Return to list
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
2013 News
