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The Public Health Enigma of U.S. Infant Mortality

March 27, 1987|ALLAN PARACHINI | Times Staff Writer

When 23-year-old Elaine Beaty left the hospital last week with her newborn daughter, Samantha, it was--for her and her husband, John--a milestone surely characterized by hope and joy, but fear, paranoia and heartbreak, too.

These latter emotions are the aftereffect of a memory--too fresh for the pain to have faded--of a Saturday morning last May when the Beatys awoke in their San Pedro home and looked at the clock. Panic-stricken when they saw it was 7 a.m., they hurried to the crib of their then 7-week-old son, John, and found him dead.

"He had awakened at 3 a.m. and we fed and diapered him and put him back to bed," Elaine recalled one day recently at her sister's house in Torrance. "He usually woke up at 6 in the morning. He was our alarm clock. But that Saturday morning, he never woke up. I knew something was wrong as soon as I looked at the clock. He was blue. He was already gone.

The boy, the coroner's office later ruled, had died of Sudden Infant Death Syndrome, a longstanding clinical mystery. But SIDS isn't why the child's death is a telling social commentary.

It is an individual tragedy--a parting with which Elaine Beaty is not yet at peace and whose memory still provokes fear in her because, she said, of "the guilt, the: 'Did I do it?' I was still feeling like it was my fault or something when I found out I was pregnant (again, with Samantha). I guess that was the best thing for me to do or else I would have had a nervous breakdown."

Eventually, Elaine said, the coroner's office wrote her a sensitive letter emphasizing that SIDS generally cannot be anticipated and she should not heap guilt on herself because her little boy was dead.

But to observers concerned with such things, John's death was only one example of a frustrating national problem--the U.S. infant mortality rate is far higher than in many countries that are less advanced. And in California and perhaps the nation at large, even modest progress of the last few years in controlling infant mortality shows growing signs of being reversed.

Significant Concerns

A definite trend is not yet clear, but a variety of observers agree the stagnation in infant mortality has raised significant concerns that the U.S. may be seeing the start a reversal of modest gains in the field achieved in the last 22 years.

Moreover, the infant mortality quagmire in the United States has political implications as well as medical ones. Among the perplexing elements is the fact that black American babies die at a rate double that of whites. And a range of experts from Dr. Myron Wegman, of the University of Michigan School of Public Health in Ann Arbor to Sen. Lawton Chiles (D-Fla.) contend that the national public health system subordinates proven prevention techniques that could avert many of the fatalities of all races.

In Los Angeles County last year, scenes like the death of Elaine Beaty's little boy--babies dying at a year old or less--were played, according to provisional statistics just assembled by the Department of Health Services, a total of 1,402 times.

Some critics believe stagnation of the infant mortality rate may be one of the first tangible results of Reagan Administration cuts in the Medicaid, Medicare and food assistance programs, although none of those was a factor in the case of Elaine Beaty's baby.

In a statement released Thursday, the U.S. Department of Health and Human Services said it "does not believe that Administration policies in this area are having any negative effect." In fact, a spokesman said the agency is not yet convinced the infant mortality rate has stagnated or may be about to increase--rather, the department believes the situation is only one in which "the infant mortality rate continues to decline, although at a slower rate than at some times in the past."

The department said Secretary Otis Bowen believes the slowdown may be due to such factors as the teen-age pregnancy rate with young mothers giving birth to underweight babies, childbirth among drug abusers and even the increasing incidence of babies born to AIDS-infected mothers. "There are a number of factors besides money that affect the performance of these statistics," the agency statement said.

Prevention Programs

Some other experts--particularly those in government who do not hold politically appointed health posts--say that technology has lowered the American infant mortality rate about as far as it can at this time and the focus should turn to prevention programs.

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