Native American infant mortality. Buehler and Hogue respond [letter]

Bultery is correct in his observation that early prenatal care was associated in the authors study with lower postneonatal mortality among Whites but not among Native Americans. However his conclusion that improved access to medical care for the Native American population can be expected to have little significant impact on postneonatal mortality is not merited by the study data. The timing of prenatal care as reported on birth certificates is likely a proxy for another variable that has a more direct link to postneonatal mortality. This proxy variable (e.g. access to postnatal care or parental health knowledge) may be stronger among Whites than Native Americans. Moreover vital records provide no information about the relative quality of prenatal care received by Native American mothers in comparison to White mothers.