Women and children of the United States are fortunate in that we have maternity and pediatric care as high in quality as exists anywhere in the world. In fact, the quality is higher f o r women and children here than for the majority of women and children of the world. However, the quality here is not the highest in the world. Furthermore, the highest quality care available to some women and children in the United States is not available to all in our country.So, while we have achieved a high level of care for some, the same degree of progress in quality of care has not occurred for all women in all segments of our population in all parts of our country. If we wish to hold our country and our services up as a model for the rest of the world to see and perhaps to learn from, we must analyze the areas where progress has occurred, and those areas where further intensive efforts and progress must be made. This paper will attempt to identify those aspects of or related to maternity care where we in the United States must concentrate.
MORTALITYAt present, the greatest burden of deaths during the period of growth is fetal death occurring shortly after conception. The next largest group of deaths is the perinatal groupthose grouped shortly before and immediately after the event of birth. These two groups, plus the third group of maternal deaths, accounts for more deaths than are registered during the next sixty years of the human Iife span. Thus, mortality associated with pregnancy, labor, delivery, and the neonatal period still constitutes a major health problem in our country.-66 -