The following lists present specific recommendations of the committee by indicator, together with the groups (e.g., researchers) or bodies (e.g., Public Health Service) to which the recommendation most pertains.

Objective 1: Promoting Successful Births

Indicator: Prenatal Care
  1. Additional research (using revised birth records, among other sources) is needed to determine the relationships among medical risk factors, the content of prenatal care, and birth outcomes. (Researchers)

  2. The National Center for Health Statistics should expedite the analysis and release of data from the 1988 National Maternal and Infant Health Survey and the 1990 longitudinal follow-up study. In addition to the potential value of these data in clarifying a range of issues related to the use of health care by pregnant women and infants, they should also be used to validate the accuracy of birth records. (National Center for Health Statistics, Public Health Service, States)

  3. The National Center for Health Statistics and the states should consider including income and insurance data or, as an alternative, some indicator of poverty status on birth certificates. (Public Health Service, National Center for Health Statistics, States)

  4. Efforts should continue to reach agreement on what constitutes adequate prenatal care and how to measure its provision. (Localities, Public Health Service, Researchers, States)

  5. There is a need to enhance the capacity to conduct research on access barriers, such as lack of or inadequate insurance and low-income, and their effects on the use of prenatal care. To this end, the development of automated birth and death records, to facilitate small-area analysis of data, would be helpful. (Localities, Researchers, States)

Indicator: Infant Mortality
  1. Until income and insurance data are available on birth and death records, efforts should continue to link zip code information on birth records to census income data. (Researchers)

  2. Research on how to measure infant mortality in ways that are sensitive to access should continue. The use of disease-specific death rates is one avenue that should be explored. (Researchers)

  3. Research should continue on the increasing disparity between black and white infant mortality, with particular focus on the effects of specific barriers. (Researchers)

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