Majid 1

Sadia Majid

English 1201

Professor Cassel

20 July 2019

(Image 1: Preemie Baby)

Premature Birth in America: Access to Care

What are the statistics on premature birth in America? Is that a question that

immediately evokes your interest, or taps into a world of commonly understood information?

Probably not. Most people in America still associate being born early to less developed

countries as much as they do hunger, child marriage, and disease. Granted, it is a nightmare

that crosses the mind of almost every parent to be, but so does the possible horror of your

baby being switched at birth. The fact is, one in eight babies in America is born too soon,

meaning that nightmare quite often becomes a reality—disproportionately affecting mothers

and babies of specific demographics. It is important to know what negative effects premature

birth can have on the baby’s life, as well all as the implications for people that surround them,

care for them, and love them. As a country advanced in all forms of technology, it is comforting

to know that care for babies born too early is advancing in America, saving the lives of many,

but care must be provided uniformly. Awareness is the best tool against any problem, and

awareness about premature birth can ensure that babies all over the country, and hopefully
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one day the world, can benefit from advances in technology and medicine, regardless of

financial status and other demographics.

Extremely Very Moderately Late

preterm, born at preterm, born at preterm, born preterm, born
or before 25 less than 32 between 32 and between 34 and
weeks weeks 34 weeks 36 weeks

(Image 2: Timeline of Prematurity: Mayo Clinic)

Firstly, in order to understand premature birth, it is important to know that babies born

at different stages have immensely different needs. According to an online guide by the Mayo

Clinic, there are four stages of preterm birth: “extremely preterm (at or before 25 weeks’

gestation), very preterm (less than 32 weeks’ gestation), moderately preterm (32 to 34 weeks’

gestation), and late preterm (34 to 36 weeks’ gestation).” The age of viability is the minimum

number of weeks that a hospital will attempt to revive a premature infant. This age has

decreased dramatically due to medicinal advances within the past years to include much

younger babies, and varies from facility to facility. Modern technology has made it possible for

babies born as young as 23 weeks’ gestation to live. A baby’s chance of survival and eventual

recovery also depends greatly on birth weight. It is also a factor that hospitals use to determine

whether the infant can be saved. For example, a baby born at a later gestation but with a

substantially lower weight may not be able to survive, as compared to a child born earlier but

with a better weight. (Mayo Clinic)

Babies that are born too early do not have the chance to develop fully. The most

common problem they face is difficulty breathing due to an immature respiratory system. They

may also develop heart problems such as defects, murmurs, and low blood pressure, and brain
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problems such as hemorrhages. Premature babies have trouble regulating their body

temperatures, and can have complications related to their gastrointestinal systems, blood,

metabolism, and immune systems. These problems can be resolved or may lead to long term

complications like cerebral palsy, learning and sensory disabilities, behavioral and psychological

problems, and other chronic illnesses. (Mayo Clinic)

Having a child that is born too early is a life changing experience. Dr. Su Laurent and

Maya Isaaks have collected stories from parents of children born early in their book Your

Preemie Baby. Some of these children are now grown and thriving while others face some

health complications. Sadly, some did not survive NICU and have passed away. One father,

Ross, remarks about the premature birth of his son, Freddie: “We knew that he was going to be

early but you don’t understand what’s to come in terms of the depth of care, how delicate it is,

and how traumatic it can be.” Dana, a mother of two premature babies, noted “I couldn’t

believe what was happening—it felt as though it was happening to someone else.”

Professionals note that the first assumption parents make if their baby is born early is that they

are somehow responsible. This guilt can cause emotional problems and is one of the negative

consequences of traumatic birth that is sometimes overlooked. (Isaaks)

Researchers conducted a study involving similar aged mothers and fathers of both full-

term and preterm babies. They found that mothers of children born early were more likely to

be intrusive or remote than those of children born full-term. They also had higher levels of

depression and lower levels of sensitivity. Both mothers and fathers of preterm children were

at a higher risk of parental stress and post-traumatic symptoms. This shows that, beyond the

physical health problems that individuals born early may have to face for the rest of their lives,
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they and their parents are also likely to face emotional struggles that can affect quality of life. It

is one of the many reasons society as a whole should be concerned about this issue. (Ionio)

