The First Injustice: Socioeconomic Disparities, Health Services Technology, and Infant Mortality

Infant mortality has long been viewed as a synoptic indicator of the health and social condition of a population. In this article we examine critically the structure of this reflective capacity with a particular emphasis on how new health care technologies may have altered traditional pathways of social influence. The infant mortality rate is a composite of a series of component rates, each with its own relationship to social factors. Advances in health care have reduced dramatically the risk of mortality for the critically ill newborn, thereby elevating the importance of access to this care in shaping absolute and disparate infant mortality rates. These advances in health services technology have also had the effect of concentrating infant mortality among extremely premature and low birth-weight infants, a group tied directly to social factors operating through maternal influences and the general well-being of women. In this manner, current patterns of infant mortality in the United States provide a useful illustration of the dynamic interaction of underlying social forces and technological innovation in determining trends in health outcomes. We review the implications of this perspective for sociological research into disparate infant mortality, including the social and economic structure of societies, access to health services, the potential for prenatal intervention, women's health status, and racial and ethnic disparities.