Distinctions between health care delivery problems and social policy problems regarding premature births

Today the March of Dimes released their 2009 premature birth report cards for each state. Premature births are an important issue to discuss for occupational therapists because so many of the children who require OT services have a history of prematurity. Even so-called 'late preterm births' where the children are 34 weeks gestation and older have a higher incidence of learning problems.

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:
  1. MDs practicing defensive medicine and increasingly using 'late preterm' cesarean delivery.
  2. Couples opting for fertility treatments that inevitably lead to increased incidence of twin/triple/quad pregnancies (and sometimes more).
  3. Poor prenatal care among illegal immigrants and undocumented aliens who do not have health insurance.
  4. Poor prenatal health care among groups who DO have access to Medicaid.
  5. Smoking, obesity, teenage pregnancy, and other lifestyle factors.
The best way to combat prematurity includes several approaches. There should be tort reform to limit the practice of defensive medicine and more education for physicians on best practice for late term pregnancy management. Couples who opt for fertility treatments (and the MDs who facilitate) should be held financially accountable for the costs of the prematurity that they create. Open border and sanctuary city policies need to be re-evaluated because rate of uninsured women is directly related to these 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.


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