Affect Infant Mortality Research Articles

Association between prenatal exposure to PM2.5 and the increased risk of specified infant mortality in South Korea

BackgroundFindings from previous studies on the association between exposure to fine particulate matter (PM2.5) and the risk of infant mortality were inconsistent. Thus, two main objectives of our study were to examine the association between exposure to PM2.5 and specified infant mortality and to identify critical trimesters. MethodsWe retrospectively created a birth cohort of singleton full-term infants born in South Korea between 2010 and 2015 using national birth and infant mortality data. The specified causes of infant mortality were circulatory and respiratory diseases, perinatal conditions, congenital anomalies, and sudden infant death syndrome. We performed 1:10 propensity score matching for various exposure windows: each trimester, prenatal, and postnatal (up to age 1). Conditional logistic regression was applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs), while accounting for gestational age, birth weight, maternal education level, season of birth, and regions (metropolitan areas/provinces). We also conducted sex-stratified analyses and used different matching ratios for sensitivity analyses. ResultsA total of 2,501,836 births and 761 deaths (0.03%) were identified in the birth cohort. We found an increased risk of infant mortality per 10 µg/m3 increase in PM2.5 exposure during the prenatal period (OR: 1.29, 95% CI: 1.07–1.55). Exposure in the 1st and 2nd trimesters was linked to an elevated risk (OR: 1.19, 95% CI: 1.02–1.37; OR: 1.21, 95% CI: 1.04–1.40). However, no association was shown in the third trimester. PM2.5 exposure in the 1st and 2nd trimesters was associated with elevated male infant mortality, but did not reach statistical significance in female infants. The use of different matching ratios did not significantly affect the results. ConclusionThe study findings suggest that exposure to PM2.5 could affect infant mortality differently by the timing of exposure and sex, which suggests a relation to fetal development. However, further investigations are warranted.

LOGISTICS REGRESSION MODELING ON INFANT MORTALITY RATES IN EAST JAVA PROVINCE

Infant Mortality Rate was death that occurs between the time after the baby was born until the baby not exactly one year old. Broadly speaked, from the side of the caused of infant mortality there are two kinds of endogenous infant death and exogenous infant mortality. Estimated about 8.8 million children whose age less than 5 years passed away. Based on previous data IDHs indicated that infant mortality has fallen by half, from 68 deaths per 1,000 live births for the 1987-1991 period to 32 deaths per 1,000 births for the 2008-2012 period. The purposed of this researched was to examine which factor most dominant influenced on infant mortality in East Java Province.This research used secondary data with a large sample of total population that consists of parents whose children (infants) died at the age <12 months. Variables in this study was infant mortality (IMR), Occupation, Education, Parity, Age of the mother during pregnancy. Access to antenatal care, Birth delivery helpers, and LBW. Inter-variables in this study tested its effect using logistic regression test. The conclusion of this study was infant mortality rated in East Java there 34 infant mortality per 1000 live birth. Factors affecting infant mortality rates was education and parity. Factors were not influenced in infant mortality such as Antenatal Care, Relief, LBW and Employment.Keywords: Baby Birth Mortality and Logistic Regression

Factors affecting infant mortality in the general population: evidence from the 2016 Ethiopian demographic and health survey (EDHS); a multilevel analysis

BackgroundInfant mortality is one of the leading public health problems globally; the problem is even more staggering in low-income countries. In Ethiopia seven in ten child deaths occurred during infancy in 2016. Even though the problem is devastating, updated information about the major determinants of infant mortality which is done on a countrywide representative sample is lacking. Therefore, this study was aimed to identify factors affecting infant mortality among the general population of Ethiopia, 2016.MethodsA Community-based cross-sectional study was conducted in all regions of Ethiopia from January 18 to June 27, 2016. A total of 10,641 live births were included in the analysis. Data were analyzed and reported with both descriptive and analytic statistics. Bivariable and multivariable multilevel logistic regression models were fitted by accounting correlation of individuals within a cluster. Adjusted odds ratio (AOR) with 95% confidence interval was reported to show the strength of the association and its significance.ResultsA total of 10,641 live-births from the Ethiopian demographic and health survey (EDHS) data were included in the analysis. Being male infant (AOR = 1.51; 1.25, 1.82), Multiple birth (AOR = 5.49; 95% CI, 3.88–7.78), Preterm (AOR = 8.47; 95% CI 5.71, 12.57), rural residents (AOR = 1.76; 95% CI; 1.16, 2.67), from Somali region (AOR = 2.07; 1.29, 3.33), Harari (AOR = 2.14; 1.22, 3.75) and Diredawa (AOR = 1.91; 1.04, 3.51) were found to be statistically significantly associated with infant mortality.ConclusionThe study has assessed the determinants of infant mortality based on EDHS data. Sex of the child, multiple births, prematurity, and residence were notably associated with infant mortality. The risk of infant mortality has also shown differences across different regions. Since infant mortality is still major public health problem interventions shall be done giving more attention to infants who were delivered multiple and who are preterm.

