Babies born to women in large U.S. cities are less likely to be big and bouncing compared to the nation as a whole, a report published on Tuesday found.
A mother's poverty, lack of education, but most of all a lack of access to health insurance are probably to blame, the report issued by the nonprofit Annie E. Casey Foundation concluded.
"Birth outcomes in the largest cities are clearly not as good, on average, as those elsewhere," said the report, based on data collected by the National Center for Health Statistics.
"For example, cities such as Baltimore and Cleveland show that negative outcomes such as low birthweight and infant mortality are concentrated in neighborhoods with high poverty and/or low per-capita income."
Researchers Dick Wertheimer of Child Trends and Bill O'Hare of the Kids Count organization compiled the data, taken from birth certificates from the 50 largest U.S. cities.
They found that 8 percent of all babies born in the United States in 1998 were low-birthweight - weighing 5.5 pounds (2.5 kg) or less. But in Baltimore, for example, 14.2 percent of babies born in 1998 were low-birthweight. In Detroit the total was 13.4 percent.
"The relatively high number of low-birthweight births in the U.S. raises a number of troubling issues," the researchers said.
The figures reflect just how many women lack health insurance, and as a result get poor prenatal care. Blacks are the most likely to have these problems, followed by Hispanics, the report said.
But while the findings reflected numbers, the study did not necessarily find the reasons behind the numbers. "It's hard to know exactly why," Wertheimer said in a telephone interview.
"It may be partially a lack of access to services. It is true that people living in inner cities are less likely to have access to health insurance," he added.
"As long as we continue to finance health insurance primarily through employers, we are not going to have universal coverage. We are still going to have people fall through the cracks."
The numbers show clear differences between women giving birth in the biggest cities compared to the nation as a whole, and statistics vary from city to city.
The study found, for example, that 43 percent of babies born in big cities were to unmarried women, compared with 33 percent for the nation as a whole. In 1998, 15 percent of all births in the 50 largest cities occurred to teenagers, compared with 13 percent in the nation as a whole.
"Children born to teenage mothers are less likely to obtain the emotional and financial resources they need to develop into independent, productive, well-adjusted adults," the researchers said.
They will have to "overcome high odds to thrive," the report adds. "Most teenage mothers are not settled into a job or career, and most young fathers are not able to help."
If a teen mother already has one baby, she will be even less able to care for a second, the report said. But it said 24 percent of all babies born to teenagers in the 48 biggest cities were second children.
A lack of education was also a factor for women giving birth in big cities. "For the 50 largest cities, 27 percent of all births were to women with less than 12 years of education in 1998," the report said, compared to 22 percent nationwide.
"The infant mortality rate for births to women with less than 12 years of education was 9.1 deaths per 1,000 live births in 1998, compared to 6.3 for women with at least a high school education."
Poorly educated women were more likely to smoke during pregnancy, the researchers said, which can lead to a low-birthweight baby.
Eleven percent of women in cities where the information was available smoked during pregnancy - ranging from 2 percent in Miami to 24 percent in Des Moines. But Wertheimer noted the overall figure was down from 18 percent in 1990.
And he said Des Moines illustrated an interesting finding. "Smoking turns out to be the vice of white, non-Hispanics," he said.