Looking to what happens after birth to understand infant mortality rates

July 11, 2016

By Esperanza Cantu

In the New York Times article “The U.S. Is Failing in Infant Mortality, Starting at One Month Old,” written by Aaron E. Carroll, the author breaks down the science behind infant death in the United States. Noting the disparity in infant mortality rates, between the United States and other industrialized nations, he delves deeply into the complications that contribute to infant death. He focuses on evidence that suggests it may be after birth, and not before, that may be strongly contribute toward the high infant mortality we experience in the United States.

As an evidence-based physician and enthusiast, Carroll discusses large bodies of research that direct the attention away from inferior prenatal care as the number one contributor to premature birth and infant mortality. Recent research shows that the disparity in infant mortality may be due to postneonatal mortality (death between one and 12 months of age); importantly, deaths within the post-neonatal period are due largely to sudden infant death syndrome (SIDS), sudden death, and accidents, and they appear to occur disproportionately in poorer women.The study estimated that, compared to European countries, it would make sense to spend up to $7,000 per infant to decrease post-neonatal mortality in the United States. Home-visiting nursing programs were recommended to reduce the incidence of SIDS and accidents.

Naturally, Nurse-Family Partnership (NFP) comes to mind. Founded in 1970, the organization arranges for home visits from registered nurses to low-income first-time mothers, and the visits continue during pregnancy until two years following birth.Nurse-Family Partnership, which has been estimated to cost $4,100 per family per year in 2011 dollars, or close to $4,300 in 2016 dollars, is a strong solution toward reducing infant mortality. Evaluated in six randomized trials and more operational analyses, the NFP National Service Office predicts that “enrollments in 1996-2013 will prevent an estimated 500 infant deaths, 10,000 pre-term births, 13,000 dangerous closely spaced second births, 4,700 abortions, 42,000 child maltreatment incidents, 36,000 intimate partner violence incidents, 90,000 violent crimes by youth, 594,000 property and public order crimes (e.g., vandalism, loitering) by youth, 36,000 youth arrests, and 41,000 person-years of youth substance abuse.”

For communities like Detroit, NFP offers great promise. Infant mortality in Detroit is one of the highest in the country, and was last reported at 11.8 per 1,000 births in 2014. Broken down by race, the infant mortality rate for Whites has increased from 7.5 per 1,000 (2003-05) to 10.4 per 1,000 (2012-14), and decreased from 17.9 per 1,000 (2003-05) to 14.5 per 1,000 (2012-14). Although the disparity has narrowed between Blacks and Whites for infant mortality, it is important to note both an increase in infant mortality in Whites, as well as a decrease in infant mortality in Blacks, have comprised of the narrowing health disparity.

Check out Aaron E. Carroll’s piece here: http://www.nytimes.com/2016/06/07/upshot/the-us-is-failing-in-infant-mortality-starting-at-one-month-old.html.

Nurse-Family Partnership – Detroit and its Nurse-Family Partnership Implementing Agency (Detroit Wayne County Health Authority) have been serving the community since 2013. NFP-Detroit currently sees 184 Detroit moms, and will have successfully graduated 61 mothers after its upcoming graduation ceremony on July 22, 2016.

Source: 2003-2013 Geocoded Michigan Death Certificate Registries; 2014 Michigan Death Certificate Registry. 2003-2014 Geocoded Michigan Birth Certificate Registries. Division for Vital Records & Health Statistics, Michigan Department of Health & Human Services. Table created: 4/22/2016. Graph created: 06/08/2016.

Links: http://www.mdch.state.mi.us/pha/osr/InDxMain/Tab4.asp;

http://www.mdch.state.mi.us/pha/osr/InDxMain/BlackCityTbl.asp;

http://www.mdch.state.mi.us/pha/osr/InDxMain/WhiteCityTbl.asp.

Esperanza Cantu is manager of Health Equity and Community Engagement at Authority Health.