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Infant mortality realities

December 17, 2013

Infant mortality is not the result of one specific medical issue but rather a measure of non-medical factors in a community, including the rates of poverty and education. Babies act as the "canaries in the coal mine," alerting the whole community that something may be wrong.

The definition of the infant mortality rate is the number of deaths in the first year of life per 1,000 live births in a given year. Since the 1990s the city of Worcester has averaged an infant mortality rate between 7 and 9. This is higher than the average rate in Massachusetts (under 5) and the U.S. (currently 6.5) during this time.

The majority of babies dying in Worcester are those born too soon and too small to be saved even in the sophisticated Neonatal Intensive Care Unit at UMass Memorial Medical Center.

Infant mortality is thus significantly related to extreme prematurity. Such prematurity usually reflects the mother's medical and living conditions.

The good news is that overall, as the national infant mortality rate has decreased from 9.2 in 1990 to 6.1 in 2011, the state infant mortality rate has also decreased. Worcester's rate is also trending downward since 2007.

There are specific socioeconomic risk factors associated with pregnancies at risk for premature birth and infant mortality. Mothers who are young (teens), poor, uneducated, unmarried, and those who smoke cigarettes, drink alcohol, or use drugs, are at high-risk for poor birth outcomes.

In 1996, the Worcester Infant Mortality Reduction Task Force was formed to address the issue of local infant mortality. Now known as the Worcester Healthy Baby Collaborative (WHBC), this partnership includes more than 30 area agencies working to promote healthy babies and pregnancies in the city. Participating agencies include local health care and social services organizations, colleges, and the Worcester and Massachusetts Departments of Public Health.

The March of Dimes Massachusetts Chapter has facilitated and funded the collaborative since 2009. We review every infant death and stillbirth in Worcester to help us learn more. The most important issue in thinking about Worcester's infant mortality rate during the last two decades is not only that it is about twice the state's infant mortality rate, but that there are striking racial and ethnic disparities.

The major concern of the WHBC has been to address the high rate of infant deaths among Worcester's African immigrant mothers. Most of the black infants born in Worcester since 1999 were born to women who have emigrated from Africa, with Ghana the most heavily represented country. There are increasing immigrant populations from Kenya, Somalia and other African countries.

Infants born to African immigrant mothers have up to three times the risk of dying in the first year of life as Caucasian infants, yet this rate is half of what the rate is in Africa. The causes do not appear to be the usual socio-economic factors related to prematurity. This group has a high rate of education and employment and does access early prenatal health care. As we continue to study how to help this group, we will learn not only what factors contribute to their infant mortality but also how we can better help others.

Nhyira Ba (or "Blessed Baby" in Ghana's primary language), a program being developed through the WHBC, aims to provide prenatal information and support to immigrant African women in Worcester. The program hopes that having medical and lifestyle information important for a healthy pregnancy and birth will help reduce the stress of moving to a new community and navigating our complex health care system.

Since 2000, we have also noted an alarming rise in infant deaths to Hispanic mothers in Worcester, at a time when minimal changes in the Hispanic rate have been observed in the state and nationally. While we do not have all the answers, we know that Hispanics in Worcester have high rates of poverty, single parenthood, and teen pregnancy, and low college-graduation rates.

Statewide, the sub-group of Hispanics who are married at the time they give birth, have a college degree, and are not on government assistance have a rate of infant mortality much lower than other racial and ethnic groups.

A key factor that these analyses have taught us is the value of an education. When college graduates are compared to high school drop outs, risks such as poverty, single parenthood, and substance use all decline. The benefits of education do not stop with infant mortality. College graduates have an average lifespan that is seven years longer and experience less lifetime illness than those with less education.

The Worcester Healthy Baby Collaborative is planning a summit next September to further educate the Worcester community about factors that not only lead to lower infant mortality, but a healthier and more prosperous community.

Worcester's high infant mortality rate is not a medical issue, but rather a reflection of socioeconomic status, stress, and living conditions in our community. In reflecting for over a decade on effective ways to improve these conditions, we believe that promoting educational attainment is the key.

As a community interested in healthier babies, we need to continue working to improve high school graduation rates and access to a college education.

Sara G. Shields, M.D., M.S., FAAFP, is Clinical Professor of Family Medicine and Community Health, University of Massachusetts, Family Health Center of Worcester, and Vice Chair, Worcester Healthy Baby Collaborative; B. Dale Magee, M.D., M.S., is with Shrewsbury OB-GYN and Worcester Healthy Baby Collaborative.

Sara G. Shields and B. Dale Magee

Worcester Telegram & Gazette

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