Every year about 75,000 to 100,000 newborns enter intensive care in the U.S. because they are underdeveloped or merely too small to thrive, weighing less than 5-1/2 pounds. The high rate of infant mortality in the U.S. results in large part from the lack of prenatal care, which is perhaps the most cost-effective type of health care available. The North Carolina Center for Health Statistics confirmed in 1989 that prenatal care can prevent the birth of many underweight babies. They found that women who received less adequate care were 30 percent more likely to have a preemie than those with access to a full-service prenatal program.

Low birthweight is a rare social problem in that it seems cheaper to address than ignore. Dozens of studies show that providing free care to poor pregnant women more than pays for itself. Prenatal care cuts down on high-tech rescues of preterm babies and on the expense of treating the approximately one in six newborns who leave the ICN with a physical or mental disability. A Harvard University study showed that for every one dollar spent on prenatal care, nearly three dollars was saved in medical costs relating to the care of low birthweight babies. If adequate pregnancy care was universally available, the state would eventually spend $49.8 million less each year treating mental retardation linked to low birthweight birth for every low birthweight birth averted by earlier or more frequent prenatal care, the U.S. health care system saves between $14,000 and $30,000.

Unfortunately, progress in reducing infant mortality has ground to a halt. In 1988, the lat year for which there are final official data, the national infant mortality rate was 10.0 deaths per 1,000 live births. The situation among certain subpopulations is even more disturbing. Among blank infants, the 1988 mortality rate was 17.6 deaths per 1,000 live births, more than twice the rate for white infants.

Today's sophisticated medical technology can save more low-birth weight or premature babies than ever before. But saving babies through intensive care is much more costly and risky than giving women timely and comprehensive prenatal care. Neonatal intensive care costs an average of $30,000 per infant in the first 60 days of life alone, and even the best care still can leave surviving babies with serious long-term health problems. Many studies suggest that low-birth weight babies are more likely to suffer child abuse or develop learning disabilities and behavior problems than normal weight babies. Among the tiniest babies, those born at less than 3.5 pounds, one in four will suffer retardation, cerebral palsy, major seizure disorders, blindness, or other severe disabilities.

Ninety percent of all pregnant women should begin prenatal care within the first three months of pregnancy. (This was the same goal that was set in 1979 for 1990.) But following substantial improvements in prenatal care rates in the 1970s, progress stopped in the 1980s, when poverty rates increased and the federal government and many states reduced support for publicly-funded health programs. In 1988, the proportion of births to women receiving early care (during the first three months of pregnancy) was 75.9 percent, the same as in 1979.

Some women are unable to find prenatal care until the last few weeks of pregnancy, or go without prenatal care altogether. 1988 was the ninth consecutive year in which the proportion of babies born to mothers who had received prenatal care after the sixth month of pregnancy, or none at all, either worsened or failed to improve. In 1988, that figure was 6.1 percent, nearly 20 percent higher than in 1979.

Prenatal care rates are particularly low for black, Native American, Latino, poorly educated, and teenage women, those most likely to be poor and without health insurance. While the percentage of white infants born to women receiving early prenatal care has remained low but relatively constant during the 1980s, the percentage among black infants generally has been shrinking. The 1988 only 61.1 percent of black births were to women who had received early prenatal care, down from 62.7 percent in 1980. By comparison, 79.4 percent of white births were to women who had received early prenatal care. Among infants born to Latino women in 1988, 61.3 percent had mothers who did not receive early care.

The racial disparity is even greater when the adequacy of care, measured by amount and frequency of care, is taken into account. In 1988, 73.5 percent of white babies were born to mothers who received care that began before the seventh month of pregnancy and included more than four visits, compared with only 50.7 percent among black babies.

Something needs to be done. What we really need is the political will to do something about the problem. From 1978 to 1984, the number of children in families with no medical insurance rose by 30 percent, to 24 percent of all kids. Meanwhile, federal funding to key sources of maternal care dropped by a third. The fall in coverage has put maternity services out of reach of more women, which boosts the likelihood of preterm birth two to fivefold.

Good baby care has no correlation with millions of dollars used to save high risk babies. People who are better informed on the facts will change their attitudes and prefer good health care and practices rather than focusing on keeping very ill people alive on machines. Once our society changes, people will no loner fund technology that saves such babies. Rather society will prevent high risk babies with good prenatal care. Then technology will work on machines that support prevention.

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