Maternal anaemia and pregnancy outcome: a descriptive study in rural areas of Kamrup District, Assam

Background: The relationship between iron deficiency anaemia and low-birth-weight babies during pregnancy remains significant. Low birth weight babies are an increasing risk affecting infant mortality and poor developmental abilities is a rising concern. We aimed to identify the changes in hemoglobin level during pregnancy and study their impact on birth outcomes. This study aimed also to investigate and compare the prevalence of anaemic and non anaemic pregnant women in Boko Bongaon block, Assam in relation to maternal, antenatal and birth-associated factors. Subject/Methods: The study setting is in a rural area of Boko-Bongaon, Kamrup situated 85km away from Guwahati city. The Study design is a community based cross-sectional study done during the period from August 2012 to July 2013. A total of 160 pregnant women were selected by simple random sampling and data collected by house to house visit. Interview was conducted with the use of Predesigned, Pretested structured schedule. Results: We analysed deliveries of 160 pregnant women of which 156 were full term births and 4 still births. There was a statistical significant association between anaemia and birth weight of the babies. Anaemia (Hb<11g/dl), was prevalent in 86% of women, but was not significantly related to the birth outcomes. Conclusion: The present study highlights the importance of regular monitoring of haemoglobin level at intervals during pregnancy to prevent anaemia. Future studies should explore other related risk factors and the reasons for poor birth outcomes in mothers in this population, to inform the design of appropriate public health policies that address this issue

The Value of Health Insurance During a Crisis: Effects of Medicaid Implementation on Pandemic Influenza Mortality

This paper studies how better access to public health insurance affects infant mortality during pandemics. Our analysis combines cross-state variation in mandated eligibility for Medicaid with two influenza pandemics — the 1957-58 Asian Flu pandemic and the 1968-69 Hong Kong Flu — that arrived shortly before and after the program's introduction. Exploiting heterogeneity in the underlying severity of these two shocks across counties, we find no relationship between Medicaid eligibility and pandemic infant mortality during the 1957-58 outbreak. After Medicaid implementation, we find that better access to insurance in high-eligibility states substantially reduced infant mortality during the 1968-69 pandemic. The reductions in pandemic infant mortality are too large to be attributable solely to new Medicaid recipients, suggesting that the expansion in health insurance coverage mitigated disease transmission among the broader population. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Sri Lanka: report on its children's environmental health.

