People will take advantage of the release of this report to politicize the findings as an indictment of the US health care system. This is only partially true because a multitude of social and cultural factors causes this problem, including:
- MDs practicing defensive medicine and increasingly using 'late preterm' cesarean delivery.
- Couples opting for fertility treatments that inevitably lead to increased incidence of twin/triple/quad pregnancies (and sometimes more).
- Poor prenatal care among illegal immigrants and undocumented aliens who do not have health insurance.
- Poor prenatal health care among groups who DO have access to Medicaid.
- Smoking, obesity, teenage pregnancy, and other lifestyle factors.
The health care system CAN do more to improve access and quality of prenatal care delivery, particularly to vulnerable or at-risk populations who already have Medicaid coverage. Continued education and outreach to help control the impact of negative lifestyle factors is also critical. Still, the larger indictment is on our social policy and NOT on our health care system. Once preterm infants are born, the care they receive in the US is unparalleled in the world. The problem is in how the prematurity occurred - which is more about social policy than anything else. There seems to be a real confusion in separating out the CARE system from the SOCIAL POLICY. They are quite different from each other and each requires a very distinct approach for improvement.