It is important to note that the physical cause of premature birth is widely unknown. As

a matter of fact, in forty percent of cases in which a baby is born early, the reason is completely

unknown, and in the remaining sixty percent, there are multiple possible causes. This makes the

availability of appropriate care after birth all the more necessary. Although there are risk

factors that can suggest the onset of preterm labor, such as preeclampsia—a condition marked

by high blood pressure and irregular protein in the mother’s urine—and cervical

incompetence—in which the cervix is not capable of holding in the fetus as it grows larger—

these circumstances can occur suddenly and without explanation. Pregnancies involving twins

or more babies are also more likely to end preterm, and are monitored more intensively by

doctors. (Isaaks)

“In low-income countries, more than 90 percent of extremely preterm babies die within

the first few days of life, while less than 10 percent die in high-income countries,” notes

Christopher Howson, PhD., epidemiologist and head of Global Programs for the March of

Dimes, an organization that has made huge strides in raising awareness and improving

treatment for infants born early (PMNCH). Dr. Howson further notes that countries such as

Ecuador, Botswana, Turkey, Oman and Sri Lanka, have been able to cut their rates of preterm

infant mortality in half by improving the care the babies are provided, showing that this is a

“solvable problem” (PMNCH). The United States is a revolutionary nation in terms of

technology and hospitals all over the country are capable of providing access to advanced

medicine, facilities and tools. It would then be assumed that all babies in the country receive
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proper care, in order to benefit from being born in a highly developed country, but this is not

always the case.

Preterm babies are almost always kept in neonatal intensive care units (NICU), after

they are born and until they are stable enough to be discharged from the hospital. Different

hospitals have NICUs of different levels, the highest being four. The higher level the facility is at,

the more intensive care it can provide, and the younger the infants it can attempt to care for.

Other than incubators, which are probably the most familiar components of NICUs, the facilities

have a variety of equipment. Ventilators help babies with underdeveloped lungs—one of the

most common results of preterm birth—breathe. Infusion pumps and intravenous lines provide

medicine and nutrition, as the babies are usually not able to consume fluids through their

mouths. A NICU also includes variety of monitors that oversee brain functions, oxygen levels,

and other vitals. The facilities are staffed with nurses and specialists. Access to proper care in a

NICU can be the difference between life and death for a child born early (Isaaks).

The fact remains that the United States ranks among the ten countries with the highest

number of preterm births—sixth, after Indonesia. There is also a huge gap when it comes to

race and the number of babies born premature: whereas the preterm birth rate in 2009 for

white Americans was 10.9%, that rate was as high as 17.5 percent for Black Americans.

(PMNCH) In 2018, the March of Dimes reported in its annual premature birth report card that

the national rate of babies born premature had risen for the third year in a row. Becky Russell,

the senior director of applied research and evaluation at March of Dimes, explains in simpler

terms: "If you look at the increases since 2014, cumulatively we're talking about 27,000 babies"

(Chatterjee). That is a substantial number, considering that the United states is already ranked
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among countries with high rates of premature births. According to Russell this rise is being

caused by social and economic factors. Although physical reasoning for why women go into

labor prematurely has not been properly discerned, it has been recognized by experts that an

un-uniform access to maternal care as well as high poverty rates are factors, and the disparity is

only getting worse in past years. (Chatterjee)

Although it may be tempting to explain the association based on a difference of race,

this is not the case. Experts say the reason is structural discrimination, which determines where

people of a certain demographic are more likely to live, what their income and education levels

are likely to be and what amenities, including health care facilities, they are likely to have

available to them. This puts racial minorities, overwhelmingly Black Americans in particular, at a

disadvantage. A 2013 study conducted by Harvard University also shows that black women who

live in states that previously enforced racial segregation laws were associated with a higher rate

of infant mortality, compared to other states. Although the “Jim Crow” laws were abolished

decades ago, they have set a foundation for structural discrimination that affects children born

to this day. These studies shows that it is not enough for a society to possess advanced

technology—it’s availability should be universal in order to benefit all of its members and

improve overall rates of health for preterm babies and their families. (Chatterjee)