Sri Lanka is an island country located in the Indian Ocean, characterized by tropical weather, with an estimated population of 21.4 million in 2017, one third of them being children. Advancing and rapidly changing technology, novel industries, consumer goods and equipment have introduced new health hazards of a chemical, biological and physical nature to future generations. The infant mortality rate has declined to around 8-9 per 100,000 since 2015. Congenital malformations were the most significant cause of neonatal death. Thus, there might be unproven environmental factors which affect infant mortality rates despite robust field and hospital services. Air pollution is a major environmental health hazard to children, largely due to hazardous industries, vehicular emissions and traditional cooking stoves. The health of children living in urban households and attending schools in cities is adversely affected by air pollution. Usage of polythene and plastic for toys, utensils, bags, lunch sheets and other daily essentials leads to overusage and improper waste management and open burning. This emits dioxins, which are carcinogens, hormone disruptors, and which can be transferred to the fetus via the placenta. In rural areas, the burning of agricultural waste and certain agro-forestry activities have also led to air pollution. Indoor air pollution (IAP) remains a large threat as 66% of the population use biomass for cooking. Use of inefficient stoves and biomass, poor ventilation and absence of chimneys, contribute to IAP. Other indoor air pollutants such as tobacco smoke, volatile organic compounds, asbestos, pesticides, kerosene, mercury, mosquito coils and biological pollutants also prevail. Biological pollutants, such as dust mites, droppings and urine from pets, insects and rodents, pollen from indoor plants and outdoor air, and fungi, including moulds in poorly maintained buildings, can trigger asthma or cause allergic reactions and infections among children inhabiting these environments. In rural areas, chemicals were accountable for 30.2% of acute poisonings, with kerosene oil being the most common cause, followed by paracetamol. More than 80% of agricultural workers in the country work in the informal sector with limited personal protective equipment use, while pesticide usage is increasing. Children who engage in agriculture-related work and hazardous industries are at risk of developing health consequences at early stages. Dengue remains a major environmental health problem as the reduction of mosquito breeding sites has been a challenging task for many years. It is essential to gain more evidence of existing environmental risk factors and their associations with the health of children. Information dissemination among local and international experts on Children's Environmental Health (CEH) issues needs to be enhanced and properly established. Training programs should be conducted for healthcare workers to update their knowledge. Pediatricians are needed for remote hospitals and primary healthcare centers. Environmental parameters and biological parameters are not routinely monitored in most of the hazardous environments.

Modeling of infant mortality in west sulawesi using zero inflated poisson regression method

The number of infant deaths, one of which can be reflected in the Infant Mortality Rate (IMR) is one indicator to determine the development of a country’s development. The AKB target in the 2015-2019 National Medium-Term Development Plan is 24 deaths per 1,000 live births. Based on the SDKI 2017, the IMR value in West Sulawesi is 42 deaths per 1,000 live births. Factors suspected of affecting infant mortality in West Sulawesi are not only in the health but also in socio-economic fields. Data on the number of infant mortality in West Sulawesi is a data count that contains a value of 0. Therefore, the analysis used is Zero Inflated Poisson (ZIP) Regression to determine what factors influence infant mortality in West Sulawesi. The results of the ZIP regression analysis showed that the best model with the smallest AIC and AICc is 324,3407 and 326,7407 were models with a combination of the variables of the percentage of active maternal and child health services, percentage of society with good drinking water adequate access and percentage of society with proper sanitation access. The variable that has a significant effect on the log model is the percentage of active maternal and child health services, percentage of society with good drinking water adequate access and percentage of society with proper sanitation access. In the variable logit model that is influential is the percentage of active maternal and child health services.

Chinese Aid and Health at the Country and Local Level

We investigate whether and to what extent Chinese development finance affects infant mortality, combining 92 demographic and health surveys (DHS) for a maximum of 53 countries and almost 55,000 sub-national locations over the 2002-2014 period. We address causality by instrumenting aid with a set of interacted variables. Variation over time results from indicators that measure the availability of funding in a given year. Cross-sectional variation results from a sub-national region's to receive aid. Controlled for this probability in tandem with fixed effects for country-years and provinces, the interactions of these variables form powerful and excludable instruments. Our results show that Chinese aid increases infant mortality at sub-national scales, but decreases mortality at the country-level. In several tests, we show that this stark contrast likely results from aid being fungible within recipient countries.

The Value of Health Insurance During a Crisis: Effects of Medicaid Implementation on Pandemic Influenza Mortality

This paper studies how better access to public health insurance affects infant mortality during pandemics. Our analysis combines cross-state variation in mandated eligibility for Medicaid with two influenza pandemics — the 1957-58 Asian Flu pandemic and the 1968-69 Hong Kong Flu — that arrived shortly before and after the program's introduction. Exploiting heterogeneity in the underlying severity of these two shocks across counties, we find no relationship between Medicaid eligibility and pandemic infant mortality during the 1957-58 outbreak. After Medicaid implementation, we find that better access to insurance in high-eligibility states substantially reduced infant mortality during the 1968-69 pandemic. The reductions in pandemic infant mortality are too large to be attributable solely to new Medicaid recipients, suggesting that the expansion in health insurance coverage mitigated disease transmission among the broader population.

