Prematurity--infant mortality: the scourge remains.

Preterm birth is a common, complex and serious disorder that disproportionately affects African-American families in the United States. In conjunction with low birthweight, prematurity has been the leading cause of neonatal death in African-American newborns for more than a decade and significantly characterizes the continuing racial and ethnic disparities seen in health outcomes today. During the past 20 years, preterm birth rates have increased from 9.5% in 1982 to a rate of 12.3% in 2003, an impressive 30% increase. While the chance of being born premature in 2003 was 1 in 8 for all US infants, the likelihood of being born premature was 1 in 6 for African-American infants. These factors, in addition to the associated economic cost of providing healthcare resources for vulnerable racial and ethnic populations that are expanding in numbers, has catapulted prematurity and its associated infant mortality to the forefront of public health. Our current challenge is to identify effective interventions through thoughtful social, clinical, and scientific research efforts and expand our approach to achieving improved pregnancy outcomes from a narrow focus on prenatal care to more broadly address the healthcare needs of women well before pregnancy occurs.