To view this topic in a broader light, it is important to understand the connection

between social disadvantage and hospital care. As we have discussed previously, because the

physical reasoning behind preterm labor is mostly unpredictable, while the social factors that
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certainly affect it cannot be

solved overnight, babies

that have access to care

have the best chance at

leading normal healthy

lives. According to a study

published a few years ago (Images 3 and 4: a crowded ER in a less affluent area vs. a private room at John
Hopkins Hospital, listed second richest hospital in America)

by the Journal of the American Medical Association, the difference between the life

expectancies of the richest and poorest Americans is a stunning 10 to 15 years. The credentials

of this report are huge: it was conducted over 15 years (1999-2014) and included income

information and mortality data about 1.4 billion Americans. The same study associated lower

financial levels with increased risk of early birth. Although reasons can span from higher levels

of stress in both children and adults, poor access to fresh food (replaced by an abundance of

cheap, unhealthy, “fast” food), and even lead contamination in water, access to proper medical

care is an important factor. (Esposito) Because hospitals in poorer areas receive less funding

than those where patients have a higher income level and a higher pool of private insurance

holders, these facilities often go into deficit. A facility that cannot afford to pay for advanced

technology, include NICU equipment, cannot provide the same level of care. On top of this,

many hospitals are simply closing down and moving into more affluent areas. As Lillian Thomas,

who reported on this disturbing issue for the Pittsburgh Post-Gazette, aptly likens the scenerio

to “closing down a fire station in a neighborhood with a higher rate of fires” (Thomas)
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In conclusion, the physical, social and emotional health burdens that individuals born

early face are numerous. The physical reasons behind why babies are born early are yet to be

fully understood and the socioeconomic factors may still require decades to resolve: therefore,

it may be a long time before steps can be taken to prevent the phenomenon from actually

occurring. Statistics show that the best course of action at hand is to provide these vulnerable

infants with advanced care, and also proves that the more developed nations do, there is a

dramatic increase in their rates of both survival and later good health. Many individuals and

organizations are working strenuously to give the youngest born in America a voice. Increased

awareness can, and will, someday make this issue a problem of the past, rather than a

consistent hindrance to the quality of life for individuals born early, as well as the communities

they live in.

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Works Cited

Chatterjee, Rhitu. “Premature Birth Rates Rise Again, But A Few States Are Turning Things

Around.” NPR, NPR, 1 Nov. 2018, www.npr.org/sections/health-

shots/2018/11/01/662683176/premature-birth-rates-rise-again-but-a-few-states-are-

turning-things-around.

Esposito, Lisa. “The Countless Ways Poverty Affects People's Health.” U.S. News & World

Report, U.S. News & World Report, 20 Apr. 2016, health.usnews.com/health-

news/patient-advice/articles/2016-04-20/the-countless-ways-poverty-affects-peoples-

health.

Ionio, Chiara, et al. “Premature Birth: Complexities and Difficulties in Building the mother—

child Relationship.” Journal of Reproductive & Infant Psychology, vol. 35, no. 5, Nov. 2017,

pp. 509—523. doi:10.1080/02646838.2017.1383977

Laurent, Su, and Maya Isaaks. Your Preemie Baby: Caring for Your Premature Baby. DK Pub.,

2012.

Mayo Clinic Staff. “Premature Birth.” Mayo Clinic, Mayo Foundation for Medical Education and

Research, 21 Dec. 2017, www.mayoclinic.org/diseases-conditions/premature-

birth/symptoms-causes/syc-20376730.
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PMNCH. “PMNCH | Born Too Soon: The Global Action Report on Preterm Birth.” World Health

Organization, World Health Organization, 3 Feb. 2016,

www.who.int/pmnch/knowledge/publications/preterm_birth_report/en/index3.html.

Thomas, Lillian. “Pittsburgh Post-Gazette: Poor Health.” Barriers to Health Care for Low-Income

America, newsinteractive.post-gazette.com/longform/stories/poorhealth/1/.

Images Used

Image 1: Preemie Baby

https://www.whattoexpect.com/first-year/baby-care/how-parents-can-cope-when-premature-
baby-is-in-nicu/

Image 2: Table of Prematurity

Information from
https://www.mayoclinic.org/diseases-conditions/premature-birth/symptoms-causes/syc-
20376730

Image 3: John Hopkins Hospital Room

https://www.hopkinsmedicine.org/the_johns_hopkins_hospital/planning_visit/room/index.ht
ml

Image 4: Crowded ER
https://www.stltoday.com/news/multimedia/crowded-er-at-hospital/image_67cf57c6-c9a9-
11e0-ab8c-001a4bcf6878.html