The ACA and U.S. Neonatal Mortality Rate

In light of the recent ambiguous rulings toward the constitutionality of the Affordable Care Act in the U.S. Circuit Courts, this contributor decided to write about implications for Maternal and Child Health.

Neonatal mortality, defined as deaths <28 days of age per 1,000 live births, is the focus of a study published in August by the Public Library of Science (PLoS) Medicine magazine. Although globally neonatal mortality rate has decreased since 1990, the United States still lags in ranking. Of the 176 countries and 3,551 country-year data analyzed, the United States ranked 41st in neonatal mortality rate. Furthermore, even though death rate has decreased over time, it has improved at a slower rate than 117 other countries[i].

Although limited country data may hinder parts of the study, Americans should still be concerned with the researchers’ findings. The United States spends the most on health per capita compared to other developed countries. In fact, it is also has the highest rate of growth in health expenditure per capita: from 1980 to 2008, GDP health care spending proportion increased 7%[ii].

If the United States spends the most money on health care and has some of the most advanced technologies in the world, I question why newborns dying at such high rates? These queries guide my and other public health professionals’ values in prevention, and how investing in health at all ages of the lifecycle can improve outcomes for children. Quality preconception and maternal care can increase the chances of infant survival[iii]. Private insurance and out-of-pocket patient costs as sources of health expenditure are highest in the U.S. compared to other developed countries[iv]. With a lower percentage of funding from social programs and taxation, mothers, and sub sequentially their children, who do not have insurance are less likely to attend regular check-up visits. Visits help prevent premature death of infants through quality maternity care.

The Affordable Care Act signed into law last year will help fill these gaps, expand coverage to un/under insured, and hopefully change the status of U.S. babies today. In 2014, the provision that all health plans will cover pregnancy costs will go into effect. Currently, only 13% of individual health insurance plans include maternity care[v]. These debates over the legislation prevent mothers and children from getting the care they need to live happy, healthy lives. Advocacy is necessary to keep these issues in the forefront of our nation’s priorities.

Attend this free webinar sponsored by HHS’s Office on Women’s Health on “The Importance of the Affordable Care Act for Women”

Thursday Sep 29th, 2011 at 2pm EST/1pm CST:

The Archived Webinar will be posted when becomes available.

[i] Zahle Oestergaard, M., Inoue, M., Yoshida, S., Retno Mahanani, W., Gore, F. M., Cousens, S., et al. (2011). Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities. PLoS Medicine , 1-13.

[ii] Kaiser Family Foundation. (2011, April). Health Care Spending in the United States and Selected OECD Countries. Retrieved September 12, 2011, from Kaiser Family Foundation:

[iii] Braveman, P., Oliva, G., Grisham Miller, M., Reiter, R., Egerter, S. (1989). Adverse Outcomes and Lack of Health Insurance among Newborns in an Eight-County Area of California, 1982 to 1986. New England Journal of Medicine, 321:508-513.

[iv] National Audit Office. (2003). International Health Comparisons: A compendium of published information on healthcare systems, the provision of healthcare and health achievement in 10 countries. London: National Audit Office.

[v] Collins, S. R., Rustgi, S. D., & Doty, M. M. (2010, July 30). How Women Will Benefit from the ACA. Retrieved September 13, 2011, from The Commonwealth Fund: