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Trends in the United States infant mortality rate have generated concern among researchers and policy makers, according to a new report from the National Center for Health Statistics (Recent Trends in Infant Mortality in the United States, NCHS Data Brief, no. 8, Oct. 2008). In 2005 the U.S. infant mortality rate was 6.86 infant deaths per 1,000 live births, which was not significantly different from the rate of 6.89 in 2000. In 2004 the U.S. ranked 29th in the world in infant mortality, tied with Poland and Slovakia, and 22 countries had rates below 5.0, including 3.5 per 1,000 in Sweden, Norway, and Finland, and also in Japan, Hong Kong, and Singapore. The U.S. international ranking fell from 12th in 1960, to 23rd in 1990, to 29th in 2004. Key findings from the report include the following:

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    The U.S. infant mortality rate did not decline from 2000 to 2005.
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    The U.S. infant mortality rate is higher than those in most other developed countries, and the gap between the U.S. infant morality rate and the rates for the countries with the lowest infant mortality appears to be widening.
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    The infant mortality rate for non-Hispanic black women was 2.4 times the rate for non-Hispanic white women. Rates were also elevated for Puerto Rican and American Indian or Alaska Native women.
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    Increases in preterm birth and preterm-related infant mortality account for much of the lack of decline in the U.S. infant mortality rate from 2000 to 2005.

The report notes that data from the preliminary mortality file estimate an infant mortality rate of 6.71 for 2006, which is a 2 percent decline from the final rate in 2005.

Mothers who need emergency obstetrical care in Canada are increasingly at risk—this is the key finding of a recent survey conducted by the Society of Obstetricians and Gynaecologists of Canada (SOGC) (SOGC Press release, Dec. 4, 2008). The study, funded by Health Canada, surveyed obstetrician/gynecologists, obstetrician/gynecologist residents, and heads of obstetrics and gynecology departments in Canada’s 17 medical schools. As the current generation of obstetrician/gynecologists retires, residents and new graduates have signaled that they are not willing to sacrifice family life and put in long and demanding hours that currently characterize the practice of obstetrics. “The delivery of obstetrical services is at a breaking point in Canada. Many people don’t realize that most of the time only an obstetrician/gynecologist can manage the emergencies and surgical births that are happening more and more often,” said Dr. Scott Farrell, president of the SOGC. Currently only 1,370 obstetricians provide prenatal, perinatal, and postnatal care---a number expected to go down by as much as one-third over the next 5 years.

The SOGC study also surveyed Canadian women who have recently had a baby or who are planning to have one. Their priorities are clear: they want continuity of care throughout their pregnancy by the maternity caregiver of choice; they want an integral role in prenatal and birthing decision-making; and they want to give birth as close to home as possible. “This research proves there is a major disconnect between what women expect and what is actually possible,” said Dr. Andre Lalonde, executive vice president of the SOGC. Although the SOGC is firmly committed to obstetrical care that draws on the skills of other health professionals, especially midwives, Dr. Farrell notes that collaborative care models, on their own, cannot address the looming crisis in maternity care. Whereas these caregivers are invaluable attendants for women during a normal pregnancy and birth, they cannot replace the skill set of an obstetrician-gynecologist in an emergency obstetrical situation.

Complaints of pregnancy discrimination sharply increased in the United States between 1992 and 2007, according to a recent report by the National Partnership for Women and Families (NPWF Press release, Oct. 29, 2008). Pregnancy discrimination complaints filed by working women with the Equal Employment Opportunity Commission (EEOC) increased by 65 percent. A sampling of these claims found that complaints filed by women of color fueled much of this increase, and that most complaints arose in industries where large numbers of women work. The month of October 2008 marked the 30th anniversary of the Pregnancy Discrimination Act, which outlawed discrimination on the basis of pregnancy, childbirth, or related medical conditions. The National Partnership notes, “We should be celebrating, and taking a moment to be grateful that pregnancy-based discrimination is a thing of the past. . . . It is unfathomable that a woman should worry that her job is in jeopardy because she is pregnant or thinking of becoming pregnant.” The report includes recommendations to help employers, employees, and the EEOC itself respond effectively to the increase in pregnancy discrimination charges and begin reversing the upward trend. The report is available online at www.nationalpartnership.org.