THE RELATIONSHIP OF DELIVERY METHOD, BIRTH WEIGHT AND RACE ON INFANT MORTALITY [Kennesaw State University

Infant mortality is defined as the number of deaths per 1000 births. The U.S. infant mortality rate in 2014 was reported as 5.8 which is very high compared to other countries such as Japan where the rate 2.1. It is known that infant mortality is a huge problem, but the challenge right now is finding ways to solve this issue. My research aims to see what factors influence infant mortality to see how it can be reduced. I also wanted to learn about which groups are most vulnerable to experiencing high infant death rates. The purpose of this research is to find out how factors such as delivery method, birth weight, and race affect infant mortality to determine how these factors lead to the reduction of mortality rates. I wanted to see if there is a preferred delivery method for small infants compared to larger infants. To evaluate this, I analyzed 2007-2016 U.S. infant mortality data from the CDC and created bar charts relating race, birth weight, and delivery method to the death rate. I found out that the vaginal delivery method has the lower death rate compared to the C-section delivery method, that American Indians who were born through C-sections have the highest death rate out of all the other races and delivery methods, that the death rate is lower for small infants when they are delivered through the C-section method and that it is preferable to deliver larger infants through the vaginal method since the death rate would be lower. These results can serve as then beginning of a more comprehensive look into infant mortality.

Ruminant models of prenatal growth restriction

Intrauterine growth restriction (IUGR) is a significant health issue that not only affects infant mortality and morbidity, but may also predispose individuals to coronary heart disease, diabetes, hypertension and stroke as adults. The majority of IUGR pregnancies in humans are characterized by asymmetric fetal growth, resulting from inadequate nutrient transfer to the fetus. Furthermore, most of these pregnancies involve functional placental insufficiency, and may also show altered umbilical velocimetry. As the severity of IUGR increases, the fetus becomes increasingly hypoxic, hypoglycaemic and acidotic. In addition, placental transfer or utilization of some amino acids is known to be altered in IUGR pregnancies. Although a great deal has been learned from clinical studies of human IUGR, appropriate animal models are required to define completely the mechanisms involved in the development of IUGR. The pregnant sheep is a long-standing model for placental-fetal interactions, and fetal growth restriction can be induced in pregnant sheep by maternal nutrient restriction, maternal nutrient excess, administration of glucocorticoid, utero-placental embolization, carunclectomy and maternal hyperthermia. Although all of these sheep models are capable of inducing fetal growth restriction, the degree of restriction is variable. This review compares these sheep models of IUGR with the characteristics of human IUGR.

Public Health Expenditure and Child Mortality: Does Institutional Quality Matter?

The main objective of this paper is to test the impact of public health spending on infant health taking into account the role that institutional quality can play. We use a two-step system dynamic GMM method for 93 developed and developing countries over the1995–2015 period. Our main findings show that there is a clear positive and significant effect of health expenditure on infant mortality only for high-income countries, whereas for lower, lower-middle, and upper-middle-income ones, health spending does not have a significant impact on infant health status. Our findings show also that there is a certain threshold level that these groups must achieve to make government health spending (% GDP) positively affect infant mortality rates. This level is estimated at about 7%. Finally, estimations demonstrate also that institutional quality plays an important and significant role in mediating the relationship between health spending and IMR’s.

Macroeconomic Determinants of Infant Mortality in WAEMU Countries: Evidence from Panel Data Analysis

This paper investigates the macroeconomic determinants of infant mortality in WAEMU countries for the period 1980–2016. A panel data model from WAEMU countries was used to identify the macroeconomic determinants of infant mortality. We used fixed effects instrumental variables (FE-IV) estimator in panel data model. Our analysis using econometric estimations after correcting for endogeneity showed that female literacy, GDP per capita as a proxy for income, public health expenditure as a percentage of GDP and urbanization significantly affect infant mortality rate in a negative way.

