Abstract
This chapter examines the distribution of preterm births across the U.S. population. Preterm births occur more frequently in certain sub-populations and under certain circumstances of fertility than under others. This chapter explores the reasons for high rates of preterm birth in sub-populations, identified by age, race, ethnicity, socioeconomic status, and whether women intended to become pregnant, among other features. The chapter also explores the ways that data is gathered and the ways that the population is divided up in order to create knowledge about these patterns. Although the impacts of maternal behaviors such as smoking, alcohol and drug use, and obesity are not large relative to other factors associated with preterm birth, these factors receive considerable attention because they fit an ideologically preferred narrative about individual versus social responsibility for health, and about women’s personal responsibility for their pregnancy outcomes. The comparison section of this chapter examines, from an epidemiological perspective, why preterm birth rates in the U.S. are higher than those of Canada, Great Britain, and Western Europe. Each high-risk segment of the population: non-White women living in predominantly White societies, teens, low income women, and women who did not intend to become pregnant, have higher preterm birth rates both in the U.S., and in the comparison countries. However, women with these characteristics comprise a larger portion of the population of child-bearing women in the U.S. than in other places.
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Notes
- 1.
- 2.
- 3.
Maternal overweight and obesity are also associated with higher rates of stillbirth, neural tube defects and other congenital anomalies, and more difficult recovery from surgical interventions (Vasudevan et al. 2011).
- 4.
The authors note that another concern cited by experts in Australia and Great Britain for not issuing advisories against moderate drinking for pregnant women is the fear that women who drink before they realize that they are pregnant might choose to abort their fetus out of guilt for the potential effects of alcohol exposure.
- 5.
For example, in some eras in some communities, high school graduation could be an indicator of high socioeconomic status; in other contexts it is an indicator of relatively lower status.
- 6.
For example, in the U.S. in the nineteenth century, some immigrant groups, including those from Ireland and Greece, were considered to be non-white (Jacobson, 1999).
- 7.
For example, anthropologist Khiara Bridges recounts the experience of a fellow researcher who was present at a difficult labor experienced by a Mexican-American patient in New York City. Clinicians were slow to provide pain medication for the patient, because of their assumption that Mexican women were healthy and tended to have easy labors (Bridges, 2011).
- 8.
Use of ART occurs more frequently in European countries than in the U.S., but fewer procedures in Europe result in a live birth (17 % compared to 27 % in the U.S. in 2001). Because of regulatory restrictions and different practice patterns, fewer ART pregnancies in Europe involve the transfer of multiple embryos to a woman’s uterus (36.3 % with three or more embryos, compared to 66.4 % in the U.S. in 2001) and fewer result in multiple births (25.5 % compared to 38.6 % in the U.S. in 2001) (Gleicher et al. 2006). This is discussed further in Chap. 6.
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Bronstein, J.M. (2016). The Population Dimension: The Distribution of Preterm Births. In: Preterm Birth in the United States. Springer, Cham. https://doi.org/10.1007/978-3-319-32715-0_2
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