Here is an article from the NYTimes this week:

http://www.nytimes.com/2009/11/27/us/27i...rate&st=cse

We have been hearing about it for the past three months in courses, and there is a huge focus on this area because of the drop.

Any thoughts?

I'm not sure about the drop in Dane county, as it says OB care did not change. In the first woman interviewed, however, there was a major change. She mentioned that a nurse came out to check on her regularly. In addition, later in the article it again talks about home visits from nurses.

I'm not going to go into the racial aspects here, because I have not looked at the actual numbers for upper class vs. lower class racial differences. It seems to me that we are talking about responsibility for self care, which is an ongoing debate.

The difference I see brought out in the article is that when women were excpected to seek out prenatal care and follow up of their own volition, there were higher rates of infant mortality than when the medical establishment took responsibility for follow up and care.

I don't know of any upper class communities where people expect monthly visits from nurses. They are expected to go to the doctor on their own. If they do not, and do not have a good outcome because of that, responsibility would be placed on the mother. People would say that she had a bad outcome because she did not go to the doctor.

In this case, it seems, that the responsibility for prenatal care has been placed in the hands of the medical authority. We have taken the responsibility away from the women and take the prenatal care to them, in order to improve outcomes.

This is an issue I have a big problem with. I grew up in a low income, inner city neighborhood. I live and work in an area that is about 75% public assistance. There are signs and advertisements everywhere about getting prenatal care, and most of my patients do. I think that people respond and act based on what is expected of them. If they expect to be spoonfed, then they will sit back and wait for it and blame the authorities/social situation/etc. if something goes wrong.

The program highlighted in the piece has actually been around since prior to 1990s, they are unsure as to why the drop has occurred and are furiously attempting to study what changed around 2002, when the sharp drop began.

Although the article chose to stereotype and focus on low SES individuals, this is a drop across all SES categories, which makes it so important to find what the causal factors are. Even in high income categories across the US, African-Americans/Latinos have higher infant mortality rates than Causasian mothers. There has to be another factor that can make a difference.

I will keep this updated as more info is published; hoping they figure out more soon!