Access-Sensitive Measures of Infant Mortality. The problem with infant mortality rates as an indicator of access is that they include causes of death, which at present cannot be affected by the personal health care system. The committee believes that there is a need for additional efforts to determine how best to aggregate the specific International Classification of Diseases (9th revision; U.S. Department of Health and Human Services, 1991) categories listed on death certificates into overall classes, which can be categorized as preventable or nonpreventable.

Hispanic Data by Subgroup. The committee encourages NCHS's plans to use the linked birth and infant death files to produce infant death information by specific racial and ethnic subgroups. This proposal is particularly important for Hispanics, whose mortality rates range from well above average for Puerto Ricans to below average for Cubans.

Black-White Gap in Infant Mortality. The committee recommends further research into the contribution of access barriers to the unacceptably large and widening gap in infant mortality between whites and blacks. Particular attention should be focused on the role of financial and insurance barriers as well as the linkage between personal health services and key social services.

Outcome Indicator: Low Birthweight

Infants weighing less than 2,500 grams (5.5 pounds) are considered to be of low birthweight. Very-low-birthweight infants, weigh less than 1,500 grams (3.3 pounds) at birth.

The most important predictor of infant survival is birthweight; survival improves exponentially as birthweight increases to its optimum level (Centers for Disease Control, 1989b). However, a successful birth is one that not only produces a live baby but also a healthy one. Compared with infants weighing more than 2,500 grams, low birthweight and very-low-birthweight babies are much more likely to die during the first year of life and to be hospitalized more frequently. They also have a higher incidence of acute infections and suffer from a range of developmental, behavioral, and physical disabilities. Births of low birthweight and very-low-birthweight infants frequently are associated with inadequate prenatal care and lack of access to nutrition services. Unlike infant mortality (which may be influenced both by the health care services received by the mother during pregnancy and the care received by the infant up to one year after delivery), low birthweight and very low birthweight are outcome indicators specific to the services that the mother received prior to giving birth.

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