Premies and infant mortality—where ethics and economics coincide

Everyone agrees that something drastic need to be done about public spending. What to do is obvious to some: reduce spending across the board. As Ronald Reagan famously said in his first inaugural address, “In this present crisis, government is not the solution to our problem; government is the problem.” Shrinking government programs to the point of invisibility solves the budget crisis, they say. Even if you don’t agree that government programs are in themselves the source of social problems, we have to slash spending in order for the government to remain solvent, is another argument for drastic reductions in social spending.

But this strikes me as being like the homeowner who has a leaking roof and won’t pay for the repair or a business that doesn’t replace worn-out machinery. While fixing a leaking roof or buying new machines is expenditure from one point of view, from another it is an investment. Sometimes it is more cost-effective to spend money now than to pay even more money later.

Whether to live with a leaking roof or make-do with inefficient machinery is a practical choice. Maybe it’s time to move to an apartment or close down the business. However, some investments are not simply money matters but also moral choices. Such is the situation with premature births.

The US has a high rate of preterm babies—about one in eight live births—with a 21% increase since 1990. The US also has a high infant mortality rate—about 6 children die out of ever 1,000 births. (Forty-six places worldwide doing better than in the area of infant morality.)

There is a connection between these two facts. Premies are far more likely to die than children born full-term. Their immature immune systems make them highly susceptible to many illnesses. And if they survive to their first birthday, according to Janice Whitty, a professor of obstetrics and gynaecology and director of the Division of Maternal-Fetal Medicine at Meharry Medical College and chief of obstetrics at Metro Nashville General Hospital, “even if they survive, they face many physical challenges. There is respiratory distress syndrome, which a) may mean that the baby will need to be on the ventilator and in the neonatal intensive care unit for some time, and b) can lead to chronic lung disease which will impact the individual for the rest of his or her life.

“Preterm babies,” Witty continues, “are also at risk for developmental impairment, such as cerebral palsy, which often leads to a lifetime of disability, including the potential for being wheelchair-bound, and unable to feed or care for themselves. These children also are more likely to have learning disabilities, recurring illnesses, poor weight gain and vision problems.

Witty adds, “As adults, individuals who were born preterm have an increased risk of diabetes and high blood pressure, and women born preterm are at increased risk for having a preterm birth themselves.”

Clearly premature births pose great risks. And we know the major reasons for them. According to Witty, these include: “absent or late prenatal care, a short interval between pregnancies, a prior preterm birth, cigarette smoking, substance abuse, anemia, poor nutrition, low pre-pregnancy weight, urinary tract infection, genital infections, chronic diseases such as diabetes and high blood pressure and high personal stress.”

Access to prenatal care is essential is preventing premature births. It is poor women and women of color who most lack this care. This is why in Milwaukee, amongst the country’s worst cities in terms of infant mortality, a city devastated by the economy and where the disparity between whites and blacks is most extreme, preterm deaths accounted for more than 50% of infant deaths and 60% of black infant deaths.

If the moral argument for providing for the lowering the infant mortality rate isn’t strong enough to move society to pay for good prenatal care and education, there is the economic one. According to Witty, “In the U.S., medical costs for a preterm birth are about 10 times higher than for a birth at full term (in 2002, $32,325 compared with $3,325). When nonmedical costs are included, such as special education and lost productivity, the total cost of a preterm birth is $51,600, which adds up to $26 billion annually.”

Spending money on prenatal programs is an investment in our economy. It is also an investment in our moral integrity. There is no good argument to neglect our poor mothers-to-be, not moral, not economic. Only those intent on eliminating all social services programs as a matter of ideology have any argument at all.


One thought on “Premies and infant mortality—where ethics and economics coincide

  1. Pingback: Premies and infant mortality—where ethics and economics coincide … « Death

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