Development aid and infant mortality. Micro-level evidence from Nigeria

While there is a vast literature studying the effects of official development aid (ODA) on economic growth, there are far fewer comparative studies addressing how aid affects health outcomes. Furthermore, while much attention has been paid to country-level effects of aid, there is a clear knowledge gap in the literature when it comes to systematic studies of aid effectiveness below the country-level. Addressing this gap, we undertake what we believe is the first systematic attempt to study how ODA affects infant mortality at the subnational level. We match new geographic aid data from the AidData on the precise location, type, and time frame of bilateral and multilateral aid projects in Nigeria with available georeferenced survey data from five Nigerian Demographic and Health Surveys. Using quasi-experimental approaches, with mother fixed-effects, we are able to control for a vast number of unobserved factors that may otherwise be spuriously correlated with both infant mortality and ODA. The results indicate very clearly that geographical proximity to active aid projects reduces infant mortality. Moreover, aid contributes to reduce systematic inter-group, or horizontal, inequalities in a setting where such differences loom large. In particular, we find that aid more effectively reduces infant mortality in less privileged groups like children of Muslim women, and children living in rural, and in Muslim-dominated areas. Finally, there is evidence that aid projects are established in areas that on average have lower infant mortality than non-aid locations, suggesting that there are biases resulting in aid not necessarily reaching those populations in greatest need.

The Differential Mortality of Undesired Infants in Sub-Saharan Africa.

With high rates of infant mortality in sub-Saharan Africa, investments in infant health are subject to tough prioritizations within the household, in which maternal preferences may play a part. How these preferences will affect infant mortality as African women have ever-lower fertility is still uncertain, as increased female empowerment and increased difficulty in achieving a desired gender composition within a smaller family pull in potentially different directions. I study how being born at a parity or of a gender undesired by the mother relates to infant mortality in sub-Saharan Africa and how such differential mortality varies between women at different stages of the demographic transition. Using data from 79 Demographic and Health Surveys, I find that a child being undesired according to the mother is associated with a differential mortality that is not due to constant maternal factors, family composition, or factors that are correlated with maternal preferences and vary continuously across siblings. As a share of overall infant mortality, the excess mortality of undesired children amounts to 3.3 % of male and 4 % of female infant mortality. Undesiredness can explain a larger share of infant mortality among mothers with lower fertility desires and a larger share of female than male infant mortality for children of women who desire 1-3 children. Undesired gender composition is more important for infant mortality than undesired childbearing and may also lead couples to increase family size beyond the maternal desire, in which case infants of the surplus gender are particularly vulnerable.

The Evidence Base for Social Determinants of Health as Risk Factors for Infant Mortality: A Systematic Scoping Review.

The objectives of this study were to identify social determinants of health as risk factors for infant mortality, particularly among African Americans, and to determine the extent to which research has demonstrated an association between each social determinant of health and infant mortality. A systematic scoping review was conducted following PRISMA guidelines. Databases searched include: EBSCOhost, CINAHL Plus, PsycINFO, SocINDEX, Social Work Abstracts, and Sociological Collection. Following a three-step selection process conducted by two reviewers, 89 studies were included. The social ecological model was used to categorize both the search terms and the findings. Findings revealed that the majority of studies focused on the individual and public policy levels, and most failed to account for the complexity of the issue. Additional research is needed to explore the social determinants of health that are hypothesized to affect infant mortality across all levels, applying more complex, system-level approaches.

Effects of recruiting midwives into family physician program on the percentage of low birth weight (LBW) infants in rural areas of Kurdistan.

Background: LBW is an important factor that can affect infant mortality and represents an index of economic and social development. It is expected that an increase in the density of midwives attending family physician programs will lead to a decrease in LBW in health centers. This study aimed to compare the percentage of LBW infants before and after the implementation of the family physician program in health centers with and without an increase in midwives density. Methods: This cross-sectional study compared the percentage of LBW infants before and after the implementation of family physician programs in rural health centers with and without changes in midwives density in Kurdistan. In this study, we included 668 mothers of 2-month-old children and administered structured interviews in 2005 and 2013. Data were analyzed using the difference-indifferences and the Matchit statistical models. Results: The Matchit model showed a significant average percentage increase 0.08 (0.006–0.17) in LBW infants born between 2005 and 2013 in health centers where the density of midwives increased compared with those where it remained unchanged. The difference-in-differences model showed that the odds ratio of LBW infants is increased by more than twice among participants who had a history of caesarean section. Conclusion: The results of this study showed that an increase in the density of midwives in a family physician program did not have an impact on reducing the percentage of LBW infants born between 2005 and 2013, in health centers where the density of midwives augmented compared to those where it remained unaltered; it indicated that the increase in the density of midwives alone was not efficient. On the other hand, the results of our study show an increase in the risk of infants born at a LBW due to caesarean section. It is recommended that obstetricians and gynecologists must strictly control pregnancies and avoid unnecessary termination of pregnancy

