Spacing of less than 18 months between pregnancies increased until 1992, then declined over the next two years. The rate of inadequate prenatal care has fluctuated over the past fifteen years, with a steady decline in the 1990's. This means that in this chapter, between 4,000 and 16,000 infants each year are subjected to physical violence before they are born. These are all behavioral choices that may be remedied by access to appropriate health care, food nutrition consultation, and family planning guidance and services. Other significant risks, such as those posed by the mother's high-risk medical condition and multiple births, call for early identification and attention by the health care system in order to reduce mother and infant risks.
Alcohol use seems under reported in birth certificate data.