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Fam Plann Perspect. 1994 Nov-Dec;26(6):252-6, 271.

Maternal marital status as a risk factor for infant mortality.

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  • 1Department of Maternal and Child Health, School of Public Health, University of North Carolina at Chapel Hill.


The increased risk of infant mortality associated with single motherhood is neither consistent among social and demographic subgroups nor inevitable, according to data from national linked birth and infant death files for 1983-1985. Maternal age is the only variable found to have a significant interaction with marital status among black mothers, and the risk associated with unmarried status increases with age. Among white mothers, age, educational level and receipt of prenatal care all show significant interactions with marital status; the increased risks of infant mortality attributed to unmarried motherhood are concentrated among subgroups usually thought to be at lower risk. For example, the risks of infant mortality among unmarried white women relative to married white women are highest among 25-29-year-olds. However, being unmarried did not affect the risk of infant mortality among babies born to college-educated white women.


Linked birth and death certificates were used in the analysis of data for 1983 to 1985 on singleton live births to Black and White women. The sample included 1,656,044 Blacks and 8,691,059 Whites. Marital status data was available directly for 41 states and inferred for the remainder from certificate information. Risk factors were age, parity, education, initiation of prenatal care, and urban residence. Differences by race converged when marital status was considered separately. Educational status of unmarrieds was similar for White and Black women. High infant mortality of over 20/1000 live births was found among unmarried Black women: women with over 3 children, women under 18 and over 34 years old, women with under 12 years of education, and women with later or no prenatal care. Increased risk of death was related to increasing age of the mother regardless of race. Risk of infant mortality was 24% higher for Black women over 35 years old than those less than 18-19 years old. The risk for unmarrieds began with adolescents, rose, and plateaued at 30 years old. Black unmarrieds had increased risk at 20-24 years, a peak at 25-29 years, and high levels for older women. White unmarrieds had the highest risk at ages 25-29, and risk associated with being single was greater for women with some college education. The caveat for the analysis was that the information was dated by 10 years; however other linked data in 1987 has been determined to be quite similar in trends. A strong finding was that unmarried status alone is not a good predictor and when combined with risk among disadvantaged women may not be a critical factor, since most unmarried women have high poverty rates. Race was considered a stronger marker of risk for infant mortality than marital status. Recommendations were for universal access to health care regardless of marital status and elimination of punitive measures restricting benefits to unmarried mothers. Programs need to build on the strengths of single mothers and promote social support systems.

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