The shackling of pregnant inmates in United States federal prisons has been barred in all but the most extreme circumstances in a recent policy change by the Bureau of Prisons, the American Civil Liberties Union (ACLU) has announced (ACLU Washington Legislative Office, Oct. 20, 2008). This new policy represents a major change in the United States, where the shackling of pregnant women during transport, labor, and even delivery has long been routine in jails and prisons. Currently, only California, Illinois, and Vermont have enacted state laws restricting the practice of shackling pregnant women. However, the ACLU notes that this change is only the beginning. In 47 states there is no legislation to restrict the practice of shackling pregnant women; state and local prisons are not subject to the new federal policy. In addition, the U.S. Immigrant and Customs Enforcement, which increasingly detains immigrant women who have never committed a crime, has refused to specifically end the use of restraints on pregnant women. Nevertheless, the new policy represents a huge victory for the thousands of women incarcerated in federal prisons throughout the country—a victory hard won by groups like the Rebecca Project for Human Rights and other organizations that have advocated for this change. The ACLU has responded to the Rebecca Project’s call for the formation of an Anti-Shackling Coalition to work together to end the practice of shackling incarcerated mothers during transport, labor, delivery, and postdelivery in state prisons and jails and all immigration facilities.

The rate of abortion in the United States is at its lowest level since 1974, having declined 33 percent from a peak of 29 abortions per 1,000 women aged 15 to 44 years in 1980 to 20 per 1,000 in 2004, according to a recent report from the Guttmacher Institute (News release, Sept. 23, 2008). However, this overall trend masks large disparities in rates of unintended pregnancy and abortion across demographic subgroups, according to the report, Trends in the Characteristics of Women Obtaining Abortions, 1974 to 2004. Hispanic and black women obtain abortions at rates three and five times higher, respectively, than non-Hispanic white women, the report found. In addition to income level and racial disparities, the study looked at other trends, reporting that compared with women in 1973, the typical woman obtaining an abortion today is older, more likely to have children, less likely to be married, and more likely to be nonwhite. “The analysis found positive trends, but highlights several issues of concern,” said Sharon Camp, Guttmacher Institute president and CEO. “Many Americans will welcome the news that there are fewer abortions, particularly among teens, and that a larger proportion of abortions are now happening very early in pregnancy. But at the same time, abortions are becoming more concentrated among women of color and low-income women. This presents a clear challenge to policymakers to redouble their efforts to improve access to subsidized contraceptive services for these women, thereby helping them to prevent the unintended pregnancies behind these abortions from occurring in the first place.”

Health coverage for midwives has been provided under new government legislation in Alberta, Canada, and pregnant women who choose to have midwife-assisted care will have that service covered by insurance, beginning April 1, 2009 (Alberta Government News release, Oct. 16, 2008). “This decision will provide better access and more choice for expectant women and will relieve pressure on doctors, nurses, and hospitals,” said Alberta Health and Wellness Minister Ron Liepert. As of September 1, 2007, there were 31 registered midwives and 6 student midwives in Alberta. With this change women will have access to innovative, publicly funded midwifery services in various locations, including hospitals, community birth centers, or their homes, and in accordance with midwifery guidelines. The Alberta Health Services Board will receive $4 million (Cdn) for midwifery service implementation across Alberta in the 2009-2010 fiscal year. In conjunction with Alberta Health and Wellness and the Alberta Association of Midwives, the Board will develop and establish a structure that provides full midwifery services to all Alberta women with low-risk pregnancies. This service will emphasize various options for expectant mothers; foster collaboration between midwives, physicians, nurses, and other health care professionals; and create a sustainable model for the future.

A new Canadian national body of nurses to serve women, newborns, and their families has been established called The Canadian Association of Nurses for Women—Association infermiére canadienne pour femmes et nouveau-nés. It is composed of nurses from all regions of Canada and will provide leadership for Canadian perinatal and women’s health nurses. Its objectives are to: (1) promote exemplary standards in perinatal (maternity) and women’s health nursing practice, research, and education; (2) advocate for Canadian women, newborns, and families in health matters; (3) represent Canadian nurses in policy development within their specialty; (4) provide continuing nursing educational opportunities; and (5) represent nurses in multidisciplinary collaborative projects. A website will be available in 2009 at http://www.canwn-aicfnn.ca.