing the first world for most of recent history
please if you do not know the answer to something do not just pick a likely culprit and blame that.... ie addiction, that is dangerous and ill willed. I have seen numerous articles over the past 15 years that infant mortality rate in the USA is most likely tied to lack of following standards of care, including pre-natal and at the same time the actual care delivered by medical professionals like us - ie not following the guidelines... And I am not even in OB or GYN - just have read them as general interest
This is from the CDC. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2bx2.htm
Challenges for the 21st Century
Despite the dramatic decline in infant and maternal mortality during the 20th century, challenges remain. Perhaps the greatest is the persistent difference in maternal and infant health among various racial/ethnic groups, particularly between black and white women and infants. Although overall rates have plummeted, black infants are more than twice as likely to die as white infants; this ratio has increased in recent decades. The higher risk for infant mortality among blacks compared with whites is attributed to higher LBW incidence and preterm births and to a higher risk for death among normal birthweight infants (greater than or equal to 5 lbs, 8 oz [greater than or equal to 2500 g]) (18). American Indian/ Alaska Native infants have higher death rates than white infants because of higher SIDS rates. Hispanics of Puerto Rican origin have higher death rates than white infants because of higher LBW rates (19). The gap in maternal mortality between black and white women has increased since the early 1900s. During the first decades of the 20th century, black women were twice as likely to die of pregnancy-related complications as white women. Today, black women are more than three times as likely to die as white women.
During the last few decades, the key reason for the decline in neonatal mortality has been the improved rates of survival among LBW babies, not the reduction in the incidence of LBW. The long-term effects of LBW include neurologic disorders, learning disabilities, and delayed development (20). During the 1990s, the increased use of assisted reproductive technology has led to an increase in multiple gestations and a concomitant increase in the preterm delivery and LBW rates (21). Therefore, in the coming decades, public health programs will need to address the two leading causes of infant mortality: deaths related to LBW and preterm births and congenital anomalies. Additional substantial decline in neonatal mortality will require effective strategies to reduce LBW and preterm births. This will be especially important in reducing racial/ethnic disparities in the health of infants.
Approximately half of all pregnancies in the United States are unintended, including approximately three quarters among women aged less than 20 years. Unintended pregnancy is associated with increased morbidity and mortality for the mother and infant. Lifestyle factors (e.g., smoking, drinking alcohol, unsafe sex practices, and poor nutrition) and inadequate intake of foods containing folic acid pose serious health hazards to the mother and fetus and are more common among women with unintended pregnancies. In addition, one fifth of all pregnant women and approximately half of women with unintended pregnancies do not start prenatal care during the first trimester. Effective strategies to reduce unintended pregnancy, to eliminate exposure to unhealthy lifestyle factors, and to ensure that all women begin prenatal care early are important challenges for the next century.
Compared with the 1970s, the 1980s and 1990s have seen a lack of decline in maternal mortality and a slower rate of decline in infant mortality. Some experts consider that the United States may be approaching an irreducible minimum in these areas. However, three factors indicate that this is unlikely. First, scientists have believed that infant and maternal mortality was as low as possible at other times during the century, when the rates were much higher than they are now. Second, the United States has higher maternal and infant mortality rates than other developed countries; it ranks 25th in infant mortality (22) and 21st in maternal mortality (23). Third, most of the U.S. population has infant and maternal mortality rates substantially lower than some racial/ethnic subgroups, and no definable biologic reason has been found to indicate that a minimum has been reached.
To develop effective strategies for the 21st century, studies of the underlying factors that contribute to morbidity and mortality should be conducted. These studies should include efforts to understand not only the biologic factors but also the social, economic, psychological, and environmental factors that contribute to maternal and infant deaths. Researchers are examining "fetal programming"--the effect of uterine environment (e.g., maternal stress, nutrition, and infection) on fetal development and its effect on health from childhood to adulthood. Because reproductive tract infections (e.g., bacterial vaginosis) are associated with preterm birth, development of effective screening and treatment strategies may reduce preterm births. Case reviews or audits are being used increasingly to investigate fetal, infant, and maternal deaths; they focus on identifying preventable deaths such as those resulting from health-care system failures and gaps in quality of care and in access to care. Another strategy is to study cases of severe morbidity in which the woman or infant did not die. More clinically focused than reviews or audits, such "near miss" studies may explain why one woman or infant with a serious problem died while another survived.
A thorough review of the quality of health care and access to care for all women and infants is needed to avoid preventable mortality and morbidity and to develop public health programs that can eliminate racial/ethnic disparities in health. Preconception health services for all women of childbearing age, including healthy women who intend to become pregnant, and quality care during pregnancy, delivery, and the postpartum period are critical elements needed to improve maternal and infant outcomes (see box, page 856).
Reported by: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.
This graphic is particularly powerful at how bad the USA is at this