Preventing Infant Mortality

Children’s health is usually a high priority in public health. Providing children with adequate care and medical attention enable them to become healthy adults. Infant mortality is one of the major public health concerns towards children. Infant mortality is defined as the death of babies within their first year of age. Infant mortality is a valuable indicator to assess a community’s development, and overall health status. The lower the infant mortality is, the healthier society is and the better are a nation’s economy and social conditions. Reducing infant mortality is one of the declared seven millennium development goals of the United Nations. In Syria, UN agencies, especially UNICEF, are concentrating on combating infant mortality as part of their human development plans. Infant mortality rate in Syria has de-creased significantly over the past 15-years according to the Syrian Family Health Survey (known as the PAPFAM study), which was conducted by the Central Bureau of Statistics in 2001 in collaboration with the Ministry of Health, the Youth Union, the State Planning Commission and the Pan Arab Project for Family Health. This study revealed that infant mortality dropped from 24‰ in 1986-1990 to 18.1‰ in 1996-2000. Noticeably, boys had higher mortality rates than girls. For boys it stood at 20.6‰ while it stood at 15.5‰ for girls. Despite this promising improvement, disparities occurred between urban and rural areas in Syria. Rural areas scored significantly higher rates of infant mortality (19.2‰) than urban areas (16.9‰). Many researchers are addressing the issue of infant mortality, trying to determine its risk factors and determinants. Most studies showed common risk factors, although with very different emphasis, depending on the country being studied. In Syria, the PAPFAM study showed that several factors contribute to the occurrence of infant mortality. These included demographic factors, such as maternal age at delivery, parity and birth intervals among siblings, socioeconomic conditions (such as maternal educational level), in addition to other factors like medical care (prenatal care, post natal and during delivery). The age of the mother at delivery affects the infant mortality rate. The PAPFAM study in Syria revealed that infants born to mothers aged 25-34 had better rates of survival than those born to older mothers, aged 35-49, or younger ones, aged 20 and below. Also, infant mortality rates were affected by the maternal educational level.

This study revealed that infant mortality dropped from 24‰ in 1986-1990 to 18.1‰ in 1996-2000. Noticeably, boys had higher mortality rates than girls. For boys it stood at 20.6‰ while it stood at 15.5‰ for girls.

It was higher among infants of illiterate mothers (25.2‰), compared to mothers with a secondary education, with 13.3‰. Also, high parity and short intervals between pregnancies result in higher infant mortality. Infants who were the fourth child or more within their families also had high mortality rates. This was 23.4‰ while first born children have a rate of 17.5‰. As for birth intervals, it was found that the longer the interval between pregnancies, the better it affects newborns. For children with a birth interval of less than two years, infant mortality was 32.7‰. Children born with an interval of four years or more, however, have an infant mortality of 13.4‰. Also lack of provision of medical care (prenatal, postnatal or during delivery), usually contribute to infant mortality. Infants of mothers who receive adequate medical care and supervision had better chances of survival in general. To combat infant mortality in Syria, several preventive measures could to be done.

1. Encourage maternal education: The more educated a mother is, the more likely she will have the needed knowledge to pay attention to her child’s health and seek clinical treatment when needed. An educated mother can also strengthen her infant’s health and prevent mortality through a planned reproductive behavior in terms of spacing child births and lowering their parity.

1. Promote awareness campaigns: These should target mothers and caregivers, especially in rural areas of Syria. They can help enhance a mother’s knowledge and skills in parenting. Such campaigns can be implemented in a variety of ways, either through educational sessions in the community, or the mass media. They should provide mothers with sufficient knowledge and skills for taking care of their infants and ignoring some common misconceptions in our culture.

2. Encourage maternity after the age of 20: This will help enhance the age of both the mother and the infant. A healthy mother can take care of her child better than a woman suffering from complications resulting from a young maternal age.

3. Encouraging adequate birth intervals and parity: A mother with longer birth intervals between pregnancies has enough time to recover her health and nutritional status after delivery. Siblings who are born within reasonable periods of time can benefit from the available resources in the home and the care of their mother. When the space is well-spread between children of similar age, they no longer compete for attention. It also prevents the youngest child from increased exposure to infections from his or her older sibling, which sometimes may lead to infant mortality.

4. Improve the quality and access of mothers and infants to medical care before, during and after delivery. Risks affecting the infant’s health during delivery can be reduced if delivery takes place in a hospital or under proper medical supervision. Unfortunately this does not happen all the time, especially in poor and rural areas, which increases infant mortalities in these areas. Proximity of health ser-vices that include qualified doctors and quality health services is necessary to increase utilization of health services and therefore to reduce child mortality. On a different note, accessibility to health ser-vices enables infants to complete their required vaccines and therefore make them less exposed to diseases that lead them to infant mortality.