Risk Analyses Factor of Infant Mortality Caused by Tetanus Neonatorum in East Java

Tetanus neonatorum is an infection in infants ( < 28 days), caused by bacteria Clostridium tetani that enter the body through the wound. Tetanus neonatorum is one of the leading causes of neonatal mortality in the world. The case of tetanus neonatorum is present in 14 provinces in Indonesia, East Java has the second highest case of tetanus neonatorum. Factors affecting infant mortality among others include maternal immunization status, parity, delay admission of TN patients, and umbilical cord care. The purpose of this study was to analyze the relationship between maternal immunization status, parity, delay admission of TN patients, and umbilical cord care with mortality of tetanus neonatorum. This study uses cross sectional design using 59 respondents obtained from T2 report to Dinas Kesehatan Provinsi Jawa Timur in 2014-2016. The result of the research by using chi-square test and α= 0,05 obtained TT immunization of pregnant women (p = 0.257), parity (p = 0.034; PR= 0.39; 95% CI 0.16-0.98), delay admission of TN patients (p = 0.061), and umbilical cord care (p = 0.007; PR = 2.31; 95% CI 1.29-4.15). The conclusion of this study is there are no relationships between maternal immunization status and delay admission with mortality of tetanus neonatorum and a significant relationships between parity and umbilical cord care with mortality of tetanus neonatorum in East Java in 2014-2016. To reduce the risk factors of infant mortality, it is necessary to socialize TT immunization to pregnant women, planning of pregnancy, clean delivery and umbilical cord care.Keywords: risk factors, delay admission, mortality of tetanus neonatorum, parity, and umbilical cord care, maternal immunization

Democracy and infant mortality within India: from whether to why

How does democratic politics affect infant mortality? The bulk of existing research has debated whether democracies have lower levels of infant mortality than non-democracies. Yet, infant mortality varies as much within countries as it does between countries, suggesting that the political processes affecting infant mortality operate at the subnational level. To shed new light on the debate, this paper examines how three core democratic attributes affect infant mortality within a single democracy: India. I argue that higher levels of political representation, citizens’ participation, and electoral competition provide political incentives for elected representatives to reduce infant mortality. The theory is tested on a times-series data set from 15 major Indian states between 1980 and 2011. Overall, the results demonstrate the significance of democratic politics, particularly political representation, in influencing infant mortality.

Increased Duration of Paid Maternity Leave Lowers Infant Mortality in Low- and Middle-Income Countries: A Quasi-Experimental Study.

BackgroundMaternity leave reduces neonatal and infant mortality rates in high-income countries. However, the impact of maternity leave on infant health has not been rigorously evaluated in low- and middle-income countries (LMICs). In this study, we utilized a difference-in-differences approach to evaluate whether paid maternity leave policies affect infant mortality in LMICs.Methods and FindingsWe used birth history data collected via the Demographic and Health Surveys to assemble a panel of approximately 300,000 live births in 20 countries from 2000 to 2008; these observational data were merged with longitudinal information on the duration of paid maternity leave provided by each country. We estimated the effect of an increase in maternity leave in the prior year on the probability of infant (<1 y), neonatal (<28 d), and post-neonatal (between 28 d and 1 y after birth) mortality. Fixed effects for country and year were included to control for, respectively, unobserved time-invariant confounders that varied across countries and temporal trends in mortality that were shared across countries. Average rates of infant, neonatal, and post-neonatal mortality over the study period were 55.2, 30.7, and 23.0 per 1,000 live births, respectively. Each additional month of paid maternity was associated with 7.9 fewer infant deaths per 1,000 live births (95% CI 3.7, 12.0), reflecting a 13% relative reduction. Reductions in infant mortality associated with increases in the duration of paid maternity leave were concentrated in the post-neonatal period. Estimates were robust to adjustment for individual, household, and country-level characteristics, although there may be residual confounding by unmeasured time-varying confounders, such as coincident policy changes.ConclusionsMore generous paid maternity leave policies represent a potential instrument for facilitating early-life interventions and reducing infant mortality in LMICs and warrant further discussion in the post-2015 sustainable development agenda. From a policy planning perspective, further work is needed to elucidate the mechanisms that explain the benefits of paid maternity leave for infant mortality.