Framing the debate: can prenatal care help to reduce the black-white disparity in infant mortality?

Prenatal care has been identified as necessary to reducing the disparity in infant mortality between black and white infants. The purpose of this paper is to review determinants of the disparity and describe the contribution that prenatal care can make to modifying those determinants, biologic or social. When examined by birthweight categories, 25% of the disparity is due to excess deaths among normal birthweight infants (> or = 2500 g); 13% is due to excess deaths among moderate low birthweight infants (1500-2499g); and 62% of the disparity is due to excess deaths among very low birthweight infants. Normal birthweight black infants have higher rates of death due to infections, injuries, and sudden infant death syndrome. Very low birthweight black infants account for the increasing disparity in infant mortality. Social determinants of the disparity in infant mortality include the effects of poverty and the accompanying problems of limited access to health care services, preventive care, and good nutrition. Prenatal care may reduce the disparity by using both high-risk and population-based prevention strategies. This combination of strategies would identify and treat medically high-risk women before delivery and provide preventive care to all women, regardless of their risk status. Although both strategies have a potential for producing modest reductions, neither has proved to be effective.