U.S. stillbirths steadily declining

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The rate of fetal deaths, also known as stillbirths, has declined substantially in the United States, according to a report released yesterday by the Centers for Disease Control and Prevention.

The overall fetal-mortality rate, or the number of fetal deaths per thousand live births, dropped steadily nationwide by an average of 1.4 percent per year from 1990 to 2003. Comparatively speaking, there were 31,386 reported deaths in 1990, when there were 4.1 million live births. Thirteen years later, there were 25,653 fetal deaths, with roughly the same number of births.

The report refers to fetal death -- or the death of a baby within the womb before birth -- as a "major but often overlooked public health issue." Risk factors for all women include smoking during pregnancy, obesity, high blood pressure, diabetes and problems with fetal growth. The report also speculated that an increased public awareness of the "magnitude" of fetal death could ultimately lead to better prenatal care for more women.

But troubling gaps persist.

"While we can see that progress has been made in preventing fetal mortality, it is also clear that substantial disparities remain along race and ethnic lines," said Marian MacDorman, lead author of the report, which is based on data from the National Center for Health Statistics.

The analysis found that the stillbirth rate among black women was more than double that of white women -- about 12 for every thousand live births. The rate among white women -- along with Asian American women -- is about five stillbirths for every thousand births. The rate has "increased slightly" from 1990, the report said.

Among American Indian and Hispanic women, the rate was about six stillbirths per thousand deaths.

Factors frequently mentioned as contributing to the black and white stillbirth gap are racial differences in health, income, access to quality health care, stress and racism, the report stated. "However, much of the black and white mortality remain unexplained."

Age also played a factor, however. The fetal mortality is highest among mothers over 45 at almost 15 deaths per thousand births, and among very young mothers under 15 -- about 13 deaths per thousand. The figure is about five for women age 25-29.

The report attributes medical conditions such as hypertension and the presence of multiple fetuses for the elevated rate among older mothers and unfavorable socioeconomic and behavioral problems among the younger group.

The report also tracked perinatal deaths -- or the deaths of infants under seven days old, or a fetus at term. Again, the overall rate has dropped, from about 11 deaths per thousand births in 1985 to about seven in 2003. Still, racial disparities are present.

The rates were lowest among Asian Americans, followed by whites, Hispanics and American Indians, who averaged about five early infant deaths per thousand births. Among blacks, the rate was 12 perinatal deaths per thousand births.