The 8 Things That End Childhood Too Soon: What Clinicians Should Know

Interviewer: Laurie Scudder, DNP, NP; Interviewee: Richard Bland, JD


June 30, 2017

In This Article

Healthcare Disparities and Their Effect on Kids

Medscape: Whereas some countries—notably, countries at war—have terrible conditions that affect virtually all children within their borders, other countries have significant within-country disparities in the prevalence of childhood-enders. Unfortunately, the United States, which ranked 36th out of 172 countries—far down the list of industrialized nations—is such an example. One childhood-ender with significant in-country variability here is teen pregnancy. According to the report, almost a quarter-million infants were born to girls 15-19 years of age in the United States in 2015. Where are the highest rates of teen pregnancy in the United States? And what are the barriers to bringing this rate down?

Mr Bland: Indeed, a "child having a child" is a childhood-ender. The issue of teenage pregnancy remains a huge problem in the United States. Arkansas reported the highest teen birth rate in 2015, at 38 teen births per 1000 females aged 15-19 years. That equates to an estimated 1 in 27 girls aged 15-19 years having a baby. That rate is nearly twice the national average, which is 1 in 45 children. There are at least five other states—Louisiana, Mississippi, New Mexico, Oklahoma, and Texas—where at least 1 in 30 girls aged 15-19 years had a baby in 2015.

One of the critical strategies to reduce teen pregnancy begins years earlier—and that is access to early childhood education.

One of the critical strategies to reduce teen pregnancy begins years earlier—and that is access to early childhood education. You may not immediately think of early childhood education as a critical prevention mechanism for teenage pregnancy. But research shows us that early childhood education makes an enormous difference for kids. Children without access to early education are 40% more likely to become a teen parent.

What we also know, and why we are such a supporter of investing more in early childhood education, is that early education affects other domestic childhood-enders. We know that children without access to early childhood education are 25% more likely to drop out of school. Kids who don't have early childhood education are 60% more likely never to attend college. And they are 70% more likely to be arrested for a violent crime.

Medscape: Another event with significant state-to-state and within-state disparity is infant mortality. The United States continues to have one of the highest infant mortality rates among high-income, industrialized countries. This tragedy, too, is concentrated in the poorest parts of the United States. The infant death rate in Mississippi, with 9.3 deaths per 1000 live births, is more than twice the rate in New Hampshire, which sees 4.2 infant deaths per 1000 live births. Where should healthcare professionals put their focus to try and bring this rate down?

Mr Bland: We looked at 16 years' worth of data on mothers and children in our once-annual State of the World's Mothers Report. We were struck by how often the United States is found to be among the worst of the developing nations in many of these events that end childhood—including infant mortality, teen pregnancy, exposure to violence, and hunger. Hence this report.

In terms of infant mortality, we have 16 years of experience in tracking year to year why it occurs and how to prevent it. And yet, even in 2017 in America, there are tremendous disparities in infant mortality rates state by state. There are also great disparities by race and ethnicity. According to the US Centers for Disease Control and Prevention, the mortality rate of African American infants is more than double that of white infants. To bring these rates down, it's important that policymakers, legislators, community leaders, and healthcare professionals work to make sure that expectant moms have what they need so that they and their babies can be healthy before, during, and after pregnancy.

It is a fundamental equity issue. If you don't focus on the disadvantaged communities that are continuing to be left behind, then you're not going to reach some of the populations that are disadvantaged.

To focus on the prevention strategies that work, you have to look at what's causing the infant mortality. Birth defects remain the number one cause. The other four leading causes of death in infancy are preterm birth; maternal complications during pregnancy; sudden infant death syndrome; and injuries, such as suffocation. Those five etiologies added up to 60% of infant deaths in the United States in 2014. A large percentage of these deaths, as you might suspect, can be avoided if expectant mothers have access to healthcare and health